OPTN- Deceased Donor Registration Worksheet

Deceased Donor Registration (DDR) Record Field
Descriptions
Deceased Donor Registration (DDR) records are generated and available as soon as the donor organ
disposition 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.
The DDR record must be completed within 30 days from the record generation date. See
OPTN/UNOS Policies for additional information. Use the search feature to locate specific policy
information on Data Submission Requirements.
To correct information that is already displayed in an electronic record, call the UNOS Help Desk at 1800-978-4334.
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 8-digit
numeric format of MM/DD/YYYY. This field is required.
Recovered Outside the U.S.: If the organs were recovered outside of the United States, select Yes.
If the organs were not recovered outside of the United States, select No. This field is required.
If Yes is selected, select the name of the Country, from the drop-down list, 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. This field is required.
First Name: Enter the first name of the donor who was referred to your OPO as a potential organ
donor. This field is required.
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. (List of Age Unit codes)
Gender: Indicate if the donor is Male or Female. This field is required.
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. This field is required.

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 located further below.
State: If the donor lived in the United States before hospitalization, select the state from the drop-down
list where the donor's home city was located. (List of State codes)
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. This field is required.
(List of Ethnicity/Race Codes)
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, 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 the donor's citizenship from the drop-down list. This field is required. (List of
Citizenship codes)
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/Specify Country: If the donor is a Non-Resident Alien (Nonimmigrant), select
the Home Country from the drop-down list. 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 nonimmigrants 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.greencardus.org/images/greencard.gif.
Cause of Death: Select the donor's cause of death from the drop-down list. This field is required. If the
cause of death is not listed, select Other Specify, and enter the cause of death in the Specify field. If
Other Specify is selected, this field is required. (List of Cause of Death codes)
Anoxia
Cerebrovascular/Stroke
Head Trauma
CNS Tumor
Other Specify
Mechanism of Death: Select the donor's mechanism of death from the drop-down list. If the
mechanism of death is not listed, select None of the Above. This field is required. (List of Mechanism
of Death codes)
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: Select the donor's circumstances of death from the drop-down list. If the
circumstance of death is not listed, select None of the Above. This field is required. (List of
Circumstances of Death codes)
MVA
Suicide
Homicide
Child-Abuse
Non-MVA
Death from Natural Causes
None of the Above
Unknown
Procurement and Consent
Medical Examiner/Coroner: If the donor's death was reported to the medical examiner/coroner, select
Yes, Medical Examiner Consented or Yes, Medical Examiner Refused Consent from the drop-

down list. If the donor's death was not reported to the medical examiner/coroner, select No. If unknown,
select Unknown. This field is required. (List of Medical Examiner codes)
No
Yes, Medical Examiner Consented
Yes, Medical Examiner Refused Consent
Unknown
Did the patient have written documentation of their intent to be a donor: If the patient had written
documentation of their intent to be a donor, select Yes. If not, select No. If unknown, select Unk. This
field is required.
If yes, indicate mechanisms (check all that apply): Select the type of documentation used for
consent. This field is required if Yes is selected for written documentation. If the mechanism is
not listed, select Other Specify, and enter the mechanism in the Specify field. If Other Specify
is selected, this field is required.
Driver's license
Donor Card
Donor Registry
Durable Power of Attorney/Healthcare Proxy
Other Specify
Was the consent based solely on this documentation: If consent was based solely on
this documentation, select Yes. If not, select No. If Yes is selected for written
documentation, this field is required.
Did the patient express to family or others the intent to be a donor: If the patient expressed their
intent to be a donor to their family or others, select Yes. If not, select No. If unknown, select Unk. This
field is required.
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 military time of pronouncement of
death of the donor. This field is required.
Date and time consent obtained for first organ: Enter the date, using the standard 8-digit numeric
format of MM/DD/YYYY, and military time consent was obtained for first organ. This field is required.
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. (List of ABO Blood Type codes)
Height: Enter the height of the donor at the time of recovery in the appropriate space, in ft (feet) and
in (inches) or cm (centimeters). This field is required.
If the donor's height at the time of recovery is unavailable, select the reason from the status (ST)
drop-down list (N/A, Not Done, Missing, Unknown). (List of Status codes)
Weight: Enter the weight of the donor at the time of recovery in the appropriate space in lbs (pounds)
or kg (kilograms). This field is required.
If the donor's weight at the time of recovery is unavailable, select the reason from the status (ST)
drop-down list (N/A, Not Done, Missing, Unknown). (List of Status codes)
Terminal Lab Data: For each of the laboratory tests enter the value, in the units indicated, from tests
performed closest to the time of recovery. These fields are required. If a lab value is unavailable, select
the reason from the status (ST) drop-down list (N/A, Not Done, Missing, Unknown). (List of Status
codes)
Serum Creatinine (mg/dl)
BUN (mg/dl)
Total Bilirubin (mg/dl)

