GENERAL SUMMARY / OVERVIEW STATEMENT
Under general supervision, performs complex clinical laboratory tests in histocompatibility for the purpose of selecting appropriate recipients for deceased and living-related organ transplantation and human stem cell transplant, monitoring recipients post-transplant, and diagnosing HLA-associated diseases. Job requires a professional level of knowledge, as well as the ability to analyze and interpret tests independently, and communicate results clearly. The following duties are characteristic of this classification. Overtime may be required as determined by workload.
PRINCIPLE DUTIES AND RESPONSIBILITIES
Responsibilities as outlined by CLIA:
Testing personnel are responsible for specimen processing, test performance and for reporting test results.
- Follow the laboratory's procedures for specimen handling and processing, test analyses, reporting and maintaining records of patient test results;
- Maintain records that demonstrate that proficiency testing samples are tested in the same manner as patient specimens;
- Adhere to the laboratory's quality control policies, document all quality control activities, instrument and procedural calibrations and maintenance performed;
- Follow the laboratory's established policies and procedures whenever test systems are not within the laboratory's established acceptable levels of performance;
- Be capable of identifying problems that may adversely affect test performance or reporting of test results and either must correct the problems or immediately notify the general supervisor, technical supervisor, clinical consultant, or director;
- Document all corrective actions taken when test systems deviate from the laboratory's established performance specifications; and
- If qualified under §493.1489(b)(5), perform high complexity testing only under the onsite, direct supervision of a general supervisor qualified under §493.1461.
Exception: For individuals qualified under §493.1489(b)(5), who were performing high complexity testing on or before January 19, 1993, the requirements of paragraph (b)(7) of this section are not effective, provided that all high complexity testing performed by the individual in the absence of a general supervisor is reviewed within 24 hours by a general supervisor qualified under §493.1461
Additional responsibilities under the direction of the Technical Director and Clinical Supervisor:
•1. Performs complex clinical laboratory tests in histocompatibility that require a professional level of knowledge to analyze and interpret results. These assays are necessary for both deceased and living donor transplantation; incorrect results which either deny engraftment or allow inappropriate transplants can have dire results for the patients. Thus, the job entails a high level of responsibility and accountability. Some examples of tests performed are listed below in each category.
i. Performs deceased donor immunologic work-ups for all organs, within the time required by current organ preservation methods. Independently verifies results and reports conclusions directly to New England Organ Bank. Job requires on-call assignments on a regular basis; most deceased donor organ distribution and crossmatching occurs between 5pm and 8am or on weekends.
ii. Extracts DNA from peripheral blood or solid tissue (e.g., lymph node, spleen), performs DNA amplification, and determines HLA antigens by current methods.
iii. Isolates and separates lymphocytes from peripheral blood or solid tissue (eg., lymph node, spleen) into two major subpopulations (B and T lymphocytes) and performs crossmatches between recipients and deceased donors identified within the New England Organ Bank region, Life Choice Donor Services region, and by the United Network for Organ Sharing (UNOS). Responsible for determination of extent of crossmatching and selection of appropriate sera, within laboratory guidelines.
iv. Screens approximately 1000 potential recipients monthly for anti-HLA antibody determination, against a panel of soluble HLA on microbeads and/or a 50 member frozen cell panel. Performs urgent screens using frozen cell trays, as requested, for medical emergency patients and potential cardiac recipients.
v. Follows UNOS rules for mandatory national organ sharing.
b. Living Donor Transplantation (donation of kidney from related or unrelated individual):
i. Isolates and separates lymphocytes from peripheral blood into two major subpopulations (B and T lymphocytes) for determination of HLA antigens via complement dependent cytotoxicity and/or extracts DNA from blood for HLA typing via molecular methodology.
ii. Performs crossmatches between recipients and potential living donors using T lymphocytes and/or B lymphocytes.
c. Bone Marrow Transplantation (bone marrow donation from related or unrelated individual)
i. Extracts DNA from cells or whole blood
ii. DNA amplification using designated programs in thermal cycler
iii. Performs tests on SSO beads and/or SSP kits and/or real time kits
iv. Prepares agarose gels and load DNA into lanes
v. Interprets results based on probe and/or band patterns.
