Recipient Histocompatibility Form

Data System for Organ Procurement and Transplantation Network

Recipient_Histocompatibility_Instructions

Recipient Histocompatibility Form

OMB: 0915-0157

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Recipient Histocompatibility (RHS) Record Field Descriptions

Recipient Histocompatibility (RHS) records are generated as soon as the Recipient Feedback is completed in Tiedi®. For living donors, the RHS record is generated when Living Donor Feedback has been completed in Tiedi. The RHS record is to be completed by the histocompatibility laboratory responsible for performing tissue typing on the recipient and crossmatch testing between the donor and recipient once an organ becomes available.

The RHS record must be completed within 30 days from the record generation date. See OPTN Policy 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 UNetSM Help Desk at 1-800-978-4334.

Provider Information

Lab: The lab, from Donor Organ Disposition in DonorNet, displays.

TX Center: The center, from Recipient Feedback, displays.

Recipient Information

Name: The recipient's name, from Recipient Feedback, displays.

DOB: The recipient's date of birth, from Recipient Feedback, displays.

Transplant Date: The recipient’s transplant date, from Recipient Feedback, displays.

Note: Determined by the beginning of organ anastomosis. For a multi-organ transplant procedure, the transplant date for each organ is determined by the transplant date of the first organ transplanted. The transplant is considered complete when the cavity is closed and the final skin stitch/staple is applied

SSN: The recipient's social security number, from Waitlist, displays.

Gender: The recipient's gender, from Recipient Feedback, displays.

HIC: The recipient's Health Insurance Claim (HIC) number, from the TCR, displays.

Most Recent CPRA: the recipient’s most recent CPRA, from Waitlist, displays

Peak CPRA: the recipient’s highest CPRA value ever calculated in the Waitlist, displays.

Organ(s): The recipient’s transplanted organ(s), from Recipient Feedback, displays.

Unacceptable Antigens: recipient’s most recent unacceptable antigens, from waiting list, display

Donor Information

UNOS Donor ID #: The donor's identification number, from Recipient Feedback, displays.

Donor Type: The donor type, from Recipient Feedback, displays.

Deceased indicates the donor was not living at the time of donation.
Living
indicates the donor was living at the time of donation.

Test Information

HLA Typing Done: If HLA typing was performed on this recipient, select Yes. If HLA typing was not performed, select No. If it is unknown if the recipient was typed, select UNK. This field is required. If HLA typing was done on the recipient, complete Section I.

HLA Antibody Screening Done: If HLA antibody screening was done on the recipient, select Yes. If not, select No. This field is required. If screening was done on the recipient, complete Section II.

Crossmatch Done: If crossmatch testing was done on the recipient, select Yes. If not, select No. This field is required. If crossmatch testing was done on the recipient, complete Section III.

If yes, was the crossmatch prospective to transplant: If the crossmatch was prospective, select Yes. If not, select No. If unknown, select UNK. If Yes is selected for Crossmatch Done, this field is required.

Donor Retyped at Your Center: If the donor was retyped at your laboratory, select Yes. If not, select No. This field is required. If the donor was retyped at your laboratory, complete Section IV.

Section I - Recipient HLA Typing

Note: If Yes is selected for HLA typing Done, the fields in Section I are required.

Date Typing Complete Class I: Enter the date that the recipient was tissue-typed by the histocompatibility laboratory for Class I antigens. Use the standard 8-digit numeric format of MM/DD/YYYY.

Typing Method Class I: Select, as appropriate, the typing method.

Serology
DNA

Other, Specify

Select the antigens from the drop-down lists. If the second antigen at a locus is blank, select No second antigen detected. If the donor was not tested for a particular antigen, select Not tested.

Note: If the split of an antigen is known, enter the split rather than the parent.

A Locus Codes: 1, 2, 3, 9, 10, 11, 19, 23, 24, 25, 26, 28, 29, 30, 31, 32, 33, 34, 36, 43, 66, 68, 69, 74, 80, 203, 210, 2403, 6601, 6602, Unknown, No second antigen detected, Not Tested

B Locus Codes: 5, 7, 8, 12, 13, 14, 15, 16, 17, 18, 21, 22, 27, 35, 37, 38, 39, 40, 41, 42, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 67, 70, 71, 72, 73, 75, 76, 77, 78, 81, 703, 804, 1304, 2708, 3901, 3902, 3905, 4005, 5102, 5103, 8201, Unknown, No second antigen detected, Not Tested

Bw4 HLA Codes: Positive, Negative, Unknown, Not Tested

Bw6 HLA Codes: Positive, Negative, Unknown, Not Tested

Cw HLA Codes: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 13, 14, 15, 16, 17, 18, Unknown, No second antigen detected, Not tested, No antigen detected

Date Typing Complete Class II: Enter the date that the recipient was tissue typed by the histocompatibility laboratory for Class I antigens. Use the standard 8-digit numeric format of MM/DD/YYYY. This field is required.