SGOT/AST (u/L)
SGPT/ALT (u/L)
Protein in Urine (Yes, No, UNK)
Last Serum Sodium Prior to Procurement (mEq/L)
INR
Blood pH
Hematocrit (%)
Pancreas (PA Donors Only): These fields are required for pancreas donors.
Serum Lipase (u/L)
Serum Amylase (u/L)
Serology: For each of the tests listed, select the results from the drop-down lists (Cannot Disclose,
Indeterminate, Negative, Not Done, Positive, or Unknown). These fields are required. (List of
Serology Results codes)
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), and EBNA) serologies, a titer
level of <1:10 is considered Negative.
Donor Management: (Any medication administered within 24 hours prior to crossclamp.) If any of
the listed medications were given to the donor within 24 hours prior to crossclamp, select Yes. If not,
select No. If unknown, select Unk. If one to three medications are not listed, enter the name of the
medication in the Other/Specify field. You may enter up to 3 medications. If a medication falls under
more than one category (antihypertensives and vasodilators) select Yes for both categories. These
fields are required, except for Other/Specify.
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
Other/Specify
Other/Specify
Inotropic Medication at Time of Cross Clamp: If any inotropic agents were administered at the time
of cross clamp, select Yes. If not, select No. If unknown, select Unk. This field is required.
If Yes is selected, complete the following:
Medication: Select the medication from the drop-down list. If Yes is selected for Inotropic
Medications at Time of Cross Clamp, this field is required. If the medication is not listed,
select Other, specify. Enter the medication in the Specify field. If Other, specify is
selected, this field is required. (List of Inotropic Medication codes)
Dopamine
Dobutamine
Epinephrine
Levophed
Neosynephrine
Isoproterenol (Isuprel)
Other, specify
Dosage at Time of Cross Clamp: Enter the dosage in the space provided. If Yes is selected
for Inotropic Medications at Time of Cross Clamp, this field is required.
Dosage Units: Select the units from the drop-down list. If Yes is selected for Inotropic
Medications at Time of Cross Clamp, this field is required. (List of Dosage Unit codes)
mcg/kg/min
mcg/min
mg/min
units/hr
mcg/hr
Final Dosage Duration: Enter the duration in hours. If Yes is selected for Inotropic
Medications at Time of Cross Clamp, this field is required.
Note: The dosage at the time of recovery for Dopamine, Dobutamine, and Levophed must
fall between .05 and 40. For Epinephrine the dosage range must fall between .01 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.
Number of transfusions during this (terminal) hospitalization: Select the number of units, from
the drop-down list, for packed red cells or whole blood transfused prior to organ recovery for this
hospitalization. If the number of transfusions is not known or it is not known if the donor received a
transfusion, select Unknown. This field is required. (List of Transfusion codes)

