CPTC Exam ACTUAL EXAM 2026/2027
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Section 1: Donor Identification & Referral
Q1: A 45-year-old male suffered a severe traumatic brain injury (TBI) from a motor vehicle collision. He
is intubated and unresponsive. Which clinical trigger mandates a referral to the Organ Procurement
Organization (OPO)?
A. Glasgow Coma Scale (GCS) of 8 or less.
B. Glasgow Coma Scale (GCS) of 5 or less. [CORRECT]
C. Loss of cranial nerve reflexes.
D. Family mention of donation.
Correct Answer: B
Rationale: Current OPTN/UNOS policies and most state laws require hospitals to refer patients with
devastating brain injuries to the OPO. The specific clinical trigger is typically a GCS of 5 or less, often
accompanied by ventilator dependence. A GCS of 8 is not the standard referral trigger. Loss of cranial
nerve reflexes suggests progression toward brain death but the referral must happen before that
determination to maximize donor potential. Board Strategy: Memorize the "GCS ≤ 5" rule as the primary
referral trigger.
Q2: A patient is declared brain dead. The OPO coordinator reviews the medical chart. Which diagnosis in
the patient's history is an absolute contraindication to organ donation?
A. Active untreated sepsis.
B. Metastatic melanoma with active spread. [CORRECT]
,C. History of cured prostate cancer 10 years ago.
D. Hepatitis C infection.
Correct Answer: B
Rationale: Active, disseminated malignancy (such as metastatic melanoma, glioblastoma multiforme
with spread outside the CNS, or choriocarcinoma) is generally an absolute contraindication due to the
high risk of transmitting cancer to the recipient. Sepsis is often treatable; Hepatitis C is now a standard
donor pool (utilizing Hep C+ donors); and cured localized cancers are often acceptable. Board Strategy:
Differentiate between absolute contraindications (active metastatic cancer, active HIV without HOPE
Act) and relative contraindications (infection, age).
Q3: A potential donor has a GCS of 3 and is ventilator-dependent. The physician wants to withdraw
support before a brain death exam. Which referral pathway is appropriate?
A. Brain Death (DBD) pathway.
B. Imminent Death / DCD (Donation after Circulatory Death) referral. [CORRECT]
C. Tissue-only referral.
D. Coroner-only referral.
Correct Answer: B
Rationale: If the patient is not brain dead but has a devastating injury and the family/surrogate has
decided to withdraw life-sustaining therapy (WLST), the DCD pathway is the appropriate referral. This
allows the OPO to evaluate DCD eligibility while the patient is still on support. Board Strategy: DBD =
Brain Dead first. DCD = Withdrawal of support first.
Q4: A 30-year-old female presents to the ER with a massive intracranial hemorrhage. She is intubated,
GCS 3, and has a positive cough reflex. What is the first step for the OPO coordinator?
A. Approach the family for consent immediately.
B. Confirm the referral meets imminent death criteria.
C. Ensure medical stability and await the brain death determination process. [CORRECT]
,D. Decline the donor due to the positive cough reflex.
Correct Answer: C
Rationale: A positive cough reflex (cranial nerve X) indicates the patient is not currently brain dead. The
coordinator must allow the medical team to optimize the patient and complete the brain death
evaluation protocol before proceeding with authorization. Approaching the family before death
determination can be confusing and ethically complex. Board Strategy: Establish death (brain or
circulatory) before consent; ensure clinical stability first.
Q5: A patient is referred with a GCS of 4. The physician states, "We are treating aggressively." What is
the OPO coordinator's appropriate response?
A. Close the referral as "Not a Candidate."
B. Maintain the referral as "Active/Pending" and monitor for withdrawal of care or progression to brain
death. [CORRECT]
C. Tell the family the patient is not a donor.
D. Document "Declined by Physician."
Correct Answer: B
Rationale: A referral with a GCS
≤
5 is valid. Even if the team is currently treating, the patient is at high risk for death. The OPO must track
the patient's trajectory (imminent death or brain death). Closing the referral prematurely violates the
Centers for Medicare & Medicaid Services (CMS) conditions of participation for timely notification.
Board Strategy: Referrals must stay open until the patient recovers (GCS improves significantly) or
expires/donates.
Q6: Which criterion is NOT part of the standard "Imminent Death" criteria for DCD evaluation?
A. GCS
≤
, 5 or catastrophic brain injury.
B. Decision to withdraw ventilator support.
C. Absence of corneal reflexes. [CORRECT]
D. Ventilator dependence.
Correct Answer: C
Rationale: Imminent death criteria focus on the severity of injury (GCS) and the plan to withdraw life
support. Specific brain death signs (like absent corneal reflexes) indicate the patient may already be
progressing to brain death (DBD). DCD donors may still have intact brainstem reflexes; they die from
circulatory arrest after withdrawal of support. Board Strategy: DCD donors often have retained
brainstem function; DBD donors do not.
Q7: A potential donor has a sodium level of 160 mEq/L. The donor management goal (DMG) for sodium
is:
A. < 145 mEq/L.
B. < 155 mEq/L. [CORRECT]
C. < 165 mEq/L.
D. No specific target.
Correct Answer: B
Rationale: The standard Donor Management Goal (DMG) for sodium is < 155 mEq/L. Severe
hypernatremia can lead to cellular dehydration in organs, particularly the liver, increasing the risk of
delayed graft function or primary non-function in the recipient. Board Strategy: Know the "< 155"
threshold for Sodium.
Q8: The Organ Procurement Organization (OPO) is notified of a patient who has been in the ICU for 14
days following a drug overdose. The patient has a persistent GCS of 4T. What is the primary concern
regarding organ viability?
