1 Deceased Donor Registration_Form.xlsx

			Deceased Donor Registration (DDR)
			Fields to be completed by members
			Form Section	Field Label	Notes
			Donor Information	Donor ID	Display Only - Cascades from feedback
			Donor Information	OPO Center Code //OPO	Display Only - Cascades from feedback
			Donor Information	OPO Center Type //OPO	Display Only - Cascades from feedback
			Donor Information	Donor Hospital Provider Number	Display Only - Cascades from feedback
			Donor Information	Donor Hospital Name	Display Only - Cascades from Database
			Donor Information	Donor Hospital	Display Only - Cascades from Database
			Donor Information	Referral Date
			Donor Information	Recovered Outside the U.S.
			Donor Information	Country
			Donor Information	Last Name
			Donor Information	First Name
			Donor Information	MI	Not required
			Donor Information	DOB
			Donor Information	Age
			Donor Information	Age Unit
			Donor Information	Gender
			Donor Information	Home City
			Donor Information	State
			Donor Information	Zip Code
			Donor Information	Ethnicity/Race
			Donor Information	Citizenship
			Donor Information	Home Country
			Donor Information	Cause of Death
			Donor Information	Cause of Death //Specify
			Donor Information	Mechanism of Death
			Donor Information	Circumstances of Death
			Procurement and Authorization	Medical Examiner/Coroner
			Procurement and Authorization	Was the patient declared legally brain dead?
			Procurement and Authorization	Did the patient have written documentation of their intent to be a donor
			Procurement and Authorization	Driver's license
			Procurement and Authorization	Donor Card
			Procurement and Authorization	Donor Registry
			Procurement and Authorization	Durable Power of Attorney / Healthcare Proxy
			Procurement and Authorization	Advanced Directive
			Procurement and Authorization	Other Consent Mechanism //Other Specify
			Procurement and Authorization	Was the consent based solely on this documentation
			Procurement and Authorization	Did the patient express to family or others the intent to be a donor
			Procurement and Authorization	Cardiac arrest since neurological event that led to declaration of brain death
			Procurement and Authorization	Duration of Resuscitation //If Yes, Duration of Resuscitation
			Procurement and Authorization	Duration of Resuscitation //Status	Value or status is reported, not both
			Procurement and Authorization	Date and time of pronouncement of death: (Complete for brain dead and DCD donors)
			Procurement and Authorization	Date and time consent obtained for organ donation
			Clinical Information	ABO Blood Group	Display Only - Cascades from feedback
			Clinical Information	Height in Ft//Height	Display Only - Cascades from Database
			Clinical Information	Height in In//Height	Display Only - Cascades from Database
			Clinical Information	Height in cm
			Clinical Information	Height in cm //Status	Value or status is reported, not both
			Clinical Information	Weight in Lbs//Weight	Display Only - Cascades from Database
			Clinical Information	Weight in kg
			Clinical Information	Weight in kg //Status	Value or status is reported, not both
			Terminal Lab Data	Protein in Urine
			Terminal Lab Data	Serum Sodium
			Terminal Lab Data	Serum Sodium Status //Status	Value or status is reported, not both
			Terminal Lab Data	BUN
			Terminal Lab Data	BUN //Status	Value or status is reported, not both
			Terminal Lab Data	Serum Creatinine
			Terminal Lab Data	Serum Creatinine //Status	Value or status is reported, not both
			Terminal Lab Data	Total Bilirubin
			Terminal Lab Data	Total Bilirubin //Status	Value or status is reported, not both
			Terminal Lab Data	SGOT/AST
			Terminal Lab Data	SGOT/AST Status //Status	Value or status is reported, not both
			Terminal Lab Data	SGPT/ALT
			Terminal Lab Data	SGPT/ALT //Status	Value or status is reported, not both
			Terminal Lab Data	INR
			Terminal Lab Data	INR //Status	Value or status is reported, not both
			Terminal Lab Data	Hematocrit
			Terminal Lab Data	Hematocrit //Status	Value or status is reported, not both
			Terminal Lab Data	Serum Amylase
			Terminal Lab Data	Serum Amylase //Status	Value or status is reported, not both
			Terminal Lab Data	Serum Lipase
			Terminal Lab Data	Serum Lipase //Status	Value or status is reported, not both
			Terminal Lab Data	HbA1c
			Terminal Lab Data	HbA1c//Status	Value or status is reported, not both
			Serology	HIV Serology Results
			Serology	HIV Antigen/Antibody
			Serology	HTLV Serology Results
			Serology	RPR-VDRL
			Serology	Anti-CMV
			Serology	HBsAg Serology Results
