OPTN- Heart/Lung Candidate Registration

Heart/Lung Transplant Candidate Registration (TCR)
Record Field Descriptions
The Transplant Candidate Registration (TCR) record is generated when a candidate for transplant is
added to the OPTN/UNOS waiting list. A TCR will also be generated in the case of a living donor
transplant, where the recipient was not added to the WaitlistSM, and was added through the living donor
feedback process.
If the candidate is already on the waiting list for a transplant, another TCR record will not be generated
unless listed by a different center or for another organ type.
The TCR 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 on an electronic record, call the UNET Help Desk at 1800-978-4334.
Provider Information
Recipient Center: The recipient center will display. Verify that the transplant center name, center code,
and the provider number, (6-character Medicare identification number of the hospital where the
transplant recipient was transplanted) are correct.
Candidate Information
Organ Registered: Verify the organ(s) displayed is/are the organ(s) listed for this candidate. If the
candidate is listed for more than one type of transplant, both organs should be displayed. Separate
records exist for certain multi-organ transplant candidates (e.g. Heart/Lung and Kidney/Pancreas).
Date of Listing or Add: The date the candidate was listed or added in Waitlist will display.
Name: The waitlisted candidate's last name, first name and middle initial will be displayed. If it is
incorrect, corrections must be completed on the active waitlist. For a candidate who has been removed
from the waitlist, the Last Name, First Name and MI fields will display. Corrections may be made
directly in the record.
Previous Surname: If the candidate had a previous surname that is different from the Name entered,
enter the previous surname.
SSN: Verify the candidate's social security number. If the information is incorrect and the candidate is
waitlisted, contact the UNOS Organ Center at 1-800-292-9537.
Gender: Verify candidate's gender. If the gender is not displayed or is incorrect and the candidate is on
the active waitlist, correction must be completed on the active waitlist record. If the candidate has been
removed from the active waitlist, corrections may be made directly in the record.
HIC: Enter the 9 to 11 character Health Insurance Claim number for the candidate. If the candidate
does not have a HIC number, you may leave this field blank.
DOB: Verify the displayed date is the candidate's date of birth. If the information is incorrect, correction
must be completed on the active waitlist. If the candidate has been removed, reenter the correct date
using the 8-digit numeric format of MM/DD/YYYY. Corrections may be made directly in the record.
State of Permanent Residence: Select the name of the state of the candidate's permanent address.
(List of State codes)
Permanent Zip Code: Enter the candidate's permanent zip code.
Is Patient waiting in permanent ZIP code: If the candidate is waiting in the permanent zip code,
select Yes. If not, select No. If unknown, select UNK. (This field is optional.)

Ethnicity/Race: Select all origins that indicate the candidate's ethnicity/race. (List of Ethnicity/Race
Codes)
American Indian or Alaska Native: Select for candidates who are of North, South, or Central
American descent (e.g. American Indian, Eskimo, Aleutian, Alaska Indian). If the candidate
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 candidates who are of Asian descent (e.g. Asian Indian/Indian Sub-Continent,
Chinese, Filipino, Japanese, Korean, Vietnamese). If the candidate 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 candidates of African descent (e.g. African American,
African (Continental), West Indian, Haitian). If the candidate 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 candidates who are of Central or South American descent (e.g.
Mexican, Puerto Rican (Mainland), Puerto Rican (Island), Cuban). If the candidate 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 candidates who are descendents of the
Native Hawaiian, Guamanian or Chamorro, or Samoan peoples. If the candidate 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 candidates who are of European Descent, Arab or Middle Eastern or North
African (non-Black). If the candidate 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 candidate's citizenship. (List of Citizenship codes)
U.S. Citizen: Select if the candidate is a U.S. Citizen by birth or naturalization.
Resident Alien: Select if the candidate 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 candidate 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 candidate was granted permanent resident
status. This date is on the candidate's Permanent Resident Card (formerly known as

Alien Registration Card). To view a sample card, go to http://www.greencardus.org/images/greencard.gif.
