Living Donor Registration Instructions

Living Donor Registration
Living Donor Registration (LDR) records are generated as soon as the Living Donor Feedback process
is completed by the Transplant Center. The Living Donor Registration record is completed for all living
organ donors. This includes kidney, segmental liver, heart, single lung, lung lobe, sectional pancreas,
sectional intestine and domino whole liver donors.
Complete the Living Donor Registration record at hospital discharge or six weeks post donation,
whichever is first.
Note: If the procedure was aborted, and the organ was not recovered, you are only required to
complete the Donor, Pre-Donation Clinical and Surgical Information sections below.
View 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.
PROVIDER INFORMATION
Recipient Center: The Recipient Center information reported in the Living Donor Feedback in Tiedi will
display. Verify that the displayed transplant center is the hospital where the transplant operation was
performed. The provider number printed in the record is the 6-character Medicare identification number
of the hospital.
DONOR INFORMATION
Donor Name: Verify the last name, first name and middle initial of the living donor is correct. If the
information is incorrect, corrections may be made to the Living Donor Feedback record.
UNOS Donor ID#: Each living donor is assigned a unique donor identification number at the time
OPTN/UNOS is notified a living donor transplant has occurred. For more information about Donor IDs,
see Donor ID Information.
Note: For resident alien donors, you must complete their US Address, Home City, State and Zip Code.
For non-resident alien donors, complete their Address, Home City and Home and Work Phone
number.
Address: Enter the street address where the donor lived before hospitalization for recovery of this
organ.
Home City: Enter the name of the city where the donor lived before hospitalization for recovery of this
organ. If the donor does not live in the United States, enter the city and country of residence in this
space.
State: Select the name of the State where the donor's home city is located.
Zip Code: Enter the U.S. Postal Zip Code of the location where the donor lived before hospitalization
for recovery of this organ.
Home Phone: Enter the donor's home phone number.
Work Phone: Enter the donor's work phone number if available.
Email: Enter the donor's email address if available.
SSN: Enter the donor's social security number.
Note: If a living donor does not have a social security number, contact the Organ Center for a 9FN
or 9CH number.
Date of Birth: Enter the date the donor was born using the standard 8-digit numeric format of
MM/DD/YYYY.
Gender: Select the appropriate choice to indicate if the donor is male or female.
Marital Status at time of Donation: Indicate what the donor's marital status was at the time of
donation.
Single
Married

Divorced
Separated
Life Partner
Unknown
ABO Blood Group: Select the donor's blood type. Acceptable values are: O, A, B or AB. If the
subgroup of A is known, it can be specified: A1, A2, A1B, or A2B.
Donor Type: Indicate the relationship of the living donor to the recipient.
Biological, blood related Parent - including blood related mother, blood related father
Biological, blood related Child - including blood related son, blood related daughter (NOT
adopted child, NOT step- child)
Biological, blood related Identical Twin - including blood related brothers, blood related sister
Biological, blood related Full Sibling - including blood-related sister or blood related brother with
whom you share both parents
Biological, blood related Half Sibling - including blood-related sister or blood related brother with
whom you share one parent
Biological, blood related Other Relative: Specify - including blood related aunt, uncle,
grandparent, grandchild, cousin, niece, nephew (NOT those related to you "by marriage"). Specify
in the space provided.
Non-Biological, Spouse: including husband, wife
Non-Biological, Life Partner
Non-Biological, Unrelated: Paired Donation - occurs when a person may want to donate an
organ to a relative or a friend but cannot because their blood types or tissue types do not match. If
another pair in the same predicament is found, a paired donation may be possible. (Two living
donor transplants)
Non-Biological, Unrelated: Non-Directed Donation (Anonymous) - altruistic donor, stranger,
anonymous donor, good Samaritan donor
Non-Biological, Living/Deceased Donation - occurs when a non-matching relative or friend
donates a kidney to the general waiting list pool, then the relative or friend of the living donor has
priority on the waiting list for a deceased kidney. (One living transplant; one deceased transplant)
Non-Biological, Unrelated Domino - occurs when an unrelated living donor receives a heart or
whole liver transplant, then donates their heart or liver to an unrelated heart or whole liver
candidate.
Non-Biological, Other Unrelated Directed Donation: Specify - including adopted child, adopted
parent or grandparent, any relative by adoption, friend, co-worker, in-law, god-children, godparents, relative by marriage, anyone NOT blood- related and NOT your spouse. Specify in the
space provided.
