Deceased Donor Instructions

DDR - Deceased Donor Registration
Deceased Donor Registration (DDR) records are generated and available as soon as the donor
®
feedback process is completed in DonorNet . The Deceased Donor Registration record is to be
completed for all consented but not recovered and recovered donors.
A consented (written) but not recovered donor is one in which consent was obtained but
the organs were not recovered for transplantation. Information about this donor is entered
on the DDR record to determine why the donor's organs may not have progressed to
donation.
A recovered organ donor refers to situations where consent was obtained and at least one
organ was recovered for the purpose of transplantation.
Click on OPTN/UNOS Policy on Data Submission Requirements for additional information.
To correct information that is already displayed in an electronic record, call 1-800-978-4334.
Donor Information
The donor's ID # will be displayed at the top of this section.
OPO: The organ procurement organization (OPO) reported in the Donor Feedback displays.
Verify the OPO name and center code of the OPO responsible for the management of the
donor and that the displayed OPO provider number is the 6-character Medicare identification
number of the OPO.
Donor Hospital: The donor hospital reported in the Donor Feedback displays. Verify the
hospital name and the 6-character Medicare provider number of the hospital which originally
referred the donor. If this information is incorrect, you may make modifications in the donor
record in DonorNet. The information will then be updated in the DDR record. A list of Medicare
provider numbers for your state can be obtained in the Donor Hospitals section of DonorNet.
Referral Date: Enter the date of the initial donor referral call to the OPO. Use the standard 8digit numeric format of MM/DD/YYYY.
Recovered Outside the U.S.: Select Yes if the organs were recovered outside of the United
States. If the organs were not recovered outside of the United States, select No. If Yes is
selected, indicate the name of the country where the organs were recovered.
Last Name: Enter the last name of the donor who was referred to your OPO as a potential
organ donor.
First Name: Enter the first name of the donor who was referred to your OPO as a potential
organ donor.
Middle initial: Enter the middle initial of the donor who was referred to your OPO as a potential
organ donor.
DOB: Enter the date the donor was born using the standard 8-digit numeric format of
MM/DD/YYYY or enter the donor's Age in Years or Months.
Gender: Indicate if the donor is Male or Female.
Home City: Enter the name of the city where the donor lived before hospitalization. If the donor
did not live in the United States before hospitalization, enter the city and country of the donor's
residence in the space provided.
Note: If the donor is a Non-Resident Alien and lived in the United States before
hospitalization, complete the Home City field, leave the State and Zip Code fields
blank and complete the Citizenship and Home Country fields further below.

State: If the donor lived in the United States before hospitalization, select the state where the
donor's home city was located.
Zip Code: Enter the U.S. Postal Zip Code of the location where the donor lived before
hospitalization.
Ethnicity/Race: Select as appropriate to indicate the donor's ethnicity/race.
American Indian or Alaska Native: Select for donors who are of North, South, or Central
American descent (e.g. American Indian, Eskimo, Aleutian, Alaska Indian). If the donor
belongs to the primary category, but does not belong to any of the subcategories listed,
select American Indian or Alaska Native: Other. If unknown, select American Indian or
Alaska Native: Not Specified/Unknown.
Asian: Select for donors who are of Asian descent (e.g. Asian Indian/Indian SubContinent, Chinese, Filipino, Japanese, Korean, Vietnamese). If the donor belongs to
the primary category, but does not belong to any of the subcategories listed, select Asian:
Other. If unknown, select Asian: Not Specified/Unknown.
Black or African American: Select for donors of African descent (e.g. African American,
African (Continental), West Indian, Haitian). If the donor belongs to the primary category,
but does not belong to any of the subcategories listed, select Black or African American:
Other. If unknown, select Black or African American: Not Specified/Unknown.
Hispanic/Latino: Select for donors who are of Central or South American descent (e.g.
Mexican, Puerto Rican (Mainland), Puerto Rican (Island), Cuban). If the donor belongs
to the primary category, but does not belong to any of the subcategories listed, select
Hispanic/Latino: Other. If unknown, select Hispanic/Latino: Not Specified/Unknown.
Native Hawaiian or Other Pacific Islander: Select for donors who are descendents of the
Native Hawaiian, Guamanian or Chamorro, or Samoan peoples. If the donor belongs to
the primary category, but does not belong to any of the subcategories listed, select Native
Hawaiian or Other Pacific Islander: Other. If unknown, select Native Hawaiian or Other
Pacific Islander: Not Specified/Unknown.
White: Select for donors who are of European Descent, Arab or Middle Eastern or
North African (non-Black). If the donor belongs to the primary category, but does not
belong to any of the subcategories listed, select White: Other. If unknown, select White:
Not Specified/Unknown.
Citizenship: Select as appropriate to indicate the donor's citizenship.
U.S. Citizen: Select if the donor is a U.S. Citizen by birth or naturalization.
Resident Alien: Select if the donor is a non-U.S. citizen currently residing in the United
States (e.g., Permanent Resident, Conditional Resident, Returning Resident). A Permanent
Resident is an individual residing in the U.S. under legally recognized and lawfully recorded
residence as an immigrant. A Conditional Resident is any alien granted permanent resident
status on a conditional basis (e.g., a spouse of a U.S. Citizen; an immigrant investor), who
is required to petition for the removal of the set conditions before the second anniversary of
the approval of the conditional status. A Returning Resident is any lawful permanent
resident who has been outside the United States and is returning to the U.S. (Also defined
as a "special immigrant".)
Non-Resident Alien/Year entered U.S.: If the donor is a Non-Resident Alien
(Nonimmigrant), enter the year the candidate entered the United States. A Nonimmigrant is
an alien who seeks temporary entry to the United States for a specific purpose. The alien
must have a permanent residence abroad and qualify for the nonimmigrant classification
sought. The nonimmigrant classifications include: foreign government officials, visitors for
business and for pleasure, aliens in transit through the U.S., treaty traders and investors,
students, international representatives, temporary workers and trainees, representatives of
foreign information media, exchange visitors, fiance(e)s of U.S. citizens, intracompany