None
1-5
6 - 10
Greater than 10
Unknown
Three or more inotropic agents at time of incision: If the donor received three or more inotropic
agents at the time of incision, select Yes. If not, select No. This field is required.
Clinical Infection: If there is documented evidence of any clinical infection during this hospitalization
for the donor, select Yes. 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. This
field is required.
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, specify. If Yes is selected for
Clinical Infection, these fields are required. If Other specify is selected, enter the source in the
space provided. If Other specify is selected, this field is required.
For each source selected, if the infection was confirmed by culture, select Yes. If the infection
was not confirmed by culture, select No. For each Source selected, this field is required.
Life Style Factors
Cigarette Use (>20 pack years) - Ever: If the donor has ever used cigarettes for more than 20 pack
years, select Yes. If the donor has never used cigarettes or the usage is less than 20 pack years,
select No. If cigarette usage is unknown, select Unk. This field is required.
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 six months: If the donor used cigarettes for more than 20 pack years
and has continued usage within the last 6 months, select Yes. If the donor has not used
cigarettes within the last 6 months, select No. If cigarette usage in the last 6 months is
unknown, select Unk. If Yes is selected for Cigarette Use, this field is required.
Cocaine Use - Ever: If the donor has ever abused or had a dependency to cocaine, select Yes. If not,
select No. If cocaine use is unknown, select Unk. This field is required.
AND continued in last six months: If the donor abused or had a dependency to cocaine within
the last 6 months, select Yes. If not, select No. If cocaine use in the last 6 months is unknown,
select Unk. If Yes is selected for Cocaine Use, this field is required.
Other Drug Use (non-IV) - Ever: 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, select
Yes. If not, select No. If drug use is unknown, select Unk. This field is required.
AND continued in last 6 months: 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, select Yes. If not, select No. If drug use is unknown, select Unk. If Yes selected
for Other Drug Use, this field is required.
Heavy Alcohol Use (heavy = 2+ drinks/day): If the donor has a history of having two or more
alcoholic drinks per day, select Yes. If not, select No. If alcohol use is unknown, select Unk. This field is
required.
Tattoos: If the donor has any tattoos, select Yes. If not, select No. If unknown, select Unk. This field is
required.

Does the Donor meet CDC guidelines for "High Risk" for an organ donor: If the donor meets CDC
guidelines for "High Risk" for an organ donor, select Yes. If not, select No. If unknown, select Unk. This
field is required.
Note: Refer to the Centers for Disease Control (CDC) for the definition of "High Risk" behavior.
History of Diabetes: If the donor has a documented history of diabetes mellitus prior to this
hospitalization, select Yes and the number of years from the drop-down list. If the duration is unknown,
select Yes, Duration Unknown. If the donor does not have a history of diabetes, select No. If the
donor’s history is unknown, select Unknown. This field is required. (List of Diabetes History Duration
codes)
No
Yes, 0-5 Years
Yes, 6-10 Years
Yes, > 10 Years
Yes, Duration Unknown
Unknown
Insulin Dependent: If the donor has a history of diabetes and is insulin dependent, select Yes
and the number of years from the drop-down list. If the duration is unknown, select Yes,
Duration Unknown. If the donor is not insulin dependent, select No. If the donor’s insulin history
is unknown, select Unknown. If Yes is selected for History of Diabetes, this field is required.
(List of Insulin Dependent Duration codes)
No
Yes, 0-5 Years
Yes, 6-10 Years
Yes, > 10 Years
Yes, Duration Unknown
Unknown
History of Hypertension: If the donor has a documented history of hypertension prior to this
hospitalization, select Yes and the number of years from the drop-down list. If the duration is
unknown, select Yes, Unknown Duration. If the donor’s hypertension history is unknown, select
Unknown. This field is required. (List of Hypertension History Duration codes)
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 (unknown) for each method of hypertension
control listed. If Yes is selected for History of Hypertension, these fields are required.
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 drop-down list. If the donor has no documented
history of any type of cancer prior to this hospitalization, select No from the drop-down list. If the
donor’s cancer history is unknown, select Unknown. This field is required. If the primary cancer site
is not listed, select Other, Specify. Enter the cancer site in the Specify field. If Other, Specify is
selected, this field is required. (List of Cancer Location codes)
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 bronchial)
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 data is unavailable, select the reason from the status
(ST) drop-down list (N/A, Not Done, Missing, Unknown). This field is required. (List of Status
codes)
Cancer at time of procurement: If the donor exhibited documented clinical signs of cancer at the
time of recovery, select Yes for each of the categories listed. 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. These fields are required.
Intracranial
Extracranial
Skin
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. This field is required.
Was this a DCD donor: If this donor was a DCD (Donation after Cardiac Death) donor, select Yes. If
this donor was not a DCD donor, select No. This field is required.
If Yes, Controlled: If this was a DCD donor and the DCD donor was controlled, select Yes. If the
DCD donor was not controlled, select No. If unknown, select Unk. If Yes is selected for DCD
donor, this field is required.

