Second blood type prior to UNOS listing

[bmarotto]

Our liver transplant team has informed us that there is a UNOS requirement that a patient must have a 2nd blood type determination prior to being listed for an organ. I have no problem with that, however they have started to order two Type & Screens or a Type & Screen and a blood type for the same blood draw. The Blood Banker in me thinks this is not the intent of that UNOS requirement. If the wrong patient is drawn, then both blood types would be wrong. Perhaps they are assuming the most likely source of error is at the point of testing. We have a policy of having a 2nd tech confirm the blood type if the sample is from a patient we do not have an historical type on. Therefore, repeating a blood type on a 2nd tube from the same draw would not increase the accuracy of our result.

Help me out. Am I missing something?

[Mabel Adams]

After that tragic case that made the papers a few years ago, someone said, "Blood types on transplant donors should be double-checked!" So someone interprets that, without a lot of thought, as doing the test twice. You are right to examine the process for the most likely source of errors and try to plug that hole. "Double-checking" without examining the process is like just throwing a solution at it so you feel better about it, but it doesn't accomplish anything useful. If you are going to expend the resource, make it provide some value. Stick to your guns!

[bmarotto]

After more discussion yesterday afternoon, they have come to understand my argument and agreed to have the 2nd blood type drawn on a different day. In the event of an emergent need to list an inpatient who has not been previously typed, we will perform typing on two separate blood draws collected the same day.

As for organ donors, I assume that cadaveric donors had a blood type performed at the hospital where the patient expired and a second by the lab that processes the samples collected during the harvest procedure. We are covered for the living donors (liver and kidney) since we type them during their initital evaluation, at the time of autologous donation, and again the day of surgery.

[UKCAT]

The interpretation of the ABO compatibility UNOS policy, effective 2/1/04, at this institution, is that the TRANSPLANT SURGEON must document ABO compatibility on 2 occasions. Here, they record this in the Transplant Operative notes and the Site Verification checklist. It has nothing to do with the Blood Bank typing 2 specimens-has something changed??

[bmarotto]

I will try to get the specific policy requirement as written by UNOS from our transplant team. It could be that they are interpreting it more stringently than it is meant.

[LABKING]

If safety is the big issue, then keeping accurate accounts of mislabeling would be helpful.

Maintaining a strict enforcement of the drawing procedure.

Have a 2nd verifier at the time of the draw recorded on the collection record.

A 2nd specimen drawn by a different person and typed by a second tech.

Stress accountability and education and enforce policy.

Any deviation from procedure needs to be with the Pathologist permission and documented.

Do not allow multiple tasks in the BB during the processing and testing of BB specimens.

[mhc]

Our facility interprets the UNOS rule as 2 separate samples drawn at 2 different times . The transplant team insists on a hard copy report as well.

[patw]

Our facility also interprets the transplant recipient type as requiring two independently collected blood samples. An immediate pre-transplant abo confirmation is also required on the organ donor before the surgeon reaches the point of no return. This is at least a second confirmation, but more importantly this abo is performed on the sample that arrives in the same container as the organ. This is the final opportunity to intercept any abo or clerical errors that might indicate any mix-up. We have an interdisciplinary team that developed interdisciplinary policies that coordinate all immediate pre-transplant activities among the teams. Part of this was to design the form used for the surgeon to document final abo compatibility of donor and recipient