Highest Education Level: Select the choice which best describes the living donor's highest level of
education. (List of Education codes)
None
Grade School (0-8)
High School (9-12) or GED
Attended College/Technical School
Associate/Bachelor Degree
Post-College Graduate Degree
N/A (< 5 Yrs Old)
Unknown
Medical Condition at time of listing: Select the choice that best describes the candidate's medical
condition at the time of listing. (This field is optional.) (List of Medical Condition codes)
In Intensive Care Unit
Hospitalized Not in ICU
Not Hospitalized
Patient on Life Support: If the candidate was on life support at the time of listing, select Yes. If not,
select No. If Yes, select life support types that apply. If Other Mechanism, Specify is selected, enter
the type of mechanism in the space provided.
Extra Corporeal Membrane Oxygenation
Intra Aortic Balloon Pump
Ventilator - Select only if the candidate was on continuous invasive ventilation.
Prostacyclin Infusion
Prostacyclin Inhalation
Inhaled NO
IV Inotropes (pediatric candidates only)
Other Mechanism, Specify
Patient on Ventricular Assist Device: If the candidate was on a Ventricular Assist Device (VAD),
select the type. If the candidate was not on a VAD, select None. (List of Device Type codes)
If a VAD was indicated, select the brand of device that the candidate was on. If LVAD+RVAD was
indicated, select the brand of device the candidate was on for both LVAD and RVAD. If Other,
Specify is selected for one of the following, specify the name in the space provided.
LVAD: (List of LVAD codes)
Abiomed AB5000
Abiomed BVS 5000
Berlin Heart EXCOR
Biomedicus
Cardiac Assist Tandem Heart
Evaheart
Heartmate II
Heartmate XVE
Heartsaver VAD
Heartware HVAD
Impella Recover 2.5
Impella Recover 5.0
Jarvik 2000
Levitronix CentriMag
Levitronix PediMag
Maquet Josta Rotaflow
Medos

MicroMed DeBakey
MicroMed DeBakey - Child
Terumo DuraHeart
Thoratec IVAD
Thoratec PVAD
Toyobo
Ventracor VentrAssist
Worldheart Levacor
Other, Specify
RVAD: (List of RVAD codes)
Abiomed AB5000
Abiomed BVS 5000
Berlin Heart EXCOR
Biomedicus
Cardiac Assist Tandem Heart
Evaheart
Heartmate II
Heartmate XVE
Heartsaver VAD
Heartware HVAD
Impella Recover 2.5
Impella Recover 5.0
Jarvik 2000
Levitronix CentriMag
Levitronix PediMag
Maquet Josta Rotaflow
Medos
MicroMed DeBakey
MicroMed DeBakey - Child
Terumo DuraHeart
Thoratec IVAD
Thoratec PVAD
Toyobo
Ventracor VentrAssist
Worldheart Levacor
Other, Specify
TAH: (List of TAH codes)
AbioCor
SynCardia CardioWest
Other, Specify
LVAD + RVAD: (List of LVAD codes) (List of RVAD codes)
Functional Status: Select the choice that best describes the candidate's functional status. (List of
Functional Status codes)
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
Note: This evaluation should be in comparison to the person's normal function, indicating how the
patient's disease has affected their normal function.
Physical Capacity: (Complete for candidates older than 18 years of age.) Select the choice that best
describes the candidate's physical capacity at the time of listing. If the candidate's Medical Condition
indicates they are hospitalized, select Not Applicable (hospitalized). (This field is optional for adult
candidates.) (List of Physical Capacity codes)
No Limitations
Limited Mobility
Wheelchair bound or more limited
Not Applicable (hospitalized)
Unknown
Physical Capacity is the ability to perform bodily activities such as walking, dressing, bathing,
grooming, etc.