A controlled DCD donor is a donor whose life sustaining treatment will be withdrawn and
whose family gave written consent for organ donation in the controlled environment. A
controlled DCD donor will be defined by the Maastricht classification III [awaiting cardiac
arrest; patient on intensive care unit with non-survivable injuries who have withdrawal of life
sustaining treatment.]
An uncontrolled DCD donor can be a patient who is declared dead and catheters may be
placed in the vessels and/or peritoneum to cool the organs until consent/authorization can
be obtained; a patient who suffers a cardiac arrest requiring CPR for rapid procurement of
the organs. As with all donors, an uncontrolled DCD donor is only a donor if at least one
organ is recovered for the purpose of transplantation.
If Yes, Date and time of withdrawal of support: Withdrawal of Support is the withdrawal of
life sustaining treatments; the actual point where the patient’s attending physician or
designee begins the process of removing life sustaining treatments and not when the order
is written. Enter the date, using the standard 8-digit format of MM/DD/YYYY format, and
military time of the withdrawal of support. The date must be between referral date and date
and time agonal phase begins. If Yes is selected for If Yes, Controlled, this field is
required.
If Yes, Date and time agonal phase begins (systolic BP < 80 or O2 sat. < 80%): Agonal
Phase begins at the onset of cardiac arrest when the systolic pressure meets the following
conditions for greater than five (5) minutes):
a. Newborn up to 28 days, with a systolic blood pressure less than 60 mm Hg,
OR
b. 29 days up to 12 months, with a systolic blood pressure less than 70 mm Hg,
OR
c. 1 year up to 10 years, with a systolic blood pressure less than 70 mm Hg,
plus 2 times the age of the patient in years, not to exceed 79 mm Hg, OR
d. 11 years or older, with a systolic blood pressure less than 80 mm Hg, OR
when the oxygen saturation is less than 80% at any age.
Enter the date, using the standard 8-digit format of MM/DD/YYYY format, and military
time when the agonal phase begins. The date must be between date and time of
withdrawal of support and the day after the recovery day. If Yes is selected for If Yes,
Controlled, this field is required.

If DCD, Total urine output during OR recovery phase: Total urine output is
measured from the point at which life sustaining treatment is withdrawn to the initiation of
cold perfusion in situ. Enter the total urine output (cc). If Yes is selected for If Yes,
Controlled, this field is required.
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 Agonal Phase and Cardiac Death.

Date: Enter the date using the standard 8-digit numeric format of (MM/DD/YYYY format).
Time (military time): Enter the time.
Systolic blood pressure: Enter the systolic blood pressure.
Systolic Blood Pressure - The top number in the blood pressure (the 120 in a blood
pressure of 120/80) measures the maximum pressure exerted on the vessel wall when
the heart contracts.

Diastolic blood pressure: Enter the diastolic blood pressure.
Diastolic Blood Pressure - The bottom number in the blood pressure measurement
(80 in a blood pressure of 120/80), indicating the pressure in the arteries when the heart
is at rest.

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. If Yes is selected for If Yes, Controlled, this
field is required.