Typing Method Class II: Select, as appropriate, the typing method(s). This field is required.

Serology
DNA

Other, Specify

Select the antigens from the drop-down lists. If the second antigen at a locus is blank, select No second antigen detected. If the donor was not tested for a particular antigen, select Not tested. These fields are required.

Note: If the split of an antigen is known, enter the split rather than the parent.

DR Locus Codes: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 103, 1403, 1404, Unknown, No second antigen detected, Not tested

DR51 HLA Code: Positive, Negative, Unknown, Not Tested

DR52 HLA Code: Positive, Negative, Unknown, Not Tested

DR53 HLA Code: Positive, Negative, Unknown, Not Tested

DQB HLA Codes: 1, 2, 3, 4, 5, 6, 7, 8, 9, Unknown, No second antigen detected, Not tested

DQA HLA Codes: 01, 0101, 0102, 0103, 0104, 0105, 0106, 0107, 0108, 0109, 0110, 0111, 0112, 02, 0201, 03, 0301, 0302, 0303, 04, 0401, 0402, 0403N, 0404, 05, 0501, 0502, 0503, 0504, 0505, 0506, 0507, 0508, 0509, 0510, 0511, 06, 0601, No second antigen detected, Not tested

DPB HLA Codes: 01, 02, 0201, 0202, 03, 04, 0401, 0402, 05, 06, 08, 09, 10, 11, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61N, 62, 63, 64N, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120N, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142, 143, 144, 145, 146, 147, 148, 149, 150, 151, 152, 153, 154N, 155, 156, 157, 158, 159N, 160, 161N, 162, 163, 164, 165, 166, 167, 168, 169, 170, 171, 172, 173, 174, 175, 176, 177, 178, 179, 180, 181, 182, 183, 184, 185, 186, 187, 188, 189, 190, 191, 192, 193, 194, 195, 196, 197, 198, 199, 200, 201, 202, 203, 204, 205, 206, 207, 208, 209, 210, 211, 212, 213, Unknown, No second antigen detected, Not tested

DPA HLA Codes: 0103, 0104, 0105, 0201, 0202, 0401, No second antigen detected, Not tested

Note: Not tested is not a valid option for the A, B, Bw4, Bw6 and DR locus codes for kidney, pancreas or kidney/pancreas recipients on a kidney record.

Section II - HLA Antibody Screening

Note: If Yes is selected for HLA Antibody Screening Done, the fields in Section II are required.

Were any HLA antibodies detected by:

Cytotoxicity: Indicate whether HLA antibodies were detected by Cytotoxicity (Yes, No, Unknown, Not done).

Solid-phase: Indicate whether HLA antibodies were detected by Solid-phase (Yes, No, Unknown, Not done).

Were there current donor specific HLA antibodies?: (Yes, No, Unknown, Not Done)

Were there historical donor specific HLA antibodies?: (Yes, No, Unknown, Not Done)

CPRA (%) – Most Recent: Enter the most recent CPRA. CPRA Calculator can be used to compute this value. If value is unavailable, select the reason from the status (ST) drop-down list (Missing, Unknown, N/A, Not Done). Only available for thoracic recipients.

CPRA (%) – Peak: Enter the peak CPRA. CPRA Calculator can be used to compute this value. If value is unavailable, select the reason from the status (ST) drop-down list (Missing, Unknown, N/A, Not Done). Only available for thoracic recipients.

Section III - Crossmatch

Note: If Yes is selected for Crossmatch Done, the fields in Section III are required. If multiple crossmatches were performed, report data on crossmatches the transplant was based on.

Most Recent

Date of the most recent crossmatch serum: Enter the date of the serum that was most recently collected and tested to obtain crossmatch results before the transplant was performed. Use the standard 8-digit numeric format of MM/DD/YYYY.

Cell Source: Select cell source(s) from the available choices.

Peripheral Blood

Lymph Nodes

Spleen
Thymocytes
Cell lines/clonal cells
Solid Matrix
Multiple
Buccal Swab
Other


Which T-cell crossmatch tests were performed? Select all tests performed from available choices.


Cytotoxicity No AHG

Cytotoxicity AHG

Flow Cytometry

Solid Phase

Not tested


Result: Select the appropriate result for each T-cell crossmatch test reported


Indeterminate
Negative
Positive
Weak Positive


Which B-cell crossmatch tests were performed? Select all tests performed from available choices.


Cytotoxicity No AHG

Cytotoxicity AHG

Flow Cytometry

Solid Phase

Not tested


Result: Select the appropriate result for each B-cell crossmatch test reported


Indeterminate
Negative
Positive
Weak Positive


Which historical crossmatch tests were performed? Select all tests performed from available choices.