			Serology	Anti-HBc Serology Results
			Serology	Anti-HCV Serology Results
			Serology	HBsAb
			Serology	EBV (VCA) (lgG)
			Serology	EBV (VCA) (lgM)
			Serology	EBNA
			Serology	Chagas Serology Results
			Serology	West Nile Serology Results
			Serology	Toxoplasma (IgG) Results
			Serology	Strongyloides Results
			NAT Results:	HIV NAT Results
			NAT Results:	HBV DNA Results
			NAT Results:	HCV NAT Results
			NAT Results:	HTLV NAT Results
			NAT Results:	Chagas NAT Results
			NAT Results:	West Nile NAT Results
			Donor Management	Steroids
			Donor Management	Diuretics
			Donor Management	T3
			Donor Management	T4
			Donor Management	Antihypertensives
			Donor Management	Vasodilators
			Donor Management	DDAVP
			Donor Management	Heparin
			Donor Management	Arginine Vasopressin
			Donor Management	Insulin
			Donor Management	Donor management other medication, specify	Not required
			Donor Management	Donor management other medication, specify (2)	Not required
			Donor Management	Donor management other medication, specify (3)	Not required
			Donor Management	Inotropic Medications at Time of Cross Clamp
			Donor Management	Medication
			Donor Management	Medication //Specify
			Donor Management	Medication
			Donor Management	Medication //Specify
			Donor Management	Medication
			Donor Management	Medication //Specify
			Donor Management	Number of transfusions during this (terminal) hospitalization
			Clinical Infection	Clinical Infection Confirmed by Culture
			Clinical Infection	Source
			Clinical Infection	Blood
			Clinical Infection	Lung
			Clinical Infection	Urine
			Clinical Infection	Other
			Clinical Infection	Other, specify
			Lifestyle Factors	Cigarette Use (> 20 pack years) - Ever
			Lifestyle Factors	Cigarette Use //AND continued in last six months
			Lifestyle Factors	Cocaine Use - Ever
			Lifestyle Factors	Cocaine Use //AND continued in last six months
			Lifestyle Factors	Other Drug Use (non - IV) - Ever
			Lifestyle Factors	Other Drug Use //AND continued in last six months
			Lifestyle Factors	Heavy Alcohol Use (heavy= 2+ drinks/day)
			Lifestyle Factors	Tattoos
			Lifestyle Factors	According to the OPTN policy in effect on the date of referral, does the donor have risk factors for blood-borne disease transmission
			Lifestyle Factors	History of Diabetes
			Lifestyle Factors	Insulin Dependent
			Lifestyle Factors	History of Hypertension
			Lifestyle Factors	Diet
			Lifestyle Factors	Diuretics
			Lifestyle Factors	Other anti-hypertensive medication
			Lifestyle Factors	History of Cancer
			Lifestyle Factors	History of Cancer //Specify
			Lifestyle Factors	Cancer Free Interval
			Lifestyle Factors	Cancer Free Interval //Status	Value or status is reported, not both
			Lifestyle Factors	Intracranial
			Lifestyle Factors	Type (Intracranial):
			Lifestyle Factors	Other Type/ Specify
			Lifestyle Factors	Extracranial
			Lifestyle Factors	Type (for Extracranial):
			Lifestyle Factors	Other Type/ Specify
			Lifestyle Factors	Skin
			Lifestyle Factors	Type (for Skin):
			Lifestyle Factors	Other Type/ Specify
			Lifestyle Factors	Chagas History
			Lifestyle Factors	TB History
			Organ Recovery	Recovery Date (donor to OR)
			Organ Recovery	Was this donor recovered under DCD protocol
			Organ Recovery	If Yes, Controlled
			Organ Recovery	If Yes, Date and time of withdrawal of support
			Organ Recovery	If Yes, Date and time agonal phase begins (systolic BP < 80 or O2 sat. < 80%)
			Organ Recovery	If DCD, Total urine output during OR recovery phase
			Organ Recovery	DCD Measures//Date and time of measures
			Organ Recovery	DCD Measures//Systolic blood pressure
			Organ Recovery	DCD Measures//Systolic blood pressure//Status	Value or status is reported, not both
			Organ Recovery	DCD Measures//Diastolic blood pressure
			Organ Recovery	DCD Measures//Diastolic blood pressure//Status	Value or status is reported, not both
			Organ Recovery	DCD Measures//Mean arterial pressure
			Organ Recovery	DCD Measures//Mean arterial pressure//Status	Value or status is reported, not both
			Organ Recovery	DCD Measures//O2 saturation
			Organ Recovery	DCD Measures//O2 saturation//Status	Value or status is reported, not both
			Organ Recovery	If Yes, Core Cooling Used
			Organ Recovery	If yes, Date and time of abdominal aorta core cooling
			Organ Recovery	Date and time of abdominal aorta core cooling://Status	Value or status is reported, not both
			Organ Recovery	If yes, Date and time of thoracic aorta core cooling
			Organ Recovery	Date and time of thoracic aorta core cooling://Status	Value or status is reported, not both