transferees, NATO officials, religious workers, and some others. Most non-immigrants can
be accompanied or joined by spouses and unmarried minor (or dependent) children.
Unknown: Select only if the donor's citizenship is unknown.
Note: Permanent residence begins on the date the donor was granted permanent
resident status. This date is on the donor's Permanent Resident Card (formerly
known as Alien Registration Card). To view a sample card, go to
http://www.immigrationagency.org/images/greencard_sample.jpg.
Cause of Death: Select the donor's cause of death. If the cause of death is not listed, select
Other, specify, and enter the cause of death in the space provided.
Anoxia
Cerebrovascular/Stroke
Head Trauma
CNS Tumor
Other Specify
Mechanism of Death: Select the donor's mechanism of death. If the mechanism of death is
not listed, select None of the Above.
Drowning
Seizure
Drug Intoxication
Asphyxiation
Cardiovascular
Electrical
Gunshot Wound
Stab
Blunt Injury
SIDS
Intracranial Hemorrhage/Stroke
Death from Natural Causes
None of the Above
Circumstances of Death: Indicate the donor's circumstances of death. If the circumstance of
death is not listed, select None of the Above.
MVA
Suicide
Homicide
Child-Abuse
Non-MVA
Death from Natural Causes
None of the Above
Unknown
Procurement and Consent
Medical Examiner/Coroner: Select Yes if the donor's death was reported to the medical
examiner/coroner. If the donor's death was not reported to the medical examiner/coroner,
select No. If Yes is selected, indicate if the medical examiner/coroner gave or refused consent
for organ donation. If unknown, select Unknown.
No
Yes, Medical Examiner Consented
Yes, Medical Examiner Refused Consent
Unknown