Cytotoxicity No AHG

Cytotoxicity AHG

Flow Cytometry

Solid Phase

Not tested


Result: Select the appropriate result for each historical crossmatch test reported


Indeterminate
Negative
Positive
Weak Positive


Section IV - Donor Retyping

Note: If Yes is selected for Donor Retyped at Your Center, the fields in Section IV are required.

Donor Retyped Class I: If the donor was retyped for HLA Class I antigens, select Yes. If not, select No. If unknown, select Unk.

Note: If Yes is selected, Donor A, B, Bw4, Bw6, and Cw HLA values, selected in DonorNet® or on the Donor Histocompatibility record, display for your reference.

Enter the Date Typing Completed for Class I using the standard 8-digit numeric format of MM/DD/YYYY.

Typing Method Class I: Indicate if the typing method is Serology and/or DNA. If a typing for Class I was done, complete the antigen section.

Select the antigens from the drop-down lists. If the second antigen at a locus is blank, select No second antigen detected. If the donor was not tested for a particular antigen, select Not tested.

Note:  If the split of an antigen is known, enter the split rather than the parent.

A Locus Codes: 1, 2, 3, 9, 10, 11, 19, 23, 24, 25, 26, 28, 29, 30, 31, 32, 33, 34, 36, 43, 66, 68, 69, 74, 80, 203, 210, 2403, 6601, 6602, Unknown, No second antigen detected, Not Tested

B Locus Codes: 5, 7, 8, 12, 13, 14, 15, 16, 17, 18, 21, 22, 27, 35, 37, 38, 39, 40, 41, 42, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 67, 70, 71, 72, 73, 75, 76, 77, 78, 81, 703, 804, 1304, 2708, 3901, 3902, 3905, 4005, 5102, 5103, 8201, Unknown, No second antigen detected, Not Tested

Bw4 HLA Codes: Positive, Negative, Not Tested

Bw6 HLA Codes: Positive, Negative, Not Tested

Cw HLA Codes: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 13, 14, 15, 16, 17, 18, No second antigen detected, Not tested, No antigen detected

Donor Retyped Class II: If the donor was retyped for HLA Class II antigens, select Yes. If not, select No. If unknown, select Unk.

Note: If Yes is selected, donor DR, DR51, DR52, DR53, DQB, DQA, DPB and DPA HLA values, selected on the donor record in DonorNet or on the Donor Histocompatibility record, display for your reference.

Enter the Date Typing Completed for Class II using the standard 8-digit numeric format of MM/DD/YYYY.

Typing Method Class II: Indicate if the typing method is Serology and/or DNA. If a typing for Class II was done, complete the antigen section.

Select the antigens from the drop-down lists. If the second antigen at a locus is blank, select No second antigen detected. If the donor was not tested for a particular antigen, select Not tested.

Note: If the split of an antigen is known, select the split rather than the parent.

DR Locus Codes: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 103, 1403, 1404, No second antigen detected, Not tested

DR51 HLA Code: Positive, Negative, Not Tested

DR52 HLA Code: Positive, Negative, Not Tested

DR53 HLA Code: Positive, Negative, Not Tested

DQB HLA Codes: 1, 2, 3, 4, 5, 6, 7, 8, 9, No second antigen detected, Not tested

DQA HLA Codes: 01, 0101, 0102, 0103, 0104, 0105, 0106, 0107, 0108, 0109, 0110, 0111, 0112, 02, 0201, 03, 0301, 0302, 0303, 04, 0401, 0402, 0403N, 0404, 05, 0501, 0502, 0503, 0504, 0505, 0506, 0507, 0508, 0509, 0510, 0511, 06, 0601, No second antigen detected, Not tested

DPB HLA Codes:01, 02, 0201, 0202, 03, 04, 0401, 0402, 05, 06, 08, 09, 10, 11, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61N, 62, 63, 64N, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120N, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142, 143, 144, 145, 146, 147, 148, 149, 150, 151, 152, 153, 154N, 155, 156, 157, 158, 159N, 160, 161N, 162, 163, 164, 165, 166, 167, 168, 169, 170, 171, 172, 173, 174, 175, 176, 177, 178, 179, 180, 181, 182, 183, 184, 185, 186, 187, 188, 189, 190, 191, 192, 193, 194, 195, 196, 197, 198, 199, 200, 201, 202, 203, 204, 205, 206, 207, 208, 209, 210, 211, 212, 213, Not testedDPA HLA Codes: 0103, 0104, 0105, 0201, 0202, 0401, No second antigen detected, Not tested

Note:  Not tested is not a valid option for the A, B and DR locus codes for kidney, pancreas or kidney/pancreas recipients on a kidney record.

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