			Organ Recovery	If yes, Date and time of portal vein core cooling
			Organ Recovery	Date and time of portal vein core cooling://Status	Value or status is reported, not both
			Organ Recovery	If yes, Date and time of pulmonary artery core cooling
			Organ Recovery	Date and time of pulmonary artery core cooling://Status	Value or status is reported, not both
			Organ Recovery	If No, Was this a consented DCD donor that progressed to brain death?
			Organ Recovery	Clamp Date
			Organ Recovery	Clamp Time: (Military Time)
			Organ Recovery	Clamp Time //Status	Value or status is reported, not both
			Organ Recovery	Clamp Time Zone
			Organ Recovery	History of previous MI
			Organ Recovery	LV ejection fraction (%)
			Organ Recovery	LV Ejection Fraction % //Status	Value or status is reported, not both
			Organ Recovery	Method
			Organ Recovery	Structural Abnormalities //Valves
			Organ Recovery	Structural Abnormalities //Congenital
			Organ Recovery	Structural Abnormalities //LVH
			Organ Recovery	Wall Abnormalities //Segmental
			Organ Recovery	Wall Abnormalities //Global
			Organ Recovery	Heart machine perfusion
			Organ Recovery	Coronary Angiogram
			Organ Recovery	If Abnormal, # of Vessels with > 50% Stenosis
			Organ Recovery	ABG Results	Display Only
			Organ Recovery	Blood pH
			Organ Recovery	PH //Status	Value or status is reported, not both
			Organ Recovery	PCO<sub>2
			Organ Recovery	PCO2 //Status	Value or status is reported, not both
			Organ Recovery	PO2
			Organ Recovery	PO2//Status	Value or status is reported, not both
			Organ Recovery	FiO2
			Organ Recovery	FiO2//Status	Value or status is reported, not both
			Organ Recovery	PEEP
			Organ Recovery	PEEP//Status	Value or status is reported, not both
			Organ Recovery	Ventilator Mode
			Organ Recovery	Ventilator Mode//Other Specify
			Organ Recovery	Was a pulmonary artery catheter placed
			Organ Recovery	MAP (initial) // MAP: (mm Hg)
			Organ Recovery	MAP (initial) //Status	Value or status is reported, not both
			Organ Recovery	MAP (final) // MAP: (mm Hg)
			Organ Recovery	MAP (final) //Status	Value or status is reported, not both
			Organ Recovery	CVP (initial) // CVP: (mm Hg)
			Organ Recovery	CVP (initial) //Status	Value or status is reported, not both
			Organ Recovery	CVP (final) // CVP: (mm Hg)
			Organ Recovery	CVP (final) //Status	Value or status is reported, not both
			Organ Recovery	PCWP (initial) // PCWP: (mm Hg)
			Organ Recovery	PCWP (initial) //Status	Value or status is reported, not both
			Organ Recovery	PCWP (final) // PCWP: (mm Hg)
			Organ Recovery	PCWP (final) //Status	Value or status is reported, not both
			Organ Recovery	SVR (initial) //SVR: ((dynes/sec/cm)^5)
			Organ Recovery	SVR (initial) //Status	Value or status is reported, not both
			Organ Recovery	SVR (final) //SVR
			Organ Recovery	SVR (final) //Status	Value or status is reported, not both
			Organ Recovery	PA Systolic (initial) // PA Systolic: (mm Hg)
			Organ Recovery	PA Systolic (initial) //Status	Value or status is reported, not both
			Organ Recovery	PA Systolic (final) // PA Systolic: (mm Hg)
			Organ Recovery	PA Systolic (final) //Status	Value or status is reported, not both
			Organ Recovery	PA Diastolic (initial) // PA Diastolic: (mm Hg)
			Organ Recovery	PA Diastolic (initial) //Status	Value or status is reported, not both
			Organ Recovery	PA Diastolic (final) // PA Diastolic: (mm Hg)
			Organ Recovery	PA Diastolic (final) //Status	Value or status is reported, not both
			Organ Recovery	CO (initial) (L/min) //CO: (L/min)
			Organ Recovery	CO (initial) //Status	Value or status is reported, not both
			Organ Recovery	CO (final) (L/min) //CO
			Organ Recovery	CO (final) //Status	Value or status is reported, not both
			Organ Recovery	Cardiac Index (initial) //Cardiac Index: (L/min/sq.m)
			Organ Recovery	Cardiac Index (initial) //Status	Value or status is reported, not both
			Organ Recovery	Cardiac Index (final) //Cardiac Index
			Organ Recovery	Cardiac Index (final) //Status	Value or status is reported, not both
			Organ Recovery	Biopsy (heart donors only)
			Organ Recovery	Other Diagnosis /Specify
			Organ Recovery	Any Extracorporeal Support Given
			Organ Recovery	How long:
			Organ Recovery	How long://Status	Value or status is reported, not both
			Organ Recovery	Flow Rate
			Organ Recovery	Flow Rate//Status	Value or status is reported, not both
			Organ Recovery	Left Kidney Biopsy
			Organ Recovery	Type of Biopsy
			Organ Recovery	Type of Biopsy//Specify
			Organ Recovery	Interstitial Fibrosis
			Organ Recovery	Vascular Changes
			Organ Recovery	Number of Glomeruli Visualized