Did the Patient have written documentation of their intent to be a donor: Select Yes if the
patient had written documentation of their intent to be a donor. If not, select No. If unknown,
select UNK.
If yes, indicate mechanisms (check all that apply): If the patient had written
documentation of their intent to be a donor, indicate whether the mechanism was a
Driver's License, Donor Card, Donor Registry and/or Durable Power of
Attorney/Healthcare Proxy. If the documentation used is not listed, enter the type of
written documentation in the Other Specify field.
Was the consent based solely on this documentation: If consent was based solely
on this documentation, select Yes. If not, select No.
Did the Patient express to family or others the intent to be a donor: If the patient
expressed to family or others the intent to be a donor, select Yes. If not, select No. If unknown,
select UNK.
Date and time of pronouncement of death (Complete for brain dead and DCD donors):
Enter the date, using the standard 8-digit numeric format of MM/DD/YYYY, and time (military)
of pronouncement of death of the donor.
Date and time consent obtained for first organ: Enter the date, using the standard 8-digit
numeric format of MM/DD/YYYY, and time (military) consent was obtained for first organ.
Clinical Information
ABO Blood Group: The donor's blood type reported in the donor record in DonorNet displays.
Verify the blood type displayed for the donor referred to your OPO. Acceptable values are: A,
B, AB or O. If this information is incorrect, you may make modifications in the donor record in
DonorNet. The DDR record will then be updated with this information. If the subgroup of A is
known, it can be specified: A1, A2, A1B, or A2B.
Height: Enter the height of the donor at the time of recovery in the appropriate space, in feet
and inches or centimeters. If the donor's height at the time of recovery is unavailable, select the
appropriate status from the ST field (N/A, Not Done, Missing, Unknown).
Weight: Enter the weight of the donor at the time of recovery in the appropriate space in
pounds or kilograms. If the donor's weight at the time of recovery is unavailable, select the
appropriate status from the ST field (N/A, Not Done, Missing, Unknown).
Terminal Lab Data: For each of the laboratory tests listed (BUN, Total Bilirubin, SGOT/AST
and SGPT/ALT, Serum Sodium, Serum Creatinine, Protein in Urine, INR, Blood PH,
Hematocrit, (PA Donors Serum Lipase and Serum Amylase)), provide the value in the units
indicated from tests performed closest to the time of recovery. If a value is unavailable, you
may select the appropriate status from the ST field (N/A, Not Done, Missing, Unknown).
Indicate whether protein was found in the urine by selecting Yes, No or UNK.
Serology: For each of the tests listed, select the appropriate result (Cannot Disclose,
Indeterminate, Negative, Not Done, Positive, or Unknown) during the recovery period. Do
not skip any tests.
Anti-HIV I/II
Anti-HTLV I/II
RPR-VDRL
Anti-CMV
HBsAg
Anti-HBC
Anti-HCV
HBsAb
EBV (VCA) (lgG)

EBV (VCA) (lgM)
EBNA
Note: For CMV, a titer of >1:4 for the complement fixation or latex agglutination tests, a titer
of >1:10 for IgG-immunofluorescence (IF) and a titer of >1:16 for IgM-IF are usually
considered positive. If the test(s) are below the threshold considered positive, the
result should be marked Negative. If testing was done, but for a rare reason, results
are inconclusive, select Indeterminate. If testing was not done, select Not Done.
Select Unknown if no results are found. If you cannot disclose the results, select
Cannot Disclose.
Note: For Epstein-Barr Virus (EBV (VCA) (lgG), EBV (VCA) (lgM), EBNA) serologies, a
titer level of <1:10 is considered Negative.
Donor Management: (Any medication administered within 24 hours prior to crossclamp.)
Select Yes, No or UNK to indicate if any of the listed medications were given to the donor
within 24 hours prior to crossclamp. If one or more medications are not listed, enter the name of
the medication in the Other/Specify space provided. If a medication falls under more than one
category (antihypertensives and vasodilators) select Yes for both categories.
Steroids
Diuretics
T3
T4
Anticonvulsants
Antihypertensives
Vasodilators
DDAVP = synthetically derived vasopressor (e.g. DDAVP or Desmopressin)
Heparin
Arginine Vasopressin = human or animal derived vasopressor (e.g. pitressin,
vasopressin, argipressin)
Insulin
Other/Specify (one)
Other/Specify (two)
Other/Specify (three)
Inotropic Medications at time of cross clamp: Select Yes if any inotropic agents were
administered at the time of cross clamp. If inotropic agents were not administered at the time of
cross clamp, select No. If unknown, select UNK. If Yes is selected, indicate the Medication(s),
the Dosage At Time of Cross Clamp, Dosage Units and the Final Dosage Duration in
hours. The dosage at the time of recovery for Dopamine, Dobutamine, Epinephrine and
Levophed must fall between .05 and 40. For Neosynephrine and Other, Specify the dosage
must fall between .01 and 300. The dosage range for Isoproterenol (Isuprel) is .10 and 40
mcg/min. Indicate whether the Dosage Units are mcg/kg/min, mcg/min, mg/min or units/hr,
mcg/hr.
Dopamine
Dobutamine
Epinephrine
Levophed
Neosynephrine