Core Cooling: the initiation of cold perfusion in situ.
If Yes, Date and time abdominal aorta cannulation: Enter the date and time of the initiation of
abdominal aorta core cooling (the date and time of the initiation of cold perfusion in situ). Enter
the date, using the standard 8-digit format of MM/DD/YYYY format, and military time of
abdominal aorta cannulation. If Yes is selected for DCD Donor, this field is required. If
unavailable, select the reason from the status (ST) drop-down list (N/A, Not Done, Missing,
Unknown). (List of Status codes)
If Yes, Date and time thoracic aorta cannulation: Enter the date and time of the initiation of
thoracic aorta core cooling (the date and time of the initiation of cold perfusion in situ). Enter the
date, using the standard 8-digit format of MM/DD/YYYY format, and military time of thoracic aorta
cannulation. If Yes is selected for DCD Donor, this field is required. If unavailable, select the
reason from the status (ST) drop-down list (N/A, Not Done, Missing, Unknown). (List of Status
codes)
If Yes, Date and time portal vein cannulation: Enter the date and time of the initiation of portal
vein core cooling (the date and time of the initiation of cold perfusion in situ). Enter the date,
using the standard 8-digit format of MM/DD/YYYY format, and military time of portal vein
cannulation. If Yes is selected for DCD Donor, this field is required. If unavailable, select the
reason from the status (ST) drop-down list (N/A, Not Done, Missing, Unknown). (List of Status
codes)
If Yes, Date and time pulmonary artery cannulation: Enter the date and Time of the initiation of
pulmonary artery core cooling (the date and time of the initiation of cold perfusion in situ). Enter the
date, using the standard 8-digit format of MM/DD/YYYY format, and military time of pulmonary
artery cannulation. If Yes is selected for DCD Donor, this field is required. If unavailable, select
the reason from the status (ST) drop-down list (N/A, Not Done, Missing, Unknown). (List of
Status codes)
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
Yes is selected for DCD Donor, this field is required. If unavailable, select the reason from the
status (ST) drop-down list (N/A, Not Done, Missing, Unknown). (List of Status codes)

If No, was this a consented DCD donor that progressed to brain death?: If this
was a consented DCD donor that progressed to brain death, select Yes. If not,
select No. If No is selected for Was this a DCD donor, this field is required.
Cardiac arrest since neurological event that lead to declaration of brain death: If cardiac
arrest occurred between a fatal brain injury event and organ recovery, select Yes. If cardiac
arrest did not occur, select No. If No is selected for Was this a DCD donor, this field is required.
Note: 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, enter the total minutes of cardiac resuscitation. If Yes is selected
for Cardiac arrest, this field is required. If unavailable, select the reason from the status
(ST) drop-down list (N/A, Not Done, Missing, Unknown). (List of Status codes)

Clamp Date: Enter the date the aorta was cross clamped. Use the standard 8-digit numeric format
of MM/DD/YYYY. This field is required.

Clamp Time: (Military Time): Enter the time the aorta was cross clamped. This field is required. If the
time the aorta was cross clamped is unavailable, select the reason from the status (ST) drop-down list
(N/A, Not Done, Missing, Unknown). (List of Status codes)
Clamp Time Zone: Select the time zone from the drop-down list which corresponds with the time and
location of the recovery. This field is required.(List of Time Zone codes)

Eastern
Central
Mountain
Pacific
Alaska
Hawaii
Atlantic
All Donors Cardiac and Pulmonary Function:
History of previous MI: If the donor had a history of myocardial infarction, select Yes. If the donor did
not have a history of myocardial infarction, select No. If this information is unknown, select Unk. This
field is required.
LV ejection fraction (%): Provide the left ventricular ejection fraction, if known. This field is required.
If the left ventricular ejection fraction is unavailable, select the reason from the status (ST) drop-down
list (N/A, Not Done, Missing, Unknown). (List of Status codes)
Method: Select the left ventricular ejection method from the drop-down list. If a value is entered
for LV ejection fraction, this field is required. (List of LV Ejection Method codes)

Echo (echocardiogram)
MUGA (scan)
Angiogram
If LV, Ejection Fraction < 50%:
Structural Abnormalities: If there were abnormalities, select Yes for each of the affected
locations. If there were no abnormalities at the location, select No. If a value is entered for
LV ejection fraction, this field is required.

Valves
Congenital
LVH
Wall Abnormalities: If there were abnormalities select Yes for each of the affected type. If
there were no abnormalities of the type, select No. If a value is entered for LV ejection
fraction, this field is required.

Segmental
Global
Coronary Angiogram: If the donor had a coronary angiogram, select Yes, normal or Yes, not normal
from the drop-down list. If the donor did not have a coronary angiogram, select No from the dropdown list. This field is required. (List of Coronary Angiogram codes)
If Abnormal, # of Vessels with > 50% Stenosis: If the results of the coronary angiogram were
abnormal, select the number of vessels with more than 50% stenosis from the drop-down list. If
this information is unknown, select Unknown from the drop-down list. If Yes, not normal is
selected, this field is required.
Pulmonary Measurements:
Lung - Was pO2 done: If a pO2 was done, select Yes. If not, select No. If unknown, select Unk.
This field is required.

