Module information
Details
- Title
- Advanced H&I – Solid Organ Transplantation and Transfusion
- Type
- Specialist
- Module code
- S-HAI-S3-2
- Credits
- 20
- Requirement
- Compulsory
Aim of this module
The aim of this module is to provide the trainee with the knowledge and skills relating to histocompatibility and immunogenetic testing applicable to solid organ transplantation and transfusion. This module will build on the Fundamentals of H&I module to provide experience and understanding of the clinical management of patients prior to and following organ transplantation. They will gain further experience in the methods that support transplantation and in the interpretation of patient results in a variety of complex clinical settings. This module will provide the trainee with the practical application of knowledge and skills relating to histocompatibility and immunogenetics techniques applicable to blood transfusion.
Work-based content
Competencies
| # | Learning outcome | Competency | Action |
|---|---|---|---|
| # 1 | Learning outcome 2,3,7 |
Competency
Review antibody screening results for sensitised patients and define unacceptable antigens |
Action View |
| # 2 | Learning outcome 3,7 |
Competency
Assess and register patients onto the national deceased donor transplant list |
Action View |
| # 3 | Learning outcome 1,2,3,7,8 |
Competency
Interpret information included on an ODT deceased donor solid organ matching run |
Action View |
| # 4 | Learning outcome 2,3,7,8 |
Competency
Perform a virtual crossmatch assessment and prepare a report for a potential transplant recipient according to local policy |
Action View |
| # 5 | Learning outcome 1,7 |
Competency
HLA type a deceased potential donor according to local protocols |
Action View |
| # 6 | Learning outcome 1,2,7,8 |
Competency
Complete a deceased donor HLA report form for submission to NHSBT-ODT |
Action View |
| # 7 | Learning outcome 2,3,7 |
Competency
Select appropriate sera for highly sensitised patient crossmatching in accordance with local and national guidelines for a complex potential solid organ recipient case |
Action View |
| # 8 | Learning outcome 2,3,7,8 |
Competency
Under the supervision of an H&I Clinical Scientist or Consultant, prepare cross match reports for solid organ recipients with:
|
Action View |
| # 9 | Learning outcome 2,3,7,8 |
Competency
Interpret testing results for a patient with an incompatible living kidney donor and outline the transplant options for the patient |
Action View |
| # 10 | Learning outcome 2,3,7,8 |
Competency
Select a sensitised patient and prepare an interpretive report for cardiothoracic transplant with a deceased donor offer |
Action View |
| # 11 | Learning outcome 2,4,7 |
Competency
Analyse test results for the detection or monitoring of donor specific antibodies for patients post transplantation |
Action View |
| # 12 | Learning outcome 2,4,7,8 |
Competency
Produce an interpretive report for a patient undergoing post-transplant antibody testing |
Action View |
| # 13 | Learning outcome 6,8 |
Competency
Present a case where a new or emerging technology or clinical intervention has been used for solid organ transplant |
Action View |
| # 14 | Learning outcome 2,5,7,8 |
Competency
Select a sensitised patient and prepare an interpretive report for clinical colleague for investigation of platelet refractoriness |
Action View |
| # 15 | Learning outcome 2,5,7 |
Competency
Select appropriate platelet units for patients requiring HLA/HPA selected platelets |
Action View |
| # 16 | Learning outcome 7 |
Competency
Review and interpret EQA report and critically evaluate results for antibody or cross match analysis |
Action View |
| # 17 | Learning outcome 7 |
Competency
Perform an audit in the laboratory and recommend corrective actions and service improvements |
Action View |
| # 18 | Learning outcome 6 |
Competency
Contribute to a service improvement project within your laboratory |
Action View |
| # 19 | Learning outcome 6 |
Competency
Attend a national meeting relevant to solid organ transplantation and provide feedback to your colleagues |
Action View |
Assessments
Complete 4 Case-Based Discussions
Complete 4 DOPS or OCEs
Direct Observation of Practical Skills Titles
- Prepare a crossmatch report.
- Analyse results of post-transplant monitoring.
- Perform a virtual crossmatch for deceased or living donation.
- Prepare a deceased donor ODT report.
- Perform an immunological risk assessment for cardiothoracic donation according to UK guidelines.
- Identify compatible HLA or HPA selected platelet units.
- Interpret results of a UKLKSS matching run.