Isoproterenol (Isuprel)
Other, specify
mcg/kg/min
mcg/min
mg/min
units/hr
mcg/hr
Number of transfusions during this (terminal) hospitalization: Indicate the number of units
of packed red cells or whole blood transfused prior to organ recovery for this hospitalization.
None
1-5
6 - 10
Greater than 10
Unknown
Three or more inotropic agents at time of incision: Select Yes or No to indicate whether or
not three or more inotropic agents were administered to the donor at the time of incision.
Clinical Infection: Select Yes if there is documented evidence of any clinical infection during
this hospitalization for the donor. If there is no documented evidence of any clinical infection
during this hospitalization for the donor, select No. If the donor's history of infection is unknown,
select UNK. If there is documented evidence of any clinical infection during this hospitalization
for the donor, select whether the source was Blood, Lung, Urine and/or Other. For each
source indicated, select Yes if the infection was confirmed by culture. If the infection was not
confirmed by culture, select No. If the source is not listed, select Other and enter the source in
the space provided. If the donor's history of infection is unknown, select UNK.
Life Style Factors
Select Yes, No or UNK (Unknown) to indicate if the donor has each of the following lifestyle
factors:
Cigarette Use (>20 pack years)-Ever: Indicate if the donor has ever used cigarettes for more
than 20 pack years. Pack years refers to the number of packs of cigarettes the donor smoked
per day multiplied by the number of years. For example, a donor smoking 2 packs of cigarettes
per day for 10 years would equal 20 pack years.
AND continued in last 6 months: Indicate if the donor used cigarettes for more than 20
pack years within the last 6 months.
Cocaine Use - Ever: Indicate if the donor has ever abused or had a dependency to cocaine.
AND continued in last 6 months: Indicate if the donor abused or had a dependency to
cocaine within the last 6 months.
Other Drug Use (non-IV) - Ever: Indicate if the donor has ever abused or had a dependency
to Non-IV street drugs, such as crack, marijuana or prescription narcotics, sedatives, hypnotics
or stimulants.
AND continued in last 6 months: Indicate if the donor abused or had a dependency to
Non-IV street drugs, such as crack, marijuana or prescription narcotics, sedatives,
hypnotics or stimulants within the last 6 months.
Heavy Alcohol Use (heavy = 2+ drinks/day): Indicate if the donor has a history of having two
or more alcoholic drinks per day.
Tattoos: Indicate if the donor has any tattoos.
Does the Donor meet CDC guidelines for "High Risk" for an organ donor: Indicate if the
donor meets CDC guidelines for "high Risk" for an organ donor.

Note: Refer to the Centers for Disease Control (CDC) for the definition of "high risk"
behaviors listed above.
History of Diabetes: Select Yes if the donor has a documented history of diabetes mellitus
prior to this hospitalization, along with the appropriate duration period. If the donor does not
have a documented history of diabetes mellitus prior to this hospitalization, select No. If
unknown, select Unknown. If Yes is selected, select one duration category to indicate the
number of years the donor has a documented history of diabetes. If the duration is unknown,
select Yes, Duration Unknown.
No
Yes, 0-5 Years
Yes, 6-10 Years
Yes, > 10 Years
Yes, Unknown Duration
Unknown
Insulin Dependent: If the donor has a history of diabetes and is insulin dependent, select Yes.
If the donor has a history of diabetes but is not insulin dependent, select No. If the donor is
insulin dependent, select one duration category to indicate the number of years the donor has
been taking insulin. If the duration is unknown, select Unknown Duration.
No
Yes, 0-5 Years
Yes, 6-10 Years
Yes, > 10 Years
Yes, Unknown Duration
Unknown
History of Hypertension: Select Yes if the donor has a documented history of hypertension
prior to this hospitalization. If the donor does not have a documented history of hypertension
prior to this hospitalization, select No. If unknown, select Unknown. If the duration is unknown,
select Yes, Unknown Duration.
No
Yes, 0-5 Years
Yes, 6-10 Years
Yes, > 10 Years
Yes, Unknown Duration
Unknown
If Yes, method of control: Select Yes, No or UNK for each method of hypertension
control listed.
Diet
Diuretics
Other hypertensive medication
History of Cancer: If the donor has a documented history of any type of cancer prior to this
hospitalization, select the primary cancer site from the list provided. If the donor has no
documented history of any type of cancer prior to this hospitalization, select No. If the primary
cancer site is not listed, select Other, specify and enter the site in the space provided.
No
Skin - Squamous, Basal Cell
Skin - Melanoma
CNS Tumor - Astrocytoma
CNS Tumor - Glioblastoma Multiforme
CNS Tumor - Medulloblastoma
CNS Tumor - Neuroblastoma
CNS Tumor - Angioblastoma

