Death Referral Instructions

Entering Donation Data (Referral Data)
All Medicare and Medicaid hospitals and all Medicare Critical Access Hospitals (CAHs) in an
OPO's service area must be included in the list of donor hospitals maintained in UNetSM.
Medicare and Medicaid hospitals and CAHs are required by Conditions of Participation (CoP)
regulations to report all deaths. The UNet donor hospital list should include all hospitals, such
as acute care hospitals, psychiatric hospitals, and rehabilitation hospitals located within the
OPO service area. Skilled-nursing facilities and nursing facilities are not required to report all
deaths and should not be included in the list.
Note: A Critical Access Hospital (CAH) is designated as such by the state in which it is
located and must be part of that state's rural health network. Because Medicare
reimbursement for CAHs differs from Medicare reimbursement for other Medicare
hospitals, Medicare places limitations on CAHs in regard to number of acute care beds,
patient length of stay, and location. Although CAHs are hospitals, they are a different
provider type under Medicare law.
In order to assess the impact of the Medicare and Medicaid Hospital Conditions of
Participation for Organ, Tissue and Eye Donation on hospital organ donation practices, OPOs
are required to provide donor hospital-specific data on donor death notifications and organ
recoveries. This reporting began in September 2001 for death notifications made to your
organization during the month of August 2001 and this data has been gathered for every
month thereafter.
Recording donation data for every hospital in your OPO service area, even if there were no
donations for that month, allows the hospital to be accurately accounted for in the data that is
used to evaluate Medicare and Medicaid Hospital Conditions of Participation.
On the first day of each month, a new report will be provided for the OPO to record donor
death notifications for the preceding month. (See OPTN/UNOS Policy 7.7 (Death
Notification Information) for clarification.) The data is due within 30 days or before the next
month's report generates.
To enter the donation data:
1. Select Donation (Referral) Data Report from the Reports drop-down menu.
2. The Monthly Donation Data Report page displays for your center.

3. Click the applicable Month to display the Monthly Donation Data Report - Add Donor
Hospital Information page for that month.

4. A monthly report displays at the top of the page, listing the number of death
notifications, eligible donors and consented eligibles that have been reported to date
by your OPO and by all OPOs. The number of OPOs that have reported their
Donation Data for this month will also display. The list of donor hospitals that appear
in this section should include ALL hospitals in your OPO's service area, regardless of
the number of death notifications you receive from the hospital each month. The list is
sorted by donor hospital provider number, but can be re-sorted by hospital name by
clicking on the red triangle.
Note: Trauma Level I and II designations are entered in the Donor Hospitals section.
These designations are given to hospitals by the American College of Surgeons
(ACS) in order to set standards with trauma care, and to evaluate and monitor their
care. For more information, visit the ACS website at
http://www.facs.org/trauma/verificationhosp.html. If the Trauma Level indicated is
incorrect, you may edit it by following the steps in Editing a Donor Hospital.
5. You must enter the number of Death Notices, Eligible Deaths donors and Consented
Eligibles obtained during the month. The number of organs Recovered/Transplanted
will automatically display in this column. The field descriptions are listed at the end
of this document.
If there were no donor death notices from a listed donor hospital during the month,
enter a zero in the Death Notification field. The Eligible Deaths and Consented
Eligibles fields for the donor hospital will then default to zero as you move to the next
field.
Note: If a donor hospital is no longer in your service area, you may inactivate the
donor hospital so it will not show up in future lists by following the instructions for
Inactivating a Donor Hospital. Hospitals that are inactivated within a particular
month will still display on that month's report. This allows any death notices to be
reported for the time that the hospital was noted as Active in UNet.
Note: If you received a death notice from a donor hospital that is not on your list, you

may add the donor hospital to the monthly report, by clicking on the Add hospital to
report link in the Related Links box. See Adding a Donor Hospital to the OPO List
for details.
6. After entering the data in the fields, click on Save. A message displays indicating that
the data was successfully updated.
7. When all the data has been entered, click on Complete. A message displays asking
you to indicate if the report is complete.
8. To return the report to make changes, click on Cancel. To proceed, click on OK. A
message displays indicating that the data was marked as complete.

Field Descriptions
Death Notice: All deaths or imminent deaths (ventilated and non-ventilated) reported by a
hospital to the OPO, tissue or eye bank located within the OPO service area.
Eligible Deaths: An eligible death for organ donation is defined as the death of a patient 70
years old or younger who ultimately is legally declared brain dead according to hospital policy
independent of family decision regarding donation or availability of next-of-kin, independent of
medical examiner or coroner involvement in the case, and independent of local acceptance
criteria or transplant center practice, who exhibits none of the following:
Active infections (specific diagnoses) [Exclusions to the Definition of Eligible]
Bacterial:

 Tuberculosis
 Gangrenous bowel or perforated bowel and/or intra-abdominal sepsis
 See "sepsis" below under “General”
Viral:

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HIV infection by serologic or molecular detection
Rabies
Reactive Hepatitis B Surface Antigen
Retroviral infections including HTLV I/II
Viral Encephalitis or Meningitis
Active Herpes simplex, varicella zoster, or cytomegalovirus viremia or
pneumonia
Acute Epstein Barr Virus (mononucleosis)
West Nile Virus infection
SARS

Fungal:
 Active infection with Cryptococcus, Aspergillus, Histoplasma, Coccidioides
 Active candidemia or invasive yeast infection
Parasites:
 Active infection with Trypanosoma cruzi (Chagas'), Leishmania, Strongyloides, or
Malaria (Plasmodium sp.)
Prion:
 Creutzfeldt-Jacob Disease
General [Exclusions to the Definition of Eligible]:

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Aplastic Anemia
Agranulocytosis
Extreme Immaturity (<500 grams or gestational age of <32 weeks)
Current malignant neoplasms except non-melanoma skin cancers such as basal cell
and squamous cell cancer and primary CNS tumors without evident metastatic
disease
Previous malignant neoplasms with current evident metastatic disease
A history of melanoma
Hematologic malignancies: Leukemia, Hodgkin's Disease, Lymphoma, Multiple
Myeloma
Multi-system organ failure (MSOF) due to overwhelming sepsis or MSOF without sepsis
defined as 3 or more systems in simultaneous failure for a period of 24 hours or more
without response to treatment or resuscitation
Active Fungal, Parasitic, viral, or Bacterial Meningitis or encephalitis

Consented Eligibles: The number of consents that were obtained on death notifications
meeting organ donor eligibility requirements.
Donor: The number of donors with organs that were reported as recovered or transplanted
from the specified donor hospital. This information is obtained from completed Donor Organ
Disposition (Feedback).
Recovered/Transplanted: The number of organs that were reported as recovered and
transplanted from the specified donor hospital. This information is obtained from the donor
record and Donor Organ Disposition (Feedback).