Ethnicity/Race: Select all origins that 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 Sub-Continent,
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, 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, 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.
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.
For resident alien donors, you must complete their US address, city, state and zip code. For nonresident alien donors, complete their home city address.
Highest Education Level: Select the choice which best describes the living donor's highest level of
education.
None
Grade School (0-8)
High School (9-12)
Attended College/Technical School
Associate/Bachelor Degree
Post-College Graduate Degree
N/A (< 5 Yrs Old)
Unknown
Did the donor have health insurance: If the donor had health insurance at the time of donation, select
Yes. If not, select No. If unknown, select UNK.
Functional Status: Select the choice that best describes the donor's functional status just prior to the
time of donation.
Note: The Karnofsky Index will display for adults aged 18 and older.

10% - Moribund, fatal processes progressing rapidly
20% - Very sick, hospitalization necessary: active treatment necessary
30% - Severely disabled: hospitalization is indicated, death not imminent
40% - Disabled: requires special care and assistance
50% - Requires considerable assistance and frequent medical care
60% - Requires occasional assistance but is able to care for needs
70% - Cares for self: unable to carry on normal activity or active work
80% - Normal activity with effort: some symptoms of disease
90% - Able to carry on normal activity: minor symptoms of disease
100% - Normal, no complaints, no evidence of disease
Unknown
Note: The Lansky Scale will display for pediatrics aged 1 to 17.
10% - No play; does not get out of bed
20% - Often sleeping; play entirely limited to very passive activities
30% - In bed; needs assistance even for quiet play
40% - Mostly in bed; participates in quiet activities
50% - Can dress but lies around much of day; no active play; can take part in quiet
play/activities
60% - Up and around, but minimal active play; keeps busy with quieter activities
70% - Both greater restriction of and less time spent in play activity
80% - Active, but tires more quickly
90% - Minor restrictions in physically strenuous activity
100% - Fully active, normal
Not Applicable (patient < 1 year old)
Unknown
Physical Capacity (check one): Select the choice that best describes the donor's physical capacity
just prior to the time of donation.
No Limitations
Limited Mobility
Wheelchair bound or more limited
Unknown
Physical Capacity is the ability to perform bodily activities such as walking, dressing, bathing,
grooming, etc.
Working for income? (Complete for donors 19 years of age or older.) If the donor was working for
income just prior to the time of donation, select Yes. If not, select No. If unknown, select UNK.
If Yes: If Yes is selected, indicate the donor's working status.
Working Full Time
Working Part Time due to Disability
Working Part Time due to Insurance Conflict
Working Part Time due to Inability to Find Full Time Work
Working Part Time due to Donor Choice
Working Part Time Reason Unknown
Working, Part Time vs. Full Time Unknown
If No, Not Working Due To: If No is selected, indicate the reason why the donor is not working at
the time of listing.
Disability - A physical or mental impairment that interferes with or prevents a donor from
working (e.g. arthritis, mental retardation, cerebral palsy, etc).
Insurance Conflict - Any differences between a donor and insurance company that prevents
them from working.
Inability to Find Work - The lack of one's ability to find work. (e.g. lack of transportation, work
experience, over qualification, unavailable work, etc.)
Donor Choice - Homemaker - A donor who chooses to manage their own household, instead
of performing work for pay.

Donor Choice - Student Full Time/Part Time - A donor who is enrolled and/or participating in
college.
Donor Choice - Retired - A donor who no longer has an active working life such as an
occupation, business or office job.
Donor Choice - Other - Any reason not listed above that would prevent a donor from working.
Unknown
PRE-DONATION CLINICAL INFORMATION
Pre-Donation Viral Detection:
Have any of the following viruses ever been tested for: Indicate whether the donor was tested
for HIV, CMV, HBV, HCV or EBV prior to the donation by selecting Yes or No. If Yes is selected,
indicate which viruses the donor was tested for prior to donation. If the test is unknown or cannot be
disclosed, select UNK/Cannot Disclose. If the donor was tested for a virus, indicate the RESULT
of the TEST.
Pre-Donation Height and Weight:
Height: Enter the height of the living donor prior to donation in the appropriate space, in feet and
inches or centimeters. If the living donor's height is not available, select the appropriate ST field
(N/A, Not Done, Missing, Unknown).