CNS Tumor - Meningioma
CNS Tumor - Other
Genitourinary - Bladder
Genitourinary - Uterine Cervix
Genitourinary - Uterine Body Endometrial
Genitourinary - Uterine Body Choriocarcinoma
Genitourinary - Vulva
Genitourinary - Ovarian
Genitourinary - Penis, Testicular
Genitourinary - Prostate
Genitourinary - Kidney
Genitourinary - Unknown
Gastrointestinal - Esophageal
Gastrointestinal - Stomach
Gastrointestinal - Small Intestine
Gastrointestinal - Colo-Rectal
Gastrointestinal - Liver & Biliary Tract
Gastrointestinal - Pancreas
Breast
Thyroid
Tongue/Throat
Larynx
Lung (Include Broncial)
Leukemia/Lymphoma
Unknown
Other, Specify
Cancer Free Interval: If the donor has a documented history of cancer, enter the number
of years the donor has been free of any sign of cancer. Cancer free interval can be entered
in portions of a year by entering a decimal. If unavailable, select the appropriate status from
the ST field (N/A, Not Done, Missing, Unknown).
Cancer at time of procurement: Select Yes for each category listed if the donor exhibited
documented clinical signs of Intracranial, Extracranial or Skin cancer at the time of recovery.
If the donor did not exhibit documented clinical signs of cancer at the time of recovery for any
listed category, select No. If unknown, select UNK.
Organ Recovery
Recovery Date (donor to OR): Enter the date the donor entered the operating room for the
purpose of organ recovery. Use the standard 8-digit numeric format of MM/DD/YYYY. If the
operation began in the evening and concluded the next day, enter the date the operation
began. Modification can be made in the donor feedback if incorrect.
Was this a DCD donor: Select Yes if this donor was a DCD (Donation after Cardiac Death)
donor. If this donor was not a DCD donor, select No.
If Yes, Controlled: If this was a DCD donor, select Yes if the DCD donor was controlled. If
the DCD donor was not controlled, select No. If unknown, select UNK.
A controlled DCD donor is a donor whose life support will be withdrawn and whose
family gave written consent for organ donation in the controlled environment of the
operating room.
An uncontrolled DCD donor is a patient who expires in the emergency room or
elsewhere in the hospital before consent for organ donation is obtained and catheters
are placed in the femoral vessels and peritoneum to cool organs until consent can be
obtained. Also, an uncontrolled DCD donor is a patient who is consented for organ
donation but suffers a cardiac arrest requiring CPR during procurement of the organs.

If Yes, Date and time withdrawal of support: Enter the date (MM/DD/YYYY format)
and time (military time) of the withdrawal of support.
If Yes, Date and time agonal phase begins (systolic BP < 80 or O2 sat. < 80%):
Enter the date (MM/DD/YYYY format) and time (military time) when the agonal phase
begins.
If DCD, Total urine output during OR recovery phase: Enter the total urine output.
Measures Between Withdrawal of Support and Cardiac Death. Provide Serial Data
Every 15 Minutes Between Withdrawal of Support and Start of Agonal Phase, and
Every 5 Minutes Between Start of Argonal Phase and Cardiac Death.
Date: Enter the date (MM/DD/YYYY format).
Time (military time): Enter the time.
Systolic blood pressure: Enter the systolic blood pressure.
Diastolic blood pressure: Enter the diastolic blood pressure.
Mean arterial pressure: Enter the mean arterial pressure.
O2 Saturation: Enter the O2 saturation.
If Yes, Core Cooling Used: If this was a DCD donor, select Yes if core cooling was used.
If core cooling was not used for the DCD donor, select No.
Core Cooling: In the process of non-heart-beating organ donation, some centers place
large intravascular cannunlae into the femoral vessels. These cannulae are placed
before or after death. After death has been declared, they are used to drain blood and
to replace it with cold preservation solution. In addition, cold preservation solution may
be infused into the abdominal cavity through large catheters.
If Yes, Date and time abdominal aorta cannulation: Enter the date (MM/DD/YYYY
format) and time (military time) of abdominal aorta cannulation. If unavailable, select
the appropriate status from the ST field (N/A, Not Done, Missing, Unknown).
If Yes, Date and time thoracic aorta cannulation: Enter the date (MM/DD/YYYY
format) and time (military time) of thoracic aorta cannulation. If unavailable, select the
appropriate status from the ST field (N/A, Not Done, Missing, Unknown).
If Yes, Date and time portal vein cannulation: Enter the date (MM/DD/YYYY format)
and time (military time) of portal vein cannulation. If unavailable, select the appropriate
status from the ST field (N/A, Not Done, Missing, Unknown).
If Yes, Date and time pulmonary artery cannulation: Enter the date (MM/DD/YYYY
format) and time (military time) of pulmonary artery cannulation. If unavailable, select
the appropriate status from the ST field (N/A, Not Done, Missing, Unknown).
Estimated Warm Ischemic Time: If this was a DCD donor, enter the estimated number of
minutes that elapsed from the time of cardiac arrest until the time core cooling was initiated.
If unavailable, select the appropriate status from the ST field (N/A, Not Done, Missing,
Unknown).
If No, was this a consented DCD donor that progressed to brain death?: Indicate if this
was a consented DCD donor that progressed to brain death by selecting Yes or No.
Cardiac arrest since neurological event that lead to declaration of brain death: Select
Yes or No to indicate whether cardiac arrest occurred between a fatal brain injury event
and organ recovery. With DCD donors, if cardiac arrest occurred during donor
management, then select Yes. Otherwise, select No for DCD donors.
If Yes, Duration of Resuscitation: If cardiac arrest occurred between a fatal brain
injury event and organ recovery, indicate the total minutes of cardiac resuscitation. If