Cognitive Development: (Complete for candidates 18 years of age or younger.) Select the choice that
best describes the candidate's cognitive development at the time of listing. (List of Cognitive
Development codes)
Definite Cognitive Delay/Impairment (verified by IQ score <70 or unambiguous behavioral
observation)
Probable Cognitive Delay/Impairment (not verified or unambiguous but more likely than not,
based on behavioral observation or other evidence)
Questionable Cognitive Delay/Impairment (not judged to be more likely than not, but with some
indication of cognitive delay/impairment such as expressive/receptive language and/or learning
difficulties)
No Cognitive Delay/Impairment (no obvious indicators of cognitive delay/impairment)
Not Assessed
Motor Development: (Complete for candidates 18 years of age or younger.) Select the choice that
best describes the candidate's motor development at the time of listing. (List of Motor Development
codes)
Definite Motor Delay/Impairment (verified by physical exam or unambiguous behavioral
observation)

Probable Motor Delay/Impairment (not verified or unambiguous but more likely than not, based
on behavioral observation or other evidence)
Questionable Motor Delay/Impairment (not judged to be more likely than not, but with some
indication of motor delay/impairment)
No Motor Delay/Impairment (no obvious indicators of motor delay/impairment)
Not Assessed
Working for income: (Complete for candidates 19 years of age or older.) If the candidate is working
for income, select Yes. If not, select No. If unknown, select UNK.
If No, Not Working Due To: If No is selected, indicate the reason why the candidate is not
working at the time of listing. (This field is optional for adult candidates only.) (List of Not Work
Reason codes)
Disability - A physical or mental impairment that interferes with or prevents a candidate from
working (e.g. arthritis, mental retardation, cerebral palsy, etc).
Demands of Treatment - An urgent medical treatment that prevents a candidate from working
(e.g. Dialysis).
Insurance Conflict - Any differences between a candidate 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.).
Patient Choice - Homemaker - A candidate who chooses to manage their own household,
instead of performing work for pay.
Patient Choice - Student Full Time/Part Time - A candidate who is enrolled and/or
participating in college.
Patient Choice - Retired - A candidate who no longer has an active working life such as an
occupation, business or office job.
Patient Choice - Other - Any reason not listed above that would prevent a candidate from
working.
Not Applicable - Hospitalized - Select only if the patient's Medical Condition indicates they
are in the hospital.
Unknown
If Yes: If Yes is selected, indicate the candidate's working status. (This field is optional for
adult candidates only.) (List of Working codes)
Working Full Time
Working Part Time due to Demands of Treatment
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 Patient Choice
Working Part Time Reason Unknown
Working, Part Time vs. Full Time Unknown
Academic Progress: (Complete for recipients less than 19 years of age.) Select the choice that best
describes the candidate's academic progress at the time of listing. If the candidate is less than 5 years
old or has graduated from high school, select Not Applicable < 5 years old/High School graduate or
GED. (List of Academic Progress codes)
Within One Grade Level of Peers
Delayed Grade Level

Special Education
Not Applicable <5 years old/High School graduate or GED
Status Unknown
Academic Activity Level: (Complete for recipients less than 19 years of age.) Select the choice that
best describes the candidate's academic activity level at the time of listing. If the candidate is less than
5 years old or has graduated from high school, select Not Applicable < 5 years old/High School
graduate or GED. (List of Academic Activity Level codes)
Full academic load
Reduced academic load
Unable to participate in academics due to disease or condition
Not Applicable <5 years old/High School graduate or GED
Previous Transplants: The three most recent transplant(s), indicated on the candidate's validated
Transplant Recipient Registration (TRR) record(s), will display. Verify all previous transplants listed by
organ type, transplant date and graft failure date.
Note: The three most recent transplants on record for this candidate will be displayed for
verification. If there are any prior transplants that are not listed here, contact the UNet
Helpdesk at 1-800-978-4334 or [email protected] to determine if the transplant event
is in the database.
Previous Pancreas Islet Infusion: If the candidate received a previous pancreas islet infusion, select
Yes. If not, select No. If unknown, select UNK. (This field is optional for pediatric candidates only.)