Weight: Enter the weight of the living donor prior to donation in the appropriate space, in pounds or
kilograms. If the living donor's weight is not available, select the appropriate status from the ST field
(N/A, Not Done, Missing, Unknown).
History of Cancer: Indicate whether the donor had a history of cancer prior to the donation. If the
donor had a history of cancer, select the type of cancer. If not, select No. If the type of cancer is not
listed, select the Other specify and enter the name of the cancer 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 had a history of cancer prior to donation, enter the number
of the years the donor was free of the cancer in the space provided.
History of Cigarette Use: If the donor has a history of cigarette use, select Yes. If not, select No. If
Yes is selected, indicate the number of pack years. Then indicate the Duration of Abstinence.
If Yes, Check # of pack years is 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.
0-10
11-20
21-30
31-40
41-50
>50
Unknown pack years
Duration of Abstinence: Select the number of months the donor has abstained from cigarettes. If
the time is unknown, select Unknown duration. If the donor has not stopped smoking, select
Continues To Smoke.
0-2 months
3-12 months
13-24 months
25-36 months
37-48 months
49-60 months
>60 months
Continues to Smoke
Unknown duration
Other Tobacco Used: Indicate whether the donor has a history of other tobacco use by selecting Yes,
No or UNK.
(KIDNEY, LUNG)
Diabetes: If the donor had diabetes prior to the donation, select Yes. If not, select No. If unknown,
select UNK. If Yes is selected, indicate whether the Treatment was Insulin, Oral Hypoglycemic
Agent or Diet.
Insulin
Oral Hypoglycemic Agent
Diet
Type 1 is defined as a disease in which the body does not produce any insulin, most often
occurring in children and young adults. People with Type 1 diabetes must take daily insulin
injections to stay alive. Type 1 diabetes accounts for 5 to 10 percent of diabetes.
Type 2 is defined as a metabolic disorder resulting from the body's inability to make enough, or
properly use, insulin. It is the most common form of the disease. Type 2 Diabetes accounts for
90 to 95 percent of diabetes.
PRE-DONATION KIDNEY CLINICAL INFORMATION
History of Hypertension: Indicate whether the donor had a history of hypertension prior to donation. If
the donor had a history of hypertension, select Yes along with the years of duration. If not, select No. If
unknown, select Unknown.
No
Yes, 0 - 5 Years
Yes, 6 - 10 Years
Yes, > 10 Years

Yes, Duration Unknown
Unknown
If yes, Method of Control: If the donor had a history of hypertension, indicate whether the method
of control was Diet, Diuretics and/or Other Hypertension Medication by selecting Yes, No or
UNK.
Serum Creatinine: Enter the lab value for the kidney donor's serum creatinine value in mg/dl taken
prior to donation. If the value is not available, select the appropriate ST field (N/A, Not Done, Missing,
Unknown).
Preoperative Blood Pressure Systolic: Enter the living donor's systolic blood pressure prior to
donation in the space provided. If the value is not available, select the appropriate status from the ST
field (N/A, Not Done, Missing, Unknown).
Preoperative Blood Pressure Diastolic: Enter the donor's diastolic blood pressure prior to donation in
the space provided. If the value is not available, select the appropriate status from the ST field (N/A,
Not Done, Missing, Unknown).
Urinalysis: Enter the donor's Protein-Creatinine Ratio or Urine Protein prior to the donation. If Urine
Protein is selected, indicate whether the test was Positive, Negative, Unknown or Not Done.
Kidney Biopsy: Indicate whether the donor had a kidney biopsy prior to donation by selecting Yes or
No. If Yes is selected, indicate the Glomerulosclerosis.
0-5
6 - 10
11 - 15
16 - 20
20+
Indeterminate
PRE-DONATION LIVER CLINICAL INFORMATION
Enter the most recent values prior to donation for the Serum Lab Data listed below. If any of the data
values are unavailable, select the appropriate status from the ST field (N/A, Not Done, Missing,
Unknown).
Total Bilirubin: Enter the lab value for total serum bilirubin in mg/dl.
SGOT/AST: Enter the lab value for the serum glutamic oxaloacetic transaminase or aspartate
transaminase in U/L.
SGPT/ALT: Enter the lab value for the Serum Glutamic Pyruvic Transaminase/Alanine
Aminotransferase in U/L.
Alkaline Phosphatase: Enter the lab value for the serum alkaline phosphatase value in units/L.
Serum Albumin: Enter the lab value for the serum albumin value in g/dl.