If Yes, Lung pO2 terminal value: If pO2 was done, enter the terminal value in mm/Hg. If Yes
is selected for Lung - Was pO2 done, this field required. If unavailable, select the reason
from the status (ST) drop-down list (N/A, Not Done, Missing, Unknown).
If Yes, Lung pO2on FiO2 terminal value of: If pO2 was done, enter the percent (i.e. 40%)
of Lung pO2 on FiO2. If Yes is selected for Lung - Was pO2 done, this field required.
PCO2: Enter the PCO2 in mm/Hg. If unavailable, select the reason from the status (ST) dropdown list (N/A, Not Done, Missing, Unknown). This field is required. (List of Status codes)
Was a pulmonary artery catheter placed: If a pulmonary artery catheter was placed, select Yes. If
not, select No. This field is required.
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
fields. If Yes is selected for Was a pulmonary artery catheter placed, these fields are required. If
unavailable, select the reason from the status (ST) drop-down list (N/A, Not Done, Missing,
Unknown). (List of Status codes)
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)
Biopsy (heart donors only): If a biopsy was performed, select Yes with the type of result. If Yes,
Other Diagnosis Specify is selected, enter the diagnosis in the Other Diagnosis/Specify field. If a
biopsy was not performed, select No. This field is required if the heart was transplanted. (List of
Biopsy Result codes)

No
Yes, Myocarditis
Yes, Negative Biopsy Result
Yes, Other Diagnosis Specify
Left Kidney Biopsy: If a biopsy was performed on the left kidney, select Yes. If not, select No. If the
left kidney (or en bloc kidneys) was recovered or transplanted, this field is required.
Glomerulosclerosis: If Yes is selected for Left Kidney Biopsy and the organ was recovered or
transplanted, select the glomerulosclerosis percentage for the left kidney from the drop-down list.
This field is required. (List of Kidney Glomerulosclerosis codes)
0-5
6 - 10
11 - 15
16 - 20
20+
Indeterminate
Pump: If a pump was used in preservation of the left kidney, select Yes. If not, select No. If the left
kidney (or en bloc kidneys) was recovered or transplanted, this field is required.
Final Resistance Prior to Shipping: If Yes is selected for Pump, enter the resistance value. If
Yes is selected for Pump, this field is required. If data is unavailable, select the reason from the
status (ST) drop-down list (N/A, Not Done, Missing, Unknown). (List of Status codes)
Transferred to transplant center on pump: If pump was used in preservation of the left
kidney and the organ was transferred to the transplant center on pump, select Yes. If not,
select No. If Yes is selected for Pump, this field is required.

Right Kidney Biopsy: If a biopsy was performed on the right kidney, select Yes. If not, select No. If
the right kidney (or en bloc kidneys) was recovered or transplanted, this field is required.
Glomerulosclerosis: If Yes is selected for Right Kidney Biopsy and the organ was recovered or
transplanted, select the glomerulosclerosis percentage for the right kidney from the drop-down
list. (List of Kidney Glomerulosclerosis codes)

0-5
6 - 10
11 - 15
16 - 20
20+
Indeterminate
Pump: If a pump was used in preservation of the right kidney, select Yes. If not, select No. If the right
kidney (or en bloc kidneys) was recovered or transplanted, this field is required.
Final Resistance Prior to Shipping: If Yes is selected for Pump, enter the resistance value. If
Yes is selected for Pump, this field is required. If data is unavailable, select the reason from the
status (ST) drop-down list (N/A, Not Done, Missing, Unknown). (List of Status codes)
Transferred to transplant center on pump: If pump was used in preservation of the right
kidney and the organ was transferred to the transplant center on pump, select Yes. If not,
select No. If Yes is selected for Pump, this field is required.
Liver Biopsy: If a biopsy was performed on the liver, select Yes. If not, select No. If the liver was
recovered or transplanted, this field is required.
% Macro vesicular fat: If Yes is selected for Liver Biopsy, enter the percentage of macro
vesicular fat. This field is required. If data is unavailable, select the reason from the status (ST)
drop-down list (N/A, Not Done, Missing, Unknown). (List of Status codes)
Macrovesicular - Large fat droplets balloon the liver cell, displacing the nucleus to the
periphery of the cell, like an adipocyte. Triglycerides accumulate 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: If Yes is selected for Liver Biopsy, enter the percentage of
micro/intermediate vesicular fat. This field is required. If data is unavailable, select the reason
from the status (ST) drop-down list (N/A, Not Done, Missing, Unknown). (List of Status codes)
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): If Yes is selected for Liver Biopsy, indicate if another
histology was performed.