Source of Payment:
Primary: Select as appropriate to indicate the candidate's source of primary payment (largest
contributor) for the transplant. If the source of payment is not yet determined, select Pending. (List
of Primary Insurance codes)
Private insurance refers to funds from agencies such as Blue Cross/Blue Shield, etc. It also
refers to any worker's compensation that is covered by a private insurer.
Public insurance - Medicaid refers to state Medicaid funds.
Public insurance - Medicare FFS (Fee-for-Service) refers to funds from the government in
which doctors and other health care providers are paid for each service provided to a
candidate. For additional information about Medicare, see
http://www.medicare.gov/Choices/Overview.asp.
Public insurance - Medicare & Choice (also known as Medicare Managed Care) refers to
funds from the government in which doctors and other health care providers are paid for each
service provided to a candidate, along with additional benefits such as coordination of care or
reducing-out-of-pocket expenses. Sometimes a candidate may receive additional benefits such
as prescription drugs. For additional information about Medicare, see
http://www.medicare.gov/Choices/Overview.asp.
Public insurance - CHIP (Children's Health Insurance Program)
Public insurance - Department of VA refers to funds from the Veterans Administration.
Public insurance - Other government refers to funds from another government agency.
Self indicates that the candidate will pay for the cost of transplant.
Donation indicates that a company, institution, or individual(s) donated funds to pay for the
transplant and care of the candidate.
Free Care indicates that the transplant hospital will not charge candidate for the costs of the
transplant operation.
Pending is used if the source of payment is not yet determined (Primary only).

Foreign Government, Specify refers to funds provided by a foreign government (Primary only)
Specify the foreign country in the space provided. (List of Foreign Country codes)
Secondary: Select as appropriate to indicate the candidate's source of secondary payment. (This
field is optional.) (List of Secondary Insurance codes)
Private insurance refers to funds from agencies such as Blue Cross/Blue Shield, etc. It also
refers to any worker's compensation that is covered by a private insurer.
Public insurance - Medicaid refers to state Medicaid funds.
Public insurance - Medicare FFS (Fee-for-Service) refers to funds from the government in
which doctors and other health care providers that are paid for each service provided to a
candidate. For additional information about Medicare, see
http://www.medicare.gov/Choices/Overview.asp.
Public insurance - Medicare & Choice (also known as Medicare Managed Care) refers to
funds from the government in which doctors and other health care providers are paid for each
service provided to a candidate, along with additional benefits such as coordination of care or
reducing-out-of-pocket expenses. Sometimes a candidate may receive additional benefits such
as prescription drugs. For additional information about Medicare, see
http://www.medicare.gov/Choices/Overview.asp.
Public insurance - CHIP (Children's Health Insurance Program)
Public insurance - Other government refers to funds from another government agency.
Self indicates that the candidate will pay for the cost of transplant.
Donation indicates that a company, institution, or individual(s) donated funds to pay for the
transplant and care of the candidate.
Free Care indicates that the transplant hospital will not charge candidate for the costs of the
transplant operation.
None - Select if the candidate does not have a secondary source of payment.
Clinical Information: At Listing
Date of Measurement: (Complete for candidates 18 years of age or younger.) Enter the date, using
the 8-digit format of MM/DD/YYYY, the candidate’s height and weight were measured.
Height: Enter the height of the candidate at the time of listing in the appropriate space, in feet and
inches or centimeters. If the candidate’s height is unavailable, select the appropriate status from the ST
field (N/A, Not Done, Missing, Unknown). (List of Status codes) For candidates 18 years old or
younger at the time of listing, UNet will generate and display calculated percentiles based on the 2000
CDC growth charts.
Weight: Enter the weight of the candidate at the time of listing in the appropriate space, in pounds or
kilograms. If the candidate’s weight is unavailable, select the appropriate status from the ST field (N/A,
Not Done, Missing, Unknown). (List of Status codes) For candidates 18 years old or younger at the
time of listing, UNet will generate and display calculated percentiles based on the 2000 CDC growth
charts.
BMI (Body Mass Index): The candidate's BMI will display. For candidates less than 20 years of age at
the time of listing, UNetSM will generate and display calculated percentiles based on the 2000 CDC
growth charts.