			Organ Recovery	% Glomerulosclerosis (Left Kidney) //Glomerulosclerosis
			Organ Recovery	Pump (Left Kidney) //Pump
			Organ Recovery	Final Resistance Prior to Shipping (left) //Final Resistance Prior to Shipping
			Organ Recovery	Final Resistance Prior to Shipping (left) //Status	Value or status is reported, not both
			Organ Recovery	Transferred on pump (left):// Transferred to transplant center on pump
			Organ Recovery	Type of Left Kidney Pump/Machine
			Organ Recovery	Type of Left Kidney Pump/Machine//Specify
			Organ Recovery	Kidney Biopsy (right)://Right Kidney Biopsy
			Organ Recovery	Type of Biopsy
			Organ Recovery	Type of Biopsy//Specify
			Organ Recovery	Interstitial Fibrosis
			Organ Recovery	Vascular Changes
			Organ Recovery	Number of Glomeruli Visualized
			Organ Recovery	% Glomerulosclerosis (Right Kidney)://Glomerulosclerosis
			Organ Recovery	Pump (Right Kidney) //Pump
			Organ Recovery	Final Resistance Prior to Shipping (right) //Final Resistance Prior to Shipping
			Organ Recovery	Final Resistance Prior to Shipping (right) //Status	Value or status is reported, not both
			Organ Recovery	Transferred on pump (right):// Transferred to transplant center on pump
			Organ Recovery	Type of Right Kidney Pump/Machine
			Organ Recovery	Type of Right Kidney Pump/Machine//Specify
			Organ Recovery	Liver Biopsy
			Organ Recovery	Type of Liver Biopsy
			Organ Recovery	Type of Liver Biopsy//Specify
			Organ Recovery	Fibrosis
			Organ Recovery	Portal Infiltrates
			Organ Recovery	% Macro vesicular fat
			Organ Recovery	% Macro vesicular fat //Status	Value or status is reported, not both
			Organ Recovery	% Micro/intermediate vesicular fat
			Organ Recovery	% Micro/intermediate vesicular fat //Status	Value or status is reported, not both
			Organ Recovery	Liver Machine Perfusion
			Organ Recovery	Type of Liver Machine Perfusion
			Organ Recovery	Type of Liver Machine Perfusion//Specify
			Organ Recovery	Left Lung Bronchoscopy
			Organ Recovery	Left Lung Machine Perfusion
			Organ Recovery	Right Lung Bronchoscopy
			Organ Recovery	Right Lung Machine Perfusion
			Organ Recovery	Chest X-ray
			Organ Disposition	Disposition of Organ - Right Kidney://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date and time right kidney recovered/removed from donor
			Organ Disposition	Recipient: RKI	Display Only - Cascades from Database
			Organ Disposition	SSN: RKI	Display Only - Cascades from Database
			Organ Disposition	TX Center: RKI	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Right Kidney://Reason Code
			Organ Disposition	Reason Code Right Kidney //Specify
			Organ Disposition	Reason organ not transplanted - Right Kidney://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Right Kidney //Specify
			Organ Disposition	Recovery Team# - Right Kidney://Recovery Team#
			Organ Disposition	Initial Flush Solution - Right Kidney://Initial Flush Solution
			Organ Disposition	Initial Flush - Right Kidney //Specify
			Organ Disposition	Back Table Flush Solution - Right Kidney://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Right Kidney //Specify
			Organ Disposition	chest X-ray
			Organ Disposition	Final Flush Right Kidney //Specify
			Organ Disposition	OPO sent vessels with organ: RKI	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: RKI	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: RKI	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Left Kidney://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date and time left kidney recovered/removed from donor
			Organ Disposition	Recipient: LKI	Display Only - Cascades from Database
			Organ Disposition	SSN: LKI	Display Only - Cascades from Database
			Organ Disposition	TX Center: LKI	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Left Kidney://Reason Code
			Organ Disposition	Reason Code Left Kidney //Specify
			Organ Disposition	Reason organ not transplanted - Left Kidney://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Left Kidney //Specify
			Organ Disposition	Recovery Team# - Left Kidney://Recovery Team#
			Organ Disposition	Initial Flush Solution - Left Kidney://Initial Flush Solution
			Organ Disposition	Initial Flush - Left Kidney //Specify
			Organ Disposition	Back Table Flush Solution - Left Kidney://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Left Kidney //Specify
			Organ Disposition	Final Flush Solution - Left Kidney://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Left Kidney //Specify