Serum Creatinine: Enter the lab value for the serum creatinine value in mg/dl.
INR: International Normalized Ratio. Enter the ratio of the prothrombin time (in seconds) to the
control prothrombin time (in seconds).
Liver Biopsy: Indicate whether the donor had a liver biopsy prior to donation by selecting Yes or
No. If Yes, Specify Results is selected, enter the results in the space provided.
% Macro vesicular fat: Enter the percentage of macro vesicular fat in the space provided. If
the value is not available, select the appropriate status from the ST field (N/A, Not Done,
Missing, Unknown).
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. If the value is not available, select the appropriate status from the ST
field (N/A, Not Done, Missing, Unknown).
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.
PRE-DONATION LUNG CLINICAL INFORMATION
FVC% predicted (Before and After Bronchodilators): Enter the donor's FVC% predicted values
before and after bronchodilators. If the value is not available, select the appropriate status from the ST
field (N/A, Not Done, Missing, Unknown).
FEV 1% predicted (Before and After Bronchodilators): Enter the donor's FEV 1% predicted values
before and after bronchodilators. If the value is not available, select the appropriate status from the ST
field (N/A, Not Done, Missing, Unknown).
FEF (25-75%)% predicted (Before and After Bronchodilators): Enter the donor's FEF (25-75%)%
predicted before and after bronchodilators. If the value is not available, select the appropriate status
from the ST field (N/A, Not Done, Missing, Unknown).
TLC % predicted (Before and After Bronchodilators): Enter the donor's TLC% predicted before and
after bronchodilators. If the value is not available, select the appropriate status from the ST field (N/A,
Not Done, Missing, Unknown).
Diffusing lung capacity corrected for alveolar volume % predicted: Enter the appropriate value in
the space provided. If the value is not available, select the appropriate status from the ST field (N/A,
Not Done, Missing, Unknown).
Pa02 on room air: Enter the value for Pa02 on room air for the donor in mm/Hg. If the value is not
available, select the appropriate status from the ST field (N/A, Not Done, Missing, Unknown).
LIVER SURGICAL INFORMATION
This section will only display if a liver was recovered from the donor.
Type of Transplant Graft: Indicate whether the type of transplant graft was Left Lateral Segment
(Peds), Left Lobe, Right Lobe or Domino Whole Liver.
KIDNEY SURGICAL INFORMATION
This section will only display if a kidney was recovered from the donor.
Type of Transplant Graft: The type of transplant will display from the Living Donor Feedback.
Intended Procedure Type: Indicate whether the procedure type was Transabdominal, Flank,
Laparoscopic Hand-assisted or Laparoscopic Not Hand-assisted. If Laparoscopic is selected,
then Conversion from Laparoscopic to Open must be completed.
Transabdominal
Flank (retroperitoneal)
Laparoscopic Not Hand-assisted
Laparoscopic Hand-assisted
Conversion from Laparoscopic to Open: If Laparoscopic was selected for Intended Procedure
Type, indicate whether there was a conversion from laparoscopic to open procedure by selecting
Yes or No.
LUNG SURGICAL INFORMATION
This section will only display if a lung was recovered from the donor.
Type of Transplant Graft: The type of transplant will display from the Living Donor Feedback.
Procedure Type: Indicate whether the procedure type was Open or Video Assisted Thoracoscopic.
If Open is selected, then Conversion from Thoracoscopic to Open must be completed.

Conversion from Thoracoscopic to Open: If Open was selected for Procedure Type, indicate
whether there was a conversion from thoracoscopic to an open procedure by selecting Yes or No.
Intra-operative Complications: Select Yes if there were any intra-operative complications. If not,
select No. If Yes, specify:
Sacrifice of Second Lobe: If a second lobe was sacrificed, indicate RML, RUL, LUL or Lingular.
Anesthetic Complication Specify: If anesthetic complication occurred, specify in the space
provided.
Arrhythmia requiring therapy: If there was arrhythmia requiring therapy, indicated if the Therapy
was Medical therapy or Cardioversion.
Cerebrovasular accident
Phrenic nerve injury
Brachial plexus injury
Breast implant rupture
Other specify: Specify any other complications in the space provided.
POST-OPERATIVE INFORMATION
This section will display for all organ types.
Date of Initial Discharge: Enter the date the donor was initially released to go home. The donor's
hospital stay includes total time spent in different units of the hospital, including medical and rehab.