Percentiles are the most commonly used clinical indicator to assess the size and growth patterns
of individual children in the United States. Percentiles rank the position of an individual by indicating
what percent of the reference population the individual would equal or exceed (i.e. on the weightfor-age growth charts, a 5 year-old girl whose weight is at the 25th percentile, weighs the same or
more than 25 percent of the reference population of 5-year-old girls, and weighs less than 75

percent of the 5-year-old girls in the reference population). For additional information about CDC
growth charts, see http://www.cdc.gov/.
Note: Users who check the BMI percentiles against the CDC calculator may notice a discrepancy
that is caused by the CDC calculator using 1 decimal place for height and weight and UNetsm using
4 decimal places for weight and 2 for height.
ABO Blood Group: The candidate's blood type will be displayed. If the blood type is incorrect,
correction must be completed on the active waitlist. If the candidate has been removed from the active
waitlist, you may select the candidate's correct blood type directly in the record. (List of ABO Blood
Type codes)
A
A1
A1B
A2
A2B
AB
B
O
Z (In Utero Only)
Primary Diagnosis: Select the primary diagnosis for the disease requiring a transplant at the time
of listing for this candidate. If the candidate has had a previous transplant for the same organ type, use
Retransplant/Graft Failure as the primary diagnosis for that organ. If an Other code is selected, use
the blank provided to specify the Other diagnosis. (List of Thoracic Diagnosis codes)
General Medical Factors: For each of the medical factors listed, select the appropriate responses to
indicate if the candidate has a history of the factor prior to listing.
Diabetes: If the candidate does not have a history of diabetes, select No. If the candidate has
diabetes, select Type I or Type II. If the candidate has any type of induced diabetes, select Type
Other. If the candidate has a history of diabetes but the type is unknown, select Type Unknown. If
this information is unknown, select Diabetes Status Unknown. (List of Diabetes codes)
No
Type I 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 II 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.
Type Other
Type Unknown
Diabetes Status Unknown
Dialysis: If the candidate does not have a history of dialysis, select No. If the candidate has a
history of dialysis, select the type of dialysis. If the candidate has a history of dialysis, but the type
is not known, select Dialysis - Unknown Type was performed. If this information is not known,
select Dialysis Status Unknown. (This field is optional.) (List of Dialysis codes)
No Dialysis
Hemodialysis
Peritoneal Dialysis
Dialysis - Unknown Type was performed
Dialysis Status Unknown
Peptic Ulcer: If the candidate does not have a history of peptic ulcer, select No. If the candidate
has a history, select Yes. If this information is not known, select Unknown. (This field is optional.)
(List of Peptic Ulcer codes)

No
Yes, active within the last year
Yes, not active within the last year
Unknown
Angina: If the candidate does not have a history of angina, select No angina. If the candidate has
a history of angina at the time of listing, select the appropriate Stable or Unstable choice. If this
information is not known, select Unknown if angina present. (This field is optional.) (List of Angina
codes)
No angina
Stable angina - strenuous activity results in angina
Stable angina - ordinary physical activity results in angina
Stable angina - no rest angina; does have angina with less than ordinary activity
Stable angina - angina with any physical activity or at rest
Unstable angina
Unknown if angina present
Angina Severe constricting pain in the chest area.
Stable Angina - People with stable angina (or chronic stable angina) have episodes of
chest discomfort that are usually predictable. They occur on exertion (such as running to
catch a bus) or under mental or emotional stress. Normally the chest discomfort is relieved
with rest, nitroglycerin or both.
Unstable Angina - In people with unstable angina, the chest pain is unexpected and
usually occurs while at rest. The discomfort may be more severe and prolonged than
typical angina or be the first time a person has angina.
Drug Treated Systemic Hypertension: If the candidate is being treated or has a history of being
treated with any medication for the purpose of lowering blood pressure at the time of listing, select
Yes. If not, select No. If unknown, select UNK. (This field is optional.)