A. Acute tubular necrosis (ATN) from rhabdomyolysis. [CORRECT]
CPTC Certified Professional in Talent
Development | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Donor Identification & Referral
Q1: A 45-year-old male suffered a severe traumatic brain injury (TBI) from a motor vehicle collision. He
is intubated and unresponsive. Which clinical trigger mandates a referral to the Organ Procurement
Organization (OPO)?
A. Glasgow Coma Scale (GCS) of 8 or less.
B. Glasgow Coma Scale (GCS) of 5 or less. [CORRECT]
C. Loss of cranial nerve reflexes.
D. Family mention of donation.
Correct Answer: B
Rationale: Current OPTN/UNOS policies and most state laws require hospitals to refer patients with
devastating brain injuries to the OPO. The specific clinical trigger is typically a GCS of 5 or less, often
accompanied by ventilator dependence. A GCS of 8 is not the standard referral trigger. Loss of cranial
nerve reflexes suggests progression toward brain death but the referral must happen before that
determination to maximize donor potential. Board Strategy: Memorize the "GCS ≤ 5" rule as the primary
referral trigger.
Q2: A patient is declared brain dead. The OPO coordinator reviews the medical chart. Which diagnosis in
the patient's history is an absolute contraindication to organ donation?
A. Active untreated sepsis.
B. Metastatic melanoma with active spread. [CORRECT]
,C. History of cured prostate cancer 10 years ago.
D. Hepatitis C infection.
Correct Answer: B
Rationale: Active, disseminated malignancy (such as metastatic melanoma, glioblastoma multiforme
with spread outside the CNS, or choriocarcinoma) is generally an absolute contraindication due to the
high risk of transmitting cancer to the recipient. Sepsis is often treatable; Hepatitis C is now a standard
donor pool (utilizing Hep C+ donors); and cured localized cancers are often acceptable. Board Strategy:
Differentiate between absolute contraindications (active metastatic cancer, active HIV without HOPE
Act) and relative contraindications (infection, age).
Q3: A potential donor has a GCS of 3 and is ventilator-dependent. The physician wants to withdraw
support before a brain death exam. Which referral pathway is appropriate?
A. Brain Death (DBD) pathway.
B. Imminent Death / DCD (Donation after Circulatory Death) referral. [CORRECT]
C. Tissue-only referral.
D. Coroner-only referral.
Correct Answer: B
Rationale: If the patient is not brain dead but has a devastating injury and the family/surrogate has
decided to withdraw life-sustaining therapy (WLST), the DCD pathway is the appropriate referral. This
allows the OPO to evaluate DCD eligibility while the patient is still on support. Board Strategy: DBD =
Brain Dead first. DCD = Withdrawal of support first.
Q4: A 30-year-old female presents to the ER with a massive intracranial hemorrhage. She is intubated,
GCS 3, and has a positive cough reflex. What is the first step for the OPO coordinator?
A. Approach the family for consent immediately.
B. Confirm the referral meets imminent death criteria.
C. Ensure medical stability and await the brain death determination process. [CORRECT]
,D. Decline the donor due to the positive cough reflex.
Correct Answer: C
Rationale: A positive cough reflex (cranial nerve X) indicates the patient is not currently brain dead. The
coordinator must allow the medical team to optimize the patient and complete the brain death
evaluation protocol before proceeding with authorization. Approaching the family before death
determination can be confusing and ethically complex. Board Strategy: Establish death (brain or
circulatory) before consent; ensure clinical stability first.
Q5: A patient is referred with a GCS of 4. The physician states, "We are treating aggressively." What is
the OPO coordinator's appropriate response?
A. Close the referral as "Not a Candidate."
B. Maintain the referral as "Active/Pending" and monitor for withdrawal of care or progression to brain
death. [CORRECT]
C. Tell the family the patient is not a donor.
D. Document "Declined by Physician."
Correct Answer: B
Rationale: A referral with a GCS
≤
5 is valid. Even if the team is currently treating, the patient is at high risk for death. The OPO must track
the patient's trajectory (imminent death or brain death). Closing the referral prematurely violates the
Centers for Medicare & Medicaid Services (CMS) conditions of participation for timely notification.
Board Strategy: Referrals must stay open until the patient recovers (GCS improves significantly) or
expires/donates.
Q6: Which criterion is NOT part of the standard "Imminent Death" criteria for DCD evaluation?
A. GCS
≤
, 5 or catastrophic brain injury.
B. Decision to withdraw ventilator support.
C. Absence of corneal reflexes. [CORRECT]
D. Ventilator dependence.
Correct Answer: C
Rationale: Imminent death criteria focus on the severity of injury (GCS) and the plan to withdraw life
support. Specific brain death signs (like absent corneal reflexes) indicate the patient may already be
progressing to brain death (DBD). DCD donors may still have intact brainstem reflexes; they die from
circulatory arrest after withdrawal of support. Board Strategy: DCD donors often have retained
brainstem function; DBD donors do not.
Q7: A potential donor has a sodium level of 160 mEq/L. The donor management goal (DMG) for sodium
is:
A. < 145 mEq/L.
B. < 155 mEq/L. [CORRECT]
C. < 165 mEq/L.
D. No specific target.
Correct Answer: B
Rationale: The standard Donor Management Goal (DMG) for sodium is < 155 mEq/L. Severe
hypernatremia can lead to cellular dehydration in organs, particularly the liver, increasing the risk of
delayed graft function or primary non-function in the recipient. Board Strategy: Know the "< 155"
threshold for Sodium.
Q8: The Organ Procurement Organization (OPO) is notified of a patient who has been in the ICU for 14
days following a drug overdose. The patient has a persistent GCS of 4T. What is the primary concern
regarding organ viability?
A. Acute tubular necrosis (ATN) from rhabdomyolysis. [CORRECT]