Donor Status: Indicate if the living donor is Alive or Dead.
Date Last Seen or Death: Enter the date the living donor was last seen. If the living donor died, enter
the date of death.
Cause of Death: If the living donor died, indicate the cause of death. If the cause of death is not listed,
select Other Specify and enter the cause of death in the space provided.
Other Cause
Infection: Donation/Surgery Related
Infection: Not Donation/Surgery Related
Pulmonary Embolism
Malignancy
Domino Liver Donor-Transplant Related Death (Liver donors only)
Cardiovascular
CVA
Hemorrhage: Donation/Surgery Related
Hemorrhage: Not Donation/Surgery Related
Homicide
Suicide
Accidental
Other, specify
Donation Related
Non-Autologous Blood Administration: Select Yes if non-autologous blood was administered to the
donor. If not, select No.
If Yes, Number of Units: If non-autologous blood was administered to the donor, indicate the
number of units of PRBC, Platelets and FFP the donor received.
KIDNEY RELATED POST-OPERATIVE COMPLICATIONS (IN FIRST 6 WEEKS POST-DONATION)
This section will only display if a kidney was recovered from the donor.
Vascular Complications Requiring Intervention: If the donor experienced vascular complications
requiring intervention during the first 6 weeks after the donation, select Yes. If not, select No. If Yes is
selected, indicate the type of vascular complications that required intervention from the list provided. If
Other Specify is selected, enter the name of the vascular complication in the space provided. If
unknown, select UNK.
Renal Vein
Renal Artery

Aorta
Vena Cava
Pulmonary Embolus
Deep Vein Thrombosis
Other, specify
Other Complications Requiring Intervention: If the donor experienced other complications requiring
intervention during the first 6 weeks after the donation, select Yes. If not, select No. If Yes is selected,
indicate the other type of complication that required intervention from the list provided. If Other Specify
is selected, enter the name of the other complication in the space provided. If unknown, select UNK.
Renal insufficiency requiring dialysis
Ascites
Line or IV complication
Pneumothorax
Pneumonia
Wound Complication
Brachial Nerve Injury
Other, specify
Reoperation: If the donor required reoperation the first 6 weeks after the donation, select Yes. If not,
select No. If Yes, Specify is selected, check all the applicable type(s) of operations and enter the Date
for each. If Other specify is selected, enter the name in the space provided, along with the Date. If
unknown, select UNK.
Any Readmission After Initial Discharge: If the donor required any readmission after the initial
discharge during the first 6 weeks after the donation, select Yes. If not, select No. If the donor was
readmitted after initial discharge, check all the applicable reasons from the list provided. If Yes, Specify
the Date of first readmission. If Other specify is selected, enter the name in the space provided. If
unknown, select UNK.
Wound infection
Fever
Bowel Obstruction
Pleural Effusion
Vascular Complications
Other, specify
Other Interventional Procedures: If the donor required other interventional procedures during the first
6 weeks after the donation, select Yes. If not, select No. If Yes is selected, specify the type of
procedure that was required in the space provided, along with the Date of Procedure. If unknown,
select UNK.
LIVER RELATED POST-OPERATIVE COMPLICATIONS (IN FIRST 6 WEEKS POST-DONATION
This section will only display if a liver was recovered from the donor.
Biliary Complications: If the donor experienced biliary complications during the first 6 weeks after
donation, select Yes. If not, select No. If Yes is selected, specify whether the biliary complication was a
Grade 1, Grade 2 or Grade 3. If unknown, select UNK.
Grade 1 - Bilious JP drainage more than 10 days
Grade 2 - Interventional procedure (ERCP, PTC, percutaneous drainage, etc.)
Grade 3 - Surgical intervention
Date of Surgery: If Grade 3 - Surgical Intervention was selected, enter the date of surgery.
Vascular Complications Requiring Intervention: If the donor experienced vascular complications
requiring intervention during the first 6 weeks after the donation, select Yes. If not, select No. If Yes is
selected, indicate the type of vascular complications that required intervention from the list provided. If
Other Specify is selected, enter the name of the vascular complication in the space provided. If
unknown, select UNK.
Portal Vein
Hepatic Vein

Hepatic Artery
Pulmonary Embolus
Deep Vein Thrombosis
Other, specify
Other Complications Requiring Intervention: If the donor experienced other complications requiring
intervention during the first 6 weeks after the donation, select Yes. If not, select No. If Yes is selected,
indicate the other type of complication that required intervention from the list provided. If Other Specify
is selected, enter the name of the other complication in the space provided. If unknown, select UNK.