			Organ Disposition	OPO sent vessels with organ: LKI	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: LKI	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: LKI	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Double/En-bloc Kidney://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date and time double/en-bloc kidney recovered/removed from donor
			Organ Disposition	Recipient: EKI	Display Only - Cascades from Database
			Organ Disposition	SSN: EKI	Display Only - Cascades from Database
			Organ Disposition	TX Center: EKI	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Double/En-bloc Kidney://Reason Code
			Organ Disposition	Reason Code - Double/En-bloc Kidney //Specify
			Organ Disposition	Reason organ not transplanted -Double/En-bloc Kidney://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted - Double/En-bloc Kidney //Specify
			Organ Disposition	Recovery Team# - Double/En-bloc Kidney://Recovery Team#
			Organ Disposition	Initial Flush Solution - Double/En-bloc Kidney://Initial Flush Solution
			Organ Disposition	Initial Flush - Double/En-bloc Kidney //Specify
			Organ Disposition	Back Table Flush Solution - Double/En-bloc Kidney://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Double/En-bloc Kidney //Specify
			Organ Disposition	Final Flush Solution - Double/En-bloc Kidney://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Double/En-bloc Kidney //Specify
			Organ Disposition	OPO sent vessels with organ: EKI	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: EKI	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: EKI	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Pancreas://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date and time whole pancreas recovered/removed from donor
			Organ Disposition	Recipient: PA	Display Only - Cascades from Database
			Organ Disposition	SSN: PA	Display Only - Cascades from Database
			Organ Disposition	TX Center: PA	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Pancreas://Reason Code
			Organ Disposition	Reason Code - Pancreas //Specify
			Organ Disposition	Reason organ not transplanted -Pancreas://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Pancreas //Specify
			Organ Disposition	Recovery Team# - Pancreas://Recovery Team#
			Organ Disposition	Initial Flush Solution - Pancreas://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Pancreas //Specify
			Organ Disposition	Initial Flush Solution Volume
			Organ Disposition	Initial Flush Solution Volume//Status	Value or status is reported, not both
			Organ Disposition	Back Table Flush Solution - Pancreas://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Pancreas //Specify
			Organ Disposition	Back Table Flush Solution Volume
			Organ Disposition	Back Table Flush Solution Volume//Status	Value or status is reported, not both
			Organ Disposition	Final Flush Solution - Pancreas://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Pancreas //Specify
			Organ Disposition	OPO sent vessels with organ: PA	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: PA	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: PA	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Pancreas Segment 1://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date, and time pancreas segment 1 recovered/removed from donor
			Organ Disposition	Recipient: PAS1	Display Only - Cascades from Database
			Organ Disposition	SSN: PAS1	Display Only - Cascades from Database
			Organ Disposition	TX Center: PAS1	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Pancreas Segment 1://Reason Code
			Organ Disposition	Reason Code/Specify - Pancreas Segment 1 //Specify
			Organ Disposition	Reason organ not transplanted -Pancreas Segment 1://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Pancreas Segment 1 //Specify
			Organ Disposition	Recovery Team# - Pancreas Segment 1://Recovery Team#
			Organ Disposition	Initial Flush Solution - Pancreas Segment 1://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Pancreas Segment 1 //Specify
			Organ Disposition	Initial Flush Solution Volume
			Organ Disposition	Initial Flush Solution Volume//Status	Value or status is reported, not both
			Organ Disposition	Back Table Flush Solution - Pancreas Segment 1://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Pancreas Segment 1 //Specify
			Organ Disposition	Back Table Flush Solution Volume
			Organ Disposition	Back Table Flush Solution Volume//Status	Value or status is reported, not both
			Organ Disposition	Final Flush Solution - Pancreas Segment 1://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Pancreas Segment 1 //Specify