Symptomatic Cerebrovascular Disease: If the candidate is experiencing or has a history of signs
and symptoms of transient ischemic attacks or stroke at the time of listing, select Yes. If not, select
No. If unknown, select UNK. (This field is optional.)
Symptomatic Peripheral Vascular Disease: If the candidate is experiencing or has a history of
intermittent claudication, diminished peripheral pulses or other signs and symptoms of peripheral
vascular disease at the time of listing, select Yes. If not, select No. If unknown, select UNK. (This
field is optional.)
Drug Treated COPD: If the candidate is currently or has a history of taking any medication to
control signs and symptoms of COPD (Chronic Obstructive Pulmonary Disease) at the time of
listing, select Yes. If not, select No. If unknown, select UNK. (This field is optional.)
Pulmonary Embolism: If the candidate has been diagnosed as having a pulmonary embolism
within the past six months, select Yes. If not, select No. If unknown, select UNK. (This field is
optional.)
Any previous malignancy: If the candidate has history of any previous malignant cancer prior to
the time of listing, select Yes. If the candidate has not had a history of any previous malignant
cancer prior to the time of listing, select No. If unknown, select UNK. If Yes is selected, select the
type(s) of malignancy. If Other, specify is selected, indicate the type of tumor in the space
provided. (List of Malignancy codes)
Skin Melanoma
Skin Non-Melanoma
CNS Tumor
Genitourinary
Breast
Thyroid

Tongue/Throat/Larynx
Lung
Leukemia/Lymphoma
Liver
Other, specify
Most Recent Serum Creatinine: Enter the most recent serum creatinine value in mg/dl. If the
value is unavailable, select the appropriate status from the ST field (N/A, Not Done, Missing,
Unknown). (List of Status codes) (This field is optional.)
Total Serum Albumin: Enter the total serum albumin value in g/dl. If the value is unavailable,
select the appropriate status from the ST field (N/A, Not Done, Missing, Unknown). (List of Status
codes) (This field is optional for adult candidates only.)
Heart Medical Factors
Sudden Death: If the candidate has experienced any episodes of sudden death (cardiac arrest with
resuscitation) prior to the time of listing, select Yes. If not, select No. If unknown, select UNK. (This field
is optional for adult candidates only.)
Antiarrythmics: If the candidate is taking or has a history of taking any medication other than
Amiodarone for the purpose of controlling any diagnosed arrhythmia at the time of listing, select Yes. If
not, select No. If unknown, select UNK. (This field is optional.)
Amiodarone: If the candidate was taking or has a history of taking Amiodarone at the time of listing,
select Yes. If not, select No. If unknown, select UNK. (This field is optional.)
Implantable Defibrillator: If the candidate had an implantable defibrillator at the time of listing, select
Yes. If not, select No. If unknown, select UNK.
Infection Requiring IV Drug Therapy within 2/wks prior to listing: If the candidate had an infection
that required an IV Drug Therapy within 2 weeks prior to listing, select Yes. If not, select No. If
unknown, select UNK. (This field is optional.)
Exercise Oxygen Consumption: Enter the candidate's oxygen consumption at exercise in ml/min/kg.
If the value is unavailable, select the appropriate status from the ST field (N/A, Not Done, Missing,
Unknown). (List of Status codes)
Lung Medical Factors
Pulmonary Status: Enter the most recent pulmonary function values. (These fields are optional.)
FVC - forced vital capacity (% predicted)
FeV1 - forced expiratory volume at one second (% predicted)
pCO2 - partial carbon dioxide pressure
FeV1(L)/FVC(L) ratio of FEV1(L)/FVC(L)
O2 Requirement at Rest - oxygen requirement at rest. If the candidate does not require oxygen at
rest, enter 0. If the values are unavailable, select the appropriate status from the ST field (N/A, Not
Done, Missing, Unknown). (List of Status codes)
IV Treated Pulmonary Sepsis Episodes>=2 in last 12 months: If the candidate has experienced two
or more episodes of pulmonary sepsis requiring treatment with IV antibiotics within the past 12 months,
select Yes. If not, select No. If unknown, select UNK. (This field is optional.)