Renal insufficiency requiring dialysis
Ascites
Line or IV complication
Pneumothorax
Pneumonia
Wound Complication
Brachial Nerve Injury
Other, specify
Reoperation: If the donor required reoperation the first 6 weeks after the donation, select Yes. If not,
select No. If Yes, Specify is selected, check the applicable reason(s) for the operation and enter the
Date for each. If Other specify is selected, enter the name in the space provided, along with the Date.
If unknown, select UNK.
Any Readmission After Initial Discharge: If the donor required any readmission after the initial
discharge during the first 6 weeks after the donation, select Yes. If not, select No. If the donor was
readmitted after initial discharge, check all the applicable reasons from the list provided. If Yes, Specify
the Date of first readmission. If Other specify is selected, enter the name in the space provided. If
unknown, select UNK.
Wound infection
Fever
Bowel Obstruction
Pleural Effusion
Biliary Complications
Vascular Complications
Other, specify
Other Interventional Procedures: If the donor required other interventional procedures during the first
6 weeks after the donation, select Yes. If not, select No. If Yes is selected, specify the type of
procedure that was required in the space provided, along with the Date of Procedure. If unknown,
select UNK.
LUNG RELATED POST-OPERATIVE COMPLICATIONS (IN FIRST 6 WEEKS POST-DONATION)
This section will only display if a lung was recovered from the donor.
Post-operative complications during the initial hospitalization: If the donor experienced any postoperative complications during the initial hospitalization, select Yes. If not, select No. If Yes is selected,
specify the type of post-operative complications the donor experienced. If Arryhthmia requiring
therapy or placement of additional Thoracostomy Tubes is checked, then specify the therapy.
Arrhythmia requiring therapy
Bleeding requiring surgical or therapeutic bronchoscopic intervention
Bowel obstruction or ileus not requiring surgical intervention
Bowel obstruction or ileus requiring surgical intervention
Bronchial Stenosis/Stricture not requiring surgical or therapeutic bronchoscopic
intervention
Bronchial Stenosis/Stricture requiring surgical or therapeutic bronchoscopic intervention
Bronchopleural Fistula requiring surgical or therapeutic bronchoscopic intervention
Cerebrovascular Accident
Deep Vein Thrombosis
Empyema requiring therapeutic surgical intervention
Epidural-Related Complication
Line or IV Complication

Loculated pleural effusion requiring surgical intervention
Pericardial tamponade or pericarditis requiring surgical intervention
Pericarditis not requiring surgical intervention
Peripheral Nerve Injury
Phrenic Nerve Injury
Placement of Additional Thoracostomy Tube(s), Specify Indication
Pneumonia/Atelectasis
Prolonged (>14days) Thoracostomy Tube Requirement
Pulmonary Artery Embolus or Thrombosis
Pulmonary Vein or Left Atrial Thrombosis
Wound Complication
Wound infection requiring surgical intervention
Other Specify
Arrhythmia requiring therapy- Indicate whether the donor received Medical therapy,
Cardioversion or Electrophysiologic Ablation.
Placement of Additional Thoracostomy Tubes, specify indication- Select whether the
placement of additional thoracostomy tubes was Pneumothorax, Pleural effusion or Empyema. If
Other specify is selected, then specify the therapy in the space provided.
Any readmission After Initial Discharge: If the donor required any readmission after the initial
discharge during the first 6 weeks after the donation, select Yes. If not, select No. If yes, enter the Date
of first readmission. If unknown, select UNK.
Wound infection
Fever
Bowel Obstruction
Pleural Effusion
Vascular Complications
Other, specify
POST-OPERATIVE CLINICAL INFORMATION (WITHIN 6 WEEKS POST-DONATION)
(ALL ORGAN TYPES) The following question will display for all donated organs:
Most Recent Date of Tests: Enter the date of the donor's most recent tests in the space provided
within the 6 weeks after donation.
(KIDNEY) The questions listed below will display for donated kidney organs only.
Serum Creatinine: Enter the lab value for the kidney donor's serum creatinine value in mg/dl taken
within 6 weeks after donation. If the value is not available, select the appropriate ST field (N/A, Not
Done, Missing, Unknown).