			Organ Disposition	OPO sent vessels with organ: PAS1	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: PAS1	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: PAS1	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Pancreas Segment 2://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date and time pancreas segment 2 recovered/removed from donor
			Organ Disposition	Recipient: PAS2	Display Only - Cascades from Database
			Organ Disposition	SSN: PAS2	Display Only - Cascades from Database
			Organ Disposition	TX Center: PAS2	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Pancreas Segment 2://Reason Code
			Organ Disposition	Reason Code/Specify - Pancreas Segment 2 //Specify
			Organ Disposition	Reason organ not transplanted -Pancreas Segment 2://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Pancreas Segment 2 //Specify
			Organ Disposition	Recovery Team# - Pancreas Segment 2://Recovery Team#
			Organ Disposition	Initial Flush Solution - Pancreas Segment 2://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Pancreas Segment 2 //Specify
			Organ Disposition	Initial Flush Solution Volume
			Organ Disposition	Initial Flush Solution Volume//Status	Value or status is reported, not both
			Organ Disposition	Back Table Flush Solution - Pancreas Segment 2://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Pancreas Segment 2 //Specify
			Organ Disposition	Back Table Flush Solution Volume
			Organ Disposition	Back Table Flush Solution Volume//Status	Value or status is reported, not both
			Organ Disposition	Final Flush Solution - Pancreas Segment 2://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Pancreas Segment 2 //Specify
			Organ Disposition	OPO sent vessels with organ: PAS2	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: PAS2	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: PAS2	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Liver://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date and time whole liver recovered/removed from donor
			Organ Disposition	Recipient: LI	Display Only - Cascades from Database
			Organ Disposition	SSN: LI	Display Only - Cascades from Database
			Organ Disposition	TX Center: LI	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Liver://Reason Code
			Organ Disposition	Reason Code/Specify - Liver //Specify
			Organ Disposition	Reason organ not transplanted -Liver://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Liver //Specify
			Organ Disposition	Recovery Team# - Liver://Recovery Team#
			Organ Disposition	Initial Flush Solution - Liver://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Liver //Specify
			Organ Disposition	Initial Flush Solution Volume
			Organ Disposition	Initial Flush Solution Volume//Status	Value or status is reported, not both
			Organ Disposition	Back Table Flush Solution - Liver://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Liver //Specify
			Organ Disposition	Back Table Flush Solution Volume
			Organ Disposition	Back Table Flush Solution Volume//Status	Value or status is reported, not both
			Organ Disposition	Final Flush Solution - Liver://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Liver //Specify
			Organ Disposition	OPO sent vessels with organ: LI	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: LI	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: LI	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Liver Segment 1://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date and time liver segment 1 recovered/removed from donor
			Organ Disposition	Recipient: LIS1	Display Only - Cascades from Database
			Organ Disposition	SSN: LIS1	Display Only - Cascades from Database
			Organ Disposition	TX Center: LIS1	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Liver Segment 1://Reason Code
			Organ Disposition	Reason Code/Specify - Liver Segment 1 //Specify
			Organ Disposition	Reason organ not transplanted -Liver Segment 1://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Liver Segment 1 //Specify
			Organ Disposition	Recovery Team# - Liver Segment 1://Recovery Team#
			Organ Disposition	Initial Flush Solution - Liver Segment 1://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Liver Segment 1 //Specify
			Organ Disposition	Initial Flush Solution Volume
			Organ Disposition	Initial Flush Solution Volume//Status	Value or status is reported, not both
			Organ Disposition	Back Table Flush Solution - Liver Segment 1://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Liver Segment 1 //Specify
			Organ Disposition	Back Table Flush Solution Volume
			Organ Disposition	Back Table Flush Solution Volume//Status	Value or status is reported, not both