unavailable, select the appropriate status from the ST field (N/A, Not Done, Missing,
Unknown).
Clamp Date: Enter the date the aorta was cross clamped. Use the standard 8-digit numeric
format of MM/DD/YYYY.
Clamp Time: (Military Time): Enter the time the aorta was cross clamped. Use military time. If
the time the aorta was cross clamped is unavailable, select the appropriate status from the ST
field (N/A, Not Done, Missing, Unknown).
Clamp Time Zone: Enter the time zone which corresponds with the time and location of the
recovery.
Eastern
Central
Mountain
Pacific
Alaska
Hawaii
Atlantic
ALL Donors Cardiac and Pulmonary Function:
History of previous MI: Select Yes if the donor had a history of myocardial infarction. If
the donor did not have a history of myocardial infarction, select No. If this information is
unknown, select UNK.
LV ejection fraction (%): Provide the left ventricular ejection fraction, if known. If the left
ventricular ejection fraction is unavailable, select the appropriate status from the ST field
(N/A, Not Done, Missing, Unknown).
Method: Indicate whether the left ventricular ejection method was an Echocardiogram,
MUGA scan or Angiogram.
If LV, Ejection Fraction < 50% indicate whether the Structural Abnormalities were
Valves, Congenital and/or LVH by selecting Yes or No.
Wall Abnormalities: Indicate also whether the Wall Abnormalities were Segmental
and/or Global by selecting Yes or No.
Coronary Angiogram: If the donor did not have a coronary angiogram, select No. If the
donor had a coronary angiogram, select Yes, Normal or Yes, Not Normal.
If Abnormal, # Vessels with > 50% Stenosis: If the results of the coronary angiogram
were abnormal, select the number of vessels with more than 50% stenosis. If this
information is unknown, select Unknown.
Pulmonary Measurements:
Lung - Was pO2 done: Select Yes if a pO2 was done. If not, select No. If unknown,
select UNK.
If Yes, Lung pO2 terminal value: If pO2 was done, enter the terminal value in
mm/Hg in the space provided. If unavailable, select the appropriate status from the
ST field.
If Yes, Lung pO2 on FiO2 terminal value of: If pO2 was done, enter the percent
(i.e. 40%) of Lung pO2 was on FiO2 in the space provided.
pCO2: Enter the pCO2 in mm/Hg in the space provided.
Was a pulmonary artery catheter placed: Select Yes if a pulmonary artery catheter was
placed. If not, select No.

If Yes, Initial (baseline) and Final-Preoperative measurements: If a pulmonary
artery catheter was placed, enter the Initial (baseline) and Final-Preoperative
measurements for the following:
MAP (mm/Hg)=Mean arterial pressure
CVP (mm/Hg) = Central Venous Pressure
PCWP (mm/Hg) = Pulmonary Capillary Wedge Pressure
SVR (dynes/sec/cm)^5=Systemic vascular resistance
PA Systolic (mm/Hg) = Pulmonary Artery Pressure Systolic
PA Diastolic (mm/Hg)= Pulmonary Artery Pressure Diastolic
CO (L/min) =Cardiac output
Cardiac Index (L/min/sq. m)=Cardiac Index
Biopsy (DISPLAYS FOR HEART DONORS ONLY): Indicate whether a biopsy was
performed. If a biopsy was performed, select Yes, along with the type of result. If Yes,
Other Diagnosis Specify was selected, enter the diagnosis in the space provided. If a
biopsy was not performed, select No.
No
Yes, Myocarditis
Yes, Negative Biopsy Result
Yes, Other Diagnosis Specify
Left Kidney Biopsy: Select Yes or No to indicate if a biopsy was performed on the left
kidney.
% Glomerulosclerosis: Select the appropriate glomerulosclerosis percentage for the
left kidney.
0-5
6 - 10
11 - 15
16 - 20
20+
Indeterminate
Pump: Select Yes if a pump was used in preservation of the left kidney. If not, select No. If
Yes is selected, enter the Final Resistance Prior to Shipping in the space provided.
Transferred to transplant center on pump?: If pump was used in preservation of the
left kidney, indicate whether the organ was transferred to the transplant center on pump
by selecting Yes or No.
Right Kidney Biopsy: Select Yes or No to indicate if a biopsy was performed on the right
kidney.
Glomerulosclerosis: Select the appropriate box to indicate the glomerulosclerosis
percentage for the right kidney.
0-5
6 - 10
11 - 15
16 - 20
20+
Indeterminate
Pump: Select Yes if a pump was used in preservation of the right kidney. If not, select No.
If Yes is selected, enter the Final Resistance Prior to Shipping in the space provided.
Transferred to transplant center on pump?: If pump was used in preservation of the
right kidney, indicate whether the organ was transferred to the transplant center on
pump by selecting Yes or No.