Post-Op Blood Pressure Systolic: Enter the donor's systolic blood pressure within 6 weeks after the
donation in the space provided. If the value is not available, select the appropriate status from the ST
field (N/A, Not Done, Missing, Unknown).
Post-Op Blood Pressure Diastolic: Enter the donor's diastolic blood pressure within 6 weeks after the
donation in the space provided. If the value is not available, select the appropriate status from the ST
field (N/A, Not Done, Missing, Unknown).
Urinalysis: Enter the donor's Protein-Creatinine Ratio or Urine Protein within the 6 weeks after the
donation. If Urine Protein is selected, indicate whether the test was Positive, Negative, Unknown or
Not Done.
Donor Developed Hypertension Requiring Medication: If the donor developed hypertension within 6
weeks after donation that required medication, select Yes. If not, select No. If unknown, select UNK.
(LIVER) The following questions will display for donated liver organs only:
Most Recent Date of Tests: Enter the date of the donor's most recent tests in the space provided
within the 6 weeks after donation.
Total Bilirubin: Enter the lab value for total serum bilirubin in mg/dl.

SGOT/AST: Enter the lab value for the serum glutamic oxaloacetic transaminase or aspartate
transaminase in U/L.
SGPT/ALT: Enter the lab value for Serum Glutamic Pyruvic Transaminase/Alanine
Aminotransferase in U/L.
Alkaline Phosphatase: Enter the lab value for the serum alkaline phosphatase value in units/L.
Serum Albumin: Enter the lab value for the serum albumin value in g/dl.
Serum Creatinine: Enter the lab value for the serum creatinine value in mg/dl.
INR: International Normalized Ratio. Enter the ratio of the prothrombin time (in seconds) to the
control prothrombin time (in seconds).
(ALL ORGAN TYPES) The following questions will display for all donated organs:
Height: Enter the height of the donor within 6 weeks after donation in the appropriate space, in feet and
inches or centimeters. If the donor's height is not available, select the appropriate ST field (N/A, Not
Done, Missing, Unknown).
Weight: Enter the weight of the donor within 6 weeks after the donation in the appropriate space, in
pounds or kilograms. If the donor's weight is not available, select the appropriate status from the ST
field (N/A, Not Done, Missing, Unknown).
ORGAN RECOVERY
Organ Recovery Date: The date of the donor's recovered organ reported in the Living Donor Feedback
will display. Verify that the displayed date is the date the organ(s) was recovered from this donor. If the
date is blank or incorrect, use the standard 8-digit numeric format of MM/DD/YYYY to enter the correct
date. If the operation was started in the evening and concluded the next day, enter the date the
operation beg`an.
Did organ recovery and transplant occur at the same center?: If the organ recovery and transplant
occurred at the same center, select Yes. If not, select No.
Organ(s) Recovered: The donor's organ(s) reported as being recovered in the Living Donor Feedback
will display. Verify the organ(s) displayed in the record are the organs recovered from this donor. Verify
that the correct organ modifier (right or left) is displayed in the record.
Right Kidney
Left Kidney
Double/En-bloc Kidney
Pancreas
Pancreas Segment 1
Pancreas Segment 2
Liver
Liver Segment 1
Liver Segment 2
Intestine
Intestine Segment 1
Intestine Segment 2
Heart
Right Lung
Left Lung
Double/En-bloc Lung
Recipient Name (Last, First): The recipient's name reported in the Recipient and Living Donor
Feedback will display. Verify that the displayed name is the name of the recipient who received this
organ.
Recipient SSN#: The recipient's social security number reported in the Recipient and Living Donor
Feedback will display. Verify the social security number of the recipient.
Donor Recovery Facility: This will default with the same center as Donor Workup Facility, but can be
changed if the organ was recovered at a different center. The drop-down list contains the names of all
national Transplant Centers.

Business
Contractor
Consortia Group
Donor Hospital
Foreign OPO
Foreign Lab
Foreign Hospital
Individual
Government
Health/Pharm/Ins
Hospital Based OPO
Hospital Based Lab
Local Coalition Affiliate
Additional Non Member
Additional Non Member
Additional Non Member
Additional Non Member
Additional Non Member
Additional Non Member
Additional Non Member
Additional Non Member
Additional Non Member
Non Member
Media
Independent OPO
Public Organization
General Public
Public Organization
Independent Lab
Transplant Center
UNOS Staff
Veteran's Hospital
Donor Workup Facility: This is the name of the center that entered the Living Donor information into
UNetSM. This cannot be modified.