Observed Clinical Event Titles
- Discuss a complex case on the transplant list with the multidisciplinary team to increase opportunities for transplant.
- Present laboratory results for a solid organ transplant case at a multidisciplinary team meeting.
- Request platelet increments data following clinical transfusion.
- Take a patient history from another healthcare professional to inform interpretation of results for example sensitisation history.
Learning outcomes
| # | Learning outcome |
|---|---|
| 1 | Perform appropriate testing for potential deceased solid organ donors. |
| 2 | Interpret and report tests across the range of techniques applied and provide appropriate clinical advice for solid organ transplant. |
| 3 | Assess the suitability of patients for crossmatch and transplantation in deceased and live donor settings. |
| 4 | Perform clinical and laboratory monitoring of patients who have received a solid organ transplant. |
| 5 | Assess the suitability of patients for HLA/HPA selected platelets and identify compatible platelet units. |
| 6 | Appraise new and emerging technologies and clinical advances in the field of solid organ transplantation. |
| 7 | Practice in accordance with quality management and accreditation standards. |
| 8 | Practice effectively in partnership with service users, other clinical specialisms and the wider multidisciplinary team in the investigation of solid organ transplantation and platelet transfusion. |
Academic content (MSc in Clinical Science)
Important information
The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.
Learning outcomes
On successful completion of this module the trainee will be able to:
- Explain the relevance of HLA, HPA, HNA and other antigens in the use of a variety of blood products.
- Demonstrate a critical awareness of the adverse immunological events that can arise following transfusion of blood products and their investigation.
- Critically discuss the indications for platelet transfusion and the causes of platelet refractoriness.
- Describe the role of histocompatibility testing in pre-transplant work-up and post-transplant management of patients undergoing a variety of solid organ transplants.
- Critically appraise the novel forms of transplantation in development.
- Critically discuss and debate the ethical considerations associated with transplantation.
Indicative content
Transfusion:
- Immunology of platelets and granulocytes.
- Preparation of blood products for transfusion.
- Development of HLA and non-HLA antibodies relevant to transfusion products.
- Pathogenesis, investigation and risk reduction of transfusion-related adverse immunological events.
- Indications for platelet transfusion.
- Selection of platelet donors.
- Causes of platelet refractoriness and use of increment data.
- Indications for granulocyte transfusion.
- Novel products (e.g. in vitro developed platelets).
- Techniques for HPA and HNA screening and typing.
- GMP standards/MHRA/BSQR (in relation to transfusion products).
Complex renal transplantation:
- ABO incompatible.
- HLA incompatible.
- Non-HLA antibodies.
- Highly sensitised patients.
- Antibody titres and removal techniques.
- UK living kidney sharing scheme.
- Bioinformatics tools for donor selection in renal transplants.
- Methods to improve organ quality.
Complications of solid organ transplants:
- Post-transplant monitoring techniques.
- Organ toxicities of immunosuppression.
- Passenger lymphocyte syndrome.
- Disease transmission.
Solid organ transplants:
- National requirements for transplant patient testing and registration.
- Liver.
- Multivisceral.
- Pancreas and islets.
- Cardiothoracic (heart/lung).
- Thymus.
- Novel tissues and organs.
Tissue banking and other forms of graft:
- Skin, cornea, heart valves, bone.
In vitro products:
- Xenotransplants.
- Novel grafts.
- Mesenchymal stem cells.
Ethical considerations:
- Implications of genetic testing.
- Consent (opt-in vs. opt-out / Gillick competence / living donors).
- HTA.
- Tissue banking.
- Allocation of organs.
- Diseased organs.
- Saviour siblings & pre-implantation genetic testing.
- Novel xenografts and allografts.
Clinical experiences
Important information
Clinical experiential learning is the range of activities trainees may undertake in order to gain the experience and evidence to demonstrate their achievement of module competencies and assessments. The list is not definitive or mandatory, but training officers should ensure, as best training practice, that trainees gain as many of these clinical experiences as possible. They should be included in training plans, and once undertaken they should support the completion of module assessments and competencies within the e-portfolio.
Activities
- Visit another H&I laboratory to observe different practices or procedures which are not performed in your laboratory.
- Attend a living donor transplant.
- Shadow a transplant coordinator discussing transplantation with patients to appreciate their role and patient experience of transplantation.
- Attend a clinic where a Transplantation Surgeon is discussing the risk of transplantation with a patient to appreciate the patient experience.