Pre-Transplant Evaluation and Candidate Selection
Core concepts
Understand the purpose of the pre-transplant evaluation: confirming irreversible organ failure and medical necessity, excluding contraindications, assessing surgical risk, and ensuring psychosocial and financial readiness. Know organ-specific workups: cardiac catheterization and pulmonary pressures for liver and kidney candidates, ventricular function and pulmonary vascular resistance for heart candidates, six-minute walk and oxygen requirements for lung candidates, and nutritional and frailty assessment throughout. Master infection screening (HIV, hepatitis B and C, tuberculosis, cytomegalovirus, Epstein-Barr virus), malignancy history and waiting intervals, and vaccination. Know how the transplant candidate is listed, how status or allocation scores work, and how the panel-reactive antibody and unacceptable antigen list are entered.
Traps
Questions often test absolute versus relative contraindications: active uncontrolled infection, active malignancy outside accepted remission intervals, and severe irreversible non-adherence are commonly absolute, while advanced age alone is not. Watch for candidates with obesity, frailty, or controlled psychiatric illness, which require individualized assessment rather than automatic exclusion. Another trap is confusing listing criteria with transplant criteria, and confusing the pre-transplant evaluation with the pre-operative anesthesia assessment.
Worked example
A 62-year-old with cirrhosis, a Model for End-Stage Liver Disease score of 22, and a small hepatocellular carcinoma within Milan criteria. Rule of thumb: the cancer does not automatically exclude; accepted criteria plus an appropriate waiting period and imaging stability allow listing, and the score drives allocation priority rather than the cancer itself.
Study strategy
For each organ, write the three findings that define end-stage disease and the three findings that would delay listing.