			Organ Disposition	Final Flush Solution - Liver Segment 1://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Liver Segment 1 //Specify
			Organ Disposition	OPO sent vessels with organ: LIS1	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: LIS1	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: LIS1	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Liver Segment 2://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date and time liver segment 2 recovered/removed from donor
			Organ Disposition	Recipient: LIS2	Display Only - Cascades from Database
			Organ Disposition	SSN: LIS2	Display Only - Cascades from Database
			Organ Disposition	TX Center: LIS2	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Liver Segment 2://Reason Code
			Organ Disposition	Reason Code/Specify - Liver Segment 2 //Specify
			Organ Disposition	Reason organ not transplanted -Liver Segment 2://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Liver Segment 2 //Specify
			Organ Disposition	Recovery Team# - Liver Segment 2://Recovery Team#
			Organ Disposition	Initial Flush Solution - Liver Segment 2://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Liver Segment 2 //Specify
			Organ Disposition	Initial Flush Solution Volume
			Organ Disposition	Initial Flush Solution Volume//Status	Value or status is reported, not both
			Organ Disposition	Back Table Flush Solution - Liver Segment 2://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Liver Segment 2 //Specify
			Organ Disposition	Initial Flush Solution Volume
			Organ Disposition	Initial Flush Solution Volume//Status	Value or status is reported, not both
			Organ Disposition	Final Flush Solution - Liver Segment 2://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Liver Segment 2 //Specify
			Organ Disposition	OPO sent vessels with organ: LIS2	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: LIS2	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: LIS2	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Intestine://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date and time whole intestine recovered/removed from donor
			Organ Disposition	Recipient: IN	Display Only - Cascades from Database
			Organ Disposition	SSN: IN	Display Only - Cascades from Database
			Organ Disposition	TX Center: IN	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Intestine://Reason Code
			Organ Disposition	Reason Code/Specify - Intestine //Specify
			Organ Disposition	Reason organ not transplanted -Intestine ://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Intestine //Specify
			Organ Disposition	Recovery Team# - Intestine://Recovery Team#
			Organ Disposition	Initial Flush Solution - Intestine://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Intestine //Specify
			Organ Disposition	Back Table Flush Solution - Intestine://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Intestine //Specify
			Organ Disposition	Final Flush Solution - Intestine://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Intestine //Specify
			Organ Disposition	OPO sent vessels with organ: IN	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: IN	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: IN	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Intestine Segment 1://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date and time intestine segment 1 recovered/removed from donor
			Organ Disposition	Recipient: INS1	Display Only - Cascades from Database
			Organ Disposition	SSN: INS1	Display Only - Cascades from Database
			Organ Disposition	TX Center: INS1	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Intestine Segment 1://Reason Code
			Organ Disposition	Reason Code/Specify - Intestine Segment 1 //Specify
			Organ Disposition	Reason organ not transplanted -Intestine Segment 1://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Intestine Segment 1 //Specify
			Organ Disposition	Recovery Team# - Intestine Segment 1://Recovery Team#
			Organ Disposition	Initial Flush Solution - Intestine Segment 1://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Intestine Segment 1 //Specify
			Organ Disposition	Back Table Flush Solution - Intestine Segment 1://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Intestine Segment 1 //Specify
			Organ Disposition	Final Flush Solution - Intestine Segment 1://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Intestine Segment 1 //Specify