Hemosidera
Granulomas
Other Specify (enter the histology)
Left Lung Bronchoscopy and Right Lung Bronchoscopy: If a lung was recovered or transplanted,
select the results of the bronchoscopy procedure from the drop-down list. If the results were abnormal,
select Abnormal with the type of abnormality. If a bronchoscopy was not performed, select No
Bronchoscopy. If unknown, select Unknown if bronchoscopy performed. This field is required.
(List of Bronchoscopy Result codes)

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: If a lung was recovered or transplanted, select the results of the chest x-ray from the
drop-down list. If abnormalities were found on the chest x-ray, select Abnormal with the location. If
this information is 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 x-ray. This field is required. (List of X-ray Result codes)

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.
Organ: Verify the final disposition of the organ. (List of Feedback Disposition codes)

Consent Not Requested
Consent Not Obtained
Organ Not Recovered
Recovered Not for Tx
Recovered for Tx but Not Tx
Transplanted
N/A
If DCD, Date and time [organ] recovered/removed from donor: (when the organ is placed in
the basin): Enter the date, using the standard 8-digit format of MM/DD/YYYY format, and military
time of organ recovery/removal. If the organ was recovered or transplanted and Yes is selected
for Was this a DCD donor, this field is required.

Recipient: The recipient name from the Waitlist removal record displays. Verify that the
recipient listed is correct.
SSN: The recipient's social security number from the Waitlist removal record displays. Verify that
the recipient's social security number is correct.
TX Center: The recipient’s transplant center displays. Verify that the center is correct.
Reason Code: Select the appropriate reason code from the drop-down list. This field is
required. If Other, specify is selected, enter the reason in the space provided. If Other, specify
is selected, this field is required.
If consent was not requested, select the appropriate reason from the drop-down list. The
remaining questions for this organ will not display. (List of 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
If consent was not obtained, select the appropriate reason from the drop-down list. The
remaining questions for this organ will not display. (List of Consent Not Obtained codes)

Emotional
Cultural beliefs
Religious beliefs
Family conflict
Other, specify
If the organ was not recovered, select the appropriate reason from the drop-down list. The
remaining question for this organs will not display. (List of 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

If the organ was recovered but not for transplant use, select the appropriate reason from the
drop-down list. (List of 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 (UNOS-use only)
If the organ was recovered for a transplant but not used for a transplant, select the
appropriate reason from the drop-down list. (List of 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
(UNOS-use only)
Exported, not transplanted or transplant unknown
If the organ was transplanted, select the appropriate reason from the drop-down list. (List of
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, select the appropriate
reason from the drop-down list, the organ was not transplanted. If Other, specify is selected,
enter the reason in the Specify field. (List of Reason Not Transplanted codes)

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 exhausted
Other, specify
Recovery Team #: Enter the 6-digit Medicare Provider number of the OPO or transplant center
procurement team that performed the recovery operation. This field is required.
Initial Flush Solution: For each recovered organ, select the flush solution from the drop-down
list, used during the recovery procedure. If unknown, select Unknown. This field is required. If
Other, specify is selected, enter the flush solution used in the Specify field. If Other, Specify is
selected, this field is required. (List of Initial Flush Solution codes)

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 unknown,
select Unknown. This field is required. If Other Specify is selected, enter the flush solution
used in the Specify field. If Other Specify is selected, this field is required. (List of Back Table
Flush Solution codes)

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 unknown, select Unknown. This field is required.
If Other Specify is selected, enter the flush solution used in the Specify field. If Other, Specify
is selected, this field is required. (List of Initial Flush Solution codes)

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. If no vessels were sent,
No 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 record, Yes displays. If the
vessels were not used, No 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 UNetSM.