Liver Biopsy: Select Yes or No to indicate if a biopsy was performed on the liver. If Yes is
selected, complete the following fields:
% Macro vesicular fat: Enter the percentage of macro vesicular fat in the space
provided.
Macrovesicular type - Large fat droplets balloon the liver cell, displacing the
nucleus to the periphery of the cell, like an adipocyte. Triglyceride accumulates
most commonly because it has the highest turnover rate of all hepatic fatty acid
esters. Liver uptake of FFA from adipose tissue and the diet is unrestrained,
whereas FFA disposition by oxidation, esterification, and VLDL secretion is limited.
% Micro/intermediate vesicular fat: Enter the percentage of micro/intermediate
vesicular fat in the space provided.
Microvesicular - Fatty liver, small fat droplets accumulate, cells appear foamy,
and nuclei are central. Triglycerides collect in subcellular organelles (i.e.
endoplasmic reticulum), reflecting widespread metabolic disturbance. Mitochondrial
injury limits FFA oxidation, while apoprotein synthesis necessary for VLDL
secretion is depressed, leading to triglyceride accumulation.
Other Histology (check all that apply): Indicate if a Hemosidera and/or Granulomas
was performed. If Other, specify, enter the histology in the space provided.
Left Lung and Right Lung Bronchoscopy: Indicate the results of a bronchoscopy
procedure. If the results were normal, select Bronchoscopy, Results Normal. If the
results were abnormal, select Abnormal along with the type of abnormality. If a
bronchoscopy was not performed, select No Bronchoschopy. If unknown, select
Unknown if bronchoscopy performed.
No Bronchoscopy
Bronchoscopy Results normal
Bronchoscopy Results, Abnormal-purulent secretions
Bronchoscopy Results, Abnormal-aspiration of foreign body
Bronchoscopy Results, Abnormal-blood
Bronchoscopy Results, Abnormal-anatomy/other lesion
Bronchoscopy Results, Unknown
Unknown if bronchoscopy performed
Chest X-ray: Indicate whether abnormalities were found on the chest x-ray. If the results
are normal, select Normal. If the results are abnormal, select Abnormal along with the
location where the abnormality was found. If this information was unknown, select
Unknown if chest x-ray performed. If a chest x-ray was performed and the results are
unknown, select Results unknown. If no chest x-ray was performed, select No chest xray. If lungs were not recovered, this field is not required.
No chest x-ray
Normal
Abnormal-left
Abnormal-right
Abnormal-both
Results Unknown
Unknown if chest x-ray performed
Organ Dispositions
Complete the requested information for each displayed organ type listed below. Each
donor organ reported in the Donor Feedback in DonorNet is listed.
If DCD Date and Time Organ Recovered/Removed from Donor: Enter the date
(MM/DD/YYYY format) and time (military time) of organ recovery/removal.

Organ: Verify whether any of the following codes indicates the final disposition of each organ
type.
Consent Not Requested
Consent Not Obtained
Organ Not Recovered
Recovered Not for Tx
Recovered for Tx but Not Tx
Transplanted
N/A
Recipient: The recipient name is the name displayed from the Waitlist removal record.
Verify that the recipient listed as having received this organ is correct.
SSN: The recipient's social security number reported as accepting by the transplant center
in Recipient Feedback displays. Verify that the recipient's social security number listed as
having received this organ is correct.
Tx Center: The recipient’s transplant center displays. Verify that the information is correct.
Reason Code: Enter the reason code for each donor organ in association with the
displayed disposition. If Other, specify is selected, enter the reason in the space provided.
Reason Consent Not Requested Codes
Donor age
Non-heart beating donor
History of previous cardiac surgery (valid for heart only)
History of severe cardiac disease (valid for heart only)
History of lung disease (valid for lung only)
History of gastro-intestinal disease (valid for intestine only)
History of diabetes mellitus (valid for pancreas only)
Pancreatitis (valid for pancreas only)
Acute/chronic renal failure
Donor quality
Donor ABO
Other specify
Reason Consent Not Obtained Codes
Emotional
Cultural beliefs
Religious beliefs
Family conflict
Other, specify
Reason Organ Not Recovered Codes
Poor organ function
Cardiac Arrest
Infection
Positive Hepatitis
Positive HIV
Diseased organ
Anatomical abnormalities (not valid for PA or PA segments)
Vascular damage
No recipient located
Donor medical history
Donor social history
Positive HTLV - 1
Biopsy findings