•2. Performs appropriate absorptions with platelets and autologous cells to further characterize antibody present in patient sera.
•3. Records and reviews test results for accuracy and prepares test reports. Completes administrative tasks required for test completion. Notifies appropriate physician and/or NEOB staff (in case of deceased donor organ distribution) and gives reports to Technical Director and Medical Director for verification.
•4. Prepares and determines suitability of solutions, reagents, and stains following standard laboratory formulas and procedures. Records control values of technical equipment daily to monitor and ensure their reliability.
•5. Participates in competency and monthly proficiency testing.
•6. Performs sophisticated calculations in interpretation of certain test results (i.e., p values to determine statistical significance of some tests, correlation coefficients to evaluate the quality of reagent sera, etc.)
•7. Utilizes laboratory computer for updating of recipient status on national organ sharing (UNOS) list, for sample entry and test orders, for daily test analysis, and for record-keeping concerning patients and sophisticated reagents.
•8. Participates in research, development, and implementation of improved or new clinical laboratory techniques and procedures as required.
•9. Performs additional molecular testing for determination of specific antigens, such as HLA-B27 and HLA-B*57:01, as diagnostic aids.
•10. Teaches laboratory procedures to rotating trainees from other laboratories, pathology residents/fellows, NEOB personnel, and renal immunology fellows on a regular basis..
•11. Keeps current regarding developments in techniques and trends in histocompatibility and immunologic testing through appropriate technical journals, as well as internal and external educational programs.
•12. Is responsible for awareness of National Patient Safety Goals and to comply with BWH Hospital and Laboratory policies and procedures.
•13. Maintains an orderly work area.
•14. Maintains a working familiarity with Sunquest and Epic information systems
•15. Performs other duties as required.
SKILLS AND ABILITIES REQUIRED
1. Must have high level of analytical ability to resolve technical problems stemming from faulty equipment, reagents, or abnormal patient cells or sera, and to interpret quality control data.
2. Job requires the ability to work independently, within laboratory guidelines, particularly in distribution of cadaver organs to potential recipients.
3. Must possess ability to think clearly under stress and exercise correct judgment in performance and reporting of tests; failure to do so could result in hyperacute rejection and possibly patient death.
4a. Work requires ability to withstand stress and to complete work under pressure. Job requires that technician on-call work up to 24 hours to match organs with potential recipients. Must possess interpersonal skills sufficient to deal at length with surgeons, nephrologists, and other pertinent staff during this period.
4b. Work requires the ability to work with internal and external staff. Must maintain a level of professionalism at all times.
5. Must possess visual acuity sufficient to distinguish between variations in stained cells, including ability to distinguish clearly between green and red; must possess manual dexterity to work with small instruments and delicate equipment and tissues.
6. Work requires visual fatigue (up to 50% of work time) due to extensive examination of stained cells to determine antigen presence/absence or antibody presence/absence.
7. Works under time constraints and with the awareness that errors could be fatal to the patient.
8. Meets acceptable performance and productivity levels.
9. Work requires frequent standing and walking (about 75% of work time) and some lifting of supplies (less than 100 pounds).
WORKING CONDITIONS: Describe the conditions in which the work is performed.
Works in large, pleasant laboratory with approximately 30 technologists, administrative personnel, and directors. Technologists work with biological materials (human blood products and tissue) and chemicals such as ethidium bromide. May be required to work for extended periods of time without rest under pressure.
1. Must possess a Bachelors degree in a chemical, physical, or biological science from an accredited college or university. (There are no organized academic programs which adequately train individuals for work in this field; a broad scholastic background in biology, chemistry, and immunology is preferred.)
2. Must have satisfactorily completed in-house laboratory training/orientation program, including on-call duties. Training requires between nine and twelve months, on average, to acquire the necessary familiarity with laboratory policies, as well as theoretical and practical knowledge of procedures and tests. There are currently no licensure requirements in histocompatibility.