Corticosteroid Dependency>= 5mg/day: If the candidate is taking 5 or more milligrams of any oral
corticosteroid at the time of listing, select Yes. If not, select No. If unknown, select UNK. (This field is
optional.)

Six minute walk distance: Enter the number of feet the candidate can walk in six minutes at the time
of listing. (This field is optional.)
Pan-Resistant Bacterial Lung Infection: If the candidate has a history of pan-resistant bacterial lung
infection prior to listing, select Yes. If not, select No. If unknown, select UNK.
Heart/Lung Medical Factors
Most recent Hemodynamics: Enter the most recent hemodynamic values. For each measure, indicate
if the measurement was obtained while the candidate was on Inotropes or Vasodilators. If the tests
were not done, select Not Done in the ST field (N/A, Not Done, Missing, Unknown). (List of Status
codes)
PA (sys) mm/Hg - systolic pulmonary artery pressure
PA (dia) mm/Hg - diastolic pulmonary artery pressure
PA (mean) mm/Hg - mean pulmonary artery pressure
PCW (mean) mm/Hg - mean pulmonary capillary wedge pressure
CO L/min - cardiac output
History of Cigarette Use: If the candidate 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 candidate smoked per day
multiplied by the number of years. For example a candidate smoking 2 packs of cigarettes per day
for 10 years would equal 20 pack years. (This field is optional.) (List of Cigarette Pack Years codes)
0-10
11-20
21-30
31-40
41-50
>50
Unknown pack years
Duration of Abstinence: Select the number of months the candidate has abstained from
cigarettes. If the time is unknown, select Unknown duration. If the candidate has not stopped
smoking, select Continues To Smoke. (List of Duration of Abstinence codes)
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 Use: If the candidate has a history of other tobacco use, select Yes. If no history of
other tobacco use, select No. If unknown, select UNK. (This field is optional.)
[ADULT CANDIDATES]
Prior Cardiac Surgery (non-transplant): If the candidate had cardiac surgery prior to listing, select
Yes. If no prior cardiac surgery, select No. If Yes is selected, select all type(s) of surgery. If the type of
cardiac surgery is not listed, select Other, specify and enter the type of cardiac surgery in the space
provided. (List of Cardiac Surgery codes)

CABG
Valve Replacement/Repair
Congenital
Left Ventricular Remodeling
Other, specify
Prior Lung Surgery (non-transplant): If the candidate had lung surgery prior to listing, select Yes. If
no prior lung surgery, select No. If Yes is selected, select all type(s) of surgery. If the type of lung
surgery is not listed, select Other, specify and enter the type of cardiac surgery in the space provided.
(These fields are optional for adult candidates only.) (List of Lung Surgery codes)
Pneumoreduction
Pneumothorax Surgery-Nodule
Pneumothorax Decortication
Lobectomy
Pneumonectomy
Left Thoracotomy
Right Thoracotomy
Other, specify
[PEDIATRIC CANDIDATES]
Prior Thoracic Surgery Other Than Previous Transplant: If the candidate had thoracic surgery prior
to listing, select Yes. If no prior thoracic surgery, select No. If Yes is selected, select all type(s) of
surgery. If the type of thoracic surgery is not listed, select Other, specify and enter the type of thoracic
surgery in the space provided.
If yes, number of prior sternotomies (List of Sternotomies codes)
If yes, number of prior thoracotomies (List of Thoracotomies codes)
Prior Congenital Cardiac Surgery: If the candidate had prior surgery, select Yes. If not, select No. If
unknown, select UNK.
If Yes, palliative surgery: If the surgery was palliative, select Yes. If not, select No. If unknown,
select UNK.
If Yes, corrective surgery: If the surgery was corrective, select Yes. If not, select No. If unknown,
select UNK.
If Yes, single ventricular physiology: If the surgery was to correct single ventricular physiology,
select Yes. If not, select No. If unknown, select UNK.