			Organ Disposition	OPO sent vessels with organ: INS1	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: INS1	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: INS1	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Intestine Segment 2://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date and time intestine segment 2 recovered/removed from donor
			Organ Disposition	Recipient: INS2	Display Only - Cascades from Database
			Organ Disposition	SSN: INS2	Display Only - Cascades from Database
			Organ Disposition	TX Center: INS2	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Intestine Segment 2://Reason Code
			Organ Disposition	Reason Code/Specify - Intestine Segment 2 //Specify
			Organ Disposition	Reason organ not transplanted -Intestine Segment 2://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Intestine Segment 2 //Specify
			Organ Disposition	Recovery Team# - Intestine Segment 2://Recovery Team#
			Organ Disposition	Initial Flush Solution - Intestine Segment 2://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Intestine Segment 2 //Specify
			Organ Disposition	Back Table Flush Solution - Intestine Segment 2://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Intestine Segment 2 //Specify
			Organ Disposition	Final Flush Solution - Intestine Segment 2://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Intestine Segment 2 //Specify
			Organ Disposition	OPO sent vessels with organ: INS2	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: INS2	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: INS2	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Heart://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date and time heart recovered/removed from donor
			Organ Disposition	Recipient: HR	Display Only - Cascades from Database
			Organ Disposition	SSN: HR	Display Only - Cascades from Database
			Organ Disposition	TX Center: HR	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Heart://Reason Code
			Organ Disposition	Reason Code/Specify - Heart //Specify
			Organ Disposition	Reason organ not transplanted -Heart://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Heart //Specify
			Organ Disposition	Recovery Team# - Heart://Recovery Team#
			Organ Disposition	Initial Flush Solution - Heart://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Heart //Specify
			Organ Disposition	Back Table Flush Solution - Heart://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Heart //Specify
			Organ Disposition	Final Flush Solution - Heart://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Heart //Specify
			Organ Disposition	OPO sent vessels with organ: HR	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: HR	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: HR	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Right Lung://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date and time left lung recovered/removed from donor
			Organ Disposition	Recipient: LUL	Display Only - Cascades from Database
			Organ Disposition	SSN: LUL	Display Only - Cascades from Database
			Organ Disposition	TX Center: LUL	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Right Lung://Reason Code
			Organ Disposition	Reason Code/Specify - Right Lung //Specify
			Organ Disposition	Reason organ not transplanted -Right Lung://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Right Lung //Specify
			Organ Disposition	Recovery Team# - Right Lung://Recovery Team#
			Organ Disposition	Initial Flush Solution - Right Lung://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Right Lung //Specify
			Organ Disposition	Back Table Flush Solution - Right Lung://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Right Lung //Specify
			Organ Disposition	Final Flush Solution - Right Lung://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Right Lung //Specify
			Organ Disposition	OPO sent vessels with organ: LUL	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: LUL	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: LUL	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Left Lung://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date and time right lung recovered/removed from donor
			Organ Disposition	Recipient: LUR	Display Only - Cascades from Database
			Organ Disposition	SSN: LUR	Display Only - Cascades from Database
			Organ Disposition	TX Center: LUR	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Left Lung://Reason Code
			Organ Disposition	Reason Code/Specify - Left Lung //Specify
			Organ Disposition	Reason organ not transplanted -Left Lung://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Left Lung //Specify
			Organ Disposition	Recovery Team# - Left Lung://Recovery Team#
			Organ Disposition	Initial Flush Solution - