Death Notification Referral-Imminent

Adding a Death Notification Registration (DNR)
The purpose of the Death Notification Registration form is to collect demographic information
regarding all imminent neurological and eligible deaths reported to an OPO.
To add a Death Notification Registration:
1. Select Add from the Death Notification Registration drop-down menu.

2. The Death Notification Registration page displays.

3. At the top of the page, the status displays. This field is read-only and displays Incomplete. It
will only change to Complete once the record is successfully validated.

4. Below the status field is the Donor ID field. Enter the unique Donor ID and click Search. If it is
a valid Donor ID, then the values for OPO, Donor Hospital, Date of Referral, Medical
Examiner/Coroner, Last Name, First Name, Age, Patient's Home Zip Code, Ethnicity/Race,
Cause of Death, Mechanism of Death, Circumstance of Death are copied from the Deceased
Donor Registration (DDR) record to the DNR and will become read-only.
Note: If the status of the DDR is Validated or Expected, then the value of "How did you learn
of this case?" will set to Donor hospital Notification.
Note: If the candidate is a referral only (no Donor ID), all fields will need to be completed.

5. Complete the remaining fields.
6. At the bottom of the form, there are two buttons:
The first button is the Validate button. When clicked, the validation will be performed on the
entered data. It will also save the record. If any of the required fields are not completed
correctly, a validation message explains what the data needs to be corrected.
The second button is the Save button. When clicked, the record will be saved but not
validated.

Provider Information
OPO: If this is a donor, the OPO from the donor record displays and is read-only. If this is a referral
only, select the OPO from the drop-down list. This field is required.
Donor hospital: If this is a donor, the hospital from the donor record displays and is read-only. If this
is a referral only, select the hospital from the drop-down list. This field is required.
OPO record ID: If this is a donor, the ID from the donor record displays and is read-only. If this is a
referral only, enter the OPO record ID. This field is required.
Recovery date (donor to OR): If this is a donor, the date from the donor record displays and is readonly. This excluded referral-only donors (donor with a suspended Deceased Donor Registration
(DDR) record).
Date and time of pronouncement of death: If this is a donor, the date and time from the donor
record displays and is read-only. If this is a referral only, enter the date and time. A calendar link is
available. If the Referral Classification is Eligible or the death was identified during a death record
review, this field is required.
Format: MM/DD/YYYY and HH:MM
Note: Time should be in military format.
Date of referral or death record review: If this is a referral only, enter the date of the referral or
death record review. This field is required.
Format: MM/DD/YYYY
How did you learn of this case?: Select Donor hospital notification or Death record review, from
the drop-down list. Donor hospital notification initially displays. If applicable, change the selection to
Death record review. This field is required.
Did this referral meet your DSA definition of a timely referral?: If this referral met your DSA
definition of a timely referral, select Yes. If it did not, select No. This field is required.
Referral Classification: Select the classification of death: This field is required.
Imminent Death: A patient who is 70 years old or younger with severe neurological injury and
requiring ventilator support who, upon clinical evaluation documented in the OPO record or
donor hospital chart, has an absence of at least three brain stem reflexes but does not yet
meet the OPTN definition of an eligible death, specifically that the patient has not yet been
legally declared brain dead according to hospital policy. Persons with any condition which
would exclude them from being reported as an eligible death would also be excluded from
consideration for reporting as an imminent death. For the purposes of submitting data to the
OPTN, the OPO shall apply the definition of imminent neurological death to a patient that
meets the definition of imminent death at the time when the OPO certifies the final disposition
of the organ donation referral.
Brain Stem Reflexes:
• Pupillary reaction
• Response to iced caloric

• Gag Reflex
• Cough Reflex
• Corneal Reflex
• Doll's eyes reflex
• Response to painful stimuli
• Spontaneous breathing
Eligible Death: 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:
• 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]:
• 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
Has consent been obtained for organ donation?: If consent was obtained, select Yes. If not, select
No or Consent Not Requested. If the OPO did not request donation but the patient was designated
as donor, select Registry - yes. This field is required.
Did consent process meet your DSA definition of effective requesting?: If Yes, No, or
Registry - yes is selected for Has consent been obtained, and if consent processing met your
DSA definition of effective requesting, select Yes. If consent processing did not meet your
definition, select No. This field is required.
Medical Examiner/Coroner: If this is a donor, the selection from the donor record displays. This field
is read-only. If this is a referral only, select Yes if the donor's death was reported to the medical
examiner/coroner. If the donor's death was not reported to the medical examiner/coroner, select No. If
unknown, select unknown. If Yes is selected, indicate if the medical examiner/coroner gave or
refused consent for organ donation. This field is required.

Demographics
Last name: If this is a donor, the name from the donor record displays. This field is read-only. If this is
a referral only, enter the last name using only alphanumeric characters. This field is required.
First name: If this is a donor, the name from the donor record displays. This field is read-only. If this is
a referral only, enter the first name using only alphanumeric characters. This field is required.
Gender: If this is a donor, the selection from the donor record displays. This field is read-only. If this is
a referral only, indicate if the donor is Male or Female. This field is required.
Age: If this is a donor, the age from the donor record displays. This field is read-only. If this is a
referral only, enter the donor's age in months or years. This field is required.
Age Units: If this is a donor, the selection from the donor record displays. This field is read-only. If
this is a referral only, select whether the donor's age is in Months or Years. This field is required.
Patient's Home Zipcode: If this is a donor, the zip code from the donor record displays. This field is
read-only. If this is a referral only, enter the patient's zip code using only numeric values.
Ethnicity/Race: If this is a donor, the selection from the donor record displays. This field is read-only.
If this is a referral only, select, as appropriate, to indicate the donor's ethnicity/race. This field is
required.
American Indian or Alaska Native: Indicate if the donor is of North, South, or Central American
descent.
Values: American Indian, Eskimo, Aleutian, Alaska Indian
Note: 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: Indicate if the donor is of Asian descent.
Values: Asian Indian/Indian Sub-Continent, Chinese, Filipino, Japanese, Korean, Vietnamese

Note: 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: Indicate if the donor is of African descent.
Values: African American, African (Continental), West Indian, Haitian
Note: 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: Indicate if the donor is of Central or South American descent.
Values: Mexican, Puerto Rican (Mainland), Puerto Rican (Island), Cuban
Note: 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: Indicate if the donor is of Pacific island descent.
Values: Native Hawaiian, Guamanian, Chamorro, Samoan
Note: 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: Indicate if the donor is of European, Arab, Middle Eastern or North African descent.
Values: European, Arab, Middle Eastern, North African (non-Black)
Note: 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.
Cause of death: If this is a donor, the selection from the donor record displays. This field is read-only.
If this is a referral only, select the cause from the drop-down list. If the cause is unknown, select
Unknown. This field is required. If the cause is not listed, select Other Specify. Enter the cause in
the space provided. If Other Specify is selected, this field is required.
Anoxia
Cerebrovascular/Stroke
Head Trauma
CNS Tumor
Unknown
Other Specify
Mechanism of death: If this is a donor, the selection from the donor record displays. This field is
read-only. If this is a referral only, select the mechanism from the drop-down list. If the mechanism is
not listed, select None of the Above. This field is required.
Drug Intoxication
Cardiovascular
Gunshot Wound
Blunt Injury
Intracranial Hemorrhage/Stroke
Drowning
Seizure
Asphyxiation
Electrical
Stab
SIDS

Death from Natural Causes
None of the Above
Circumstances of death: If this is a donor, the selection from the donor record displays. This field is
read-only. If this is a referral only, select the circumstance from the drop-down list. If the circumstance
is not listed, select None of the Above. This field is required.
MVA
Suicide
Homicide
Child Abuse
Non-MVA
Death from Natural Causes
None of the Above