Surgical damage in OR
No local recovery team
Organ refused by all regional programs
Organ refused by all national programs
Organ refused by all programs with urgent need
Ruled out after evaluation in OR
Ruled out due to biopsy report
Ejection fraction < 50%
PO2 < 200 on O2 challenge
Hemodynamically unstable donor
Trauma to organ
Positive (+) gram stain
Time constraints
Medical Examiner restricted recovery
Replaced/aberrant RHA or CHA traversing head of PA
IPDA-SMA junction identified within 5mm from RHA junction
IPDA originating directly from RHA
Other anatomical abnormality
Converted anatomical abnormalities (206 for PA and PA segments) INACTIVE
Other, specify
Reason Recovered not for Transplant Codes
Recovered for Research
Recovered for Heart Valves
Recovered for Extra-corporeal Liver
Recovered only for purpose Hepatocytes
Recovered Pancreas for Technical Reasons (DMS-use only)
Reason Recovered for Transplant but not Transplanted Codes
Recovered for Transplant: Discarded Locally
Recovered for Transplant: Shared and Discarded
Recovered for Transplant: Submitted for Research
Recovered for Transplant: Sent for Heart Valves
Recovered for Transplant: whole PA/PI, processed for islets, not
transplanted or transplant unknown
Recovered for Transplant: Sent for Ex-corp Liver
Recovered for Transplant: Sent for Hepatocytes
Recovered for Transplant: Pancreas sent for Technical Reasons (DMS-use
only)
Exported, not transplanted or transplant unknown
Organ Disposition Codes
Organ Transplanted Locally
Organ Transplanted Shared
Islet Cells Transplanted
Exported Out of U.S., transplanted
Reason Organ not Transplanted: If the organ was not transplanted, indicate the reason
the organ was not transplanted.
Too old on pump
Too old on ice
Vascular damage
Ureteral damage
Inadequate urine output
Donor medical history
Donor social history

Positive CMV
Positive HIV
Positive Hepatitis
Warm ischemic time too long
Organ trauma
Organ not as described
Biopsy findings
Recipient determined to be unsuitable for TX in OR
Poor organ function
Infection
Diseased organ
Anatomical abnormalities
No recipient located - list exhasted
Other, specify
Recovery Team #: For each recovered organ, enter the 6-digit Medicare Provider number
of the OPO or transplant center procurement team that performed the recovery operation.
Initial Flush Solution: For each recovered organ, indicate the flush solution used during
the recovery procedure. If Other Specify is selected, indicate the flush solution used in the
space provided. If unknown, select Unknown.
Viaspan (UW/Belzer)
Eurocollins
Modified Collins
Cardioplege
Pulmoplege
Saline
Ringers
Celsior
Custodiol
Perfadex
No Flush
Unknown
Other, specify
Back Table Flush Solution: For each recovered organ, indicate the back table flush
solution used to preserve each organ. If a back flush solution was not used, select No
Flush. If Other Specify is selected, indicate the flush solution used in the space provided.
If unknown, select Unknown.
No Flush
Viaspan (UW/Belzer)
Eurocollins
Modified Collins
Cardioplege
Pulmoplege
Saline
Ringers
Celsior
Custodiol
Perfadex
Unknown
Other Specify
Final Flush/Storage Solution: For each recovered organ, indicate the final flush and
storage solution used during the recovery procedure. If Other Specify is selected, indicate
the flush solution used in the space provided. If unknown, select Unknown.

Viaspan (UW/Belzer)
Eurocollins
Modified Collins
Cardioplege
Pulmoplege
Saline
Ringers
Celsior
Custodiol
Perfadex
No Flush
Unknown
Other, specify
OPO sent vessels with organ: If vessels (vascular allografts) were sent with the organ, as
indicated on the Donor Organ Disposition in DonorNet, YES displays.
Tx center used extra vessels in the tx procedure: If extra vessels (vascular allografts)
were used in the transplant procedure, as indicated on the Waitlist Removal, YES displays.
Vessel Donor ID: The Donor ID entered on the Waitlist Removal displays.
Note: If the extra vessels used in a transplant procedure are procured from a tissue
processing organization, they are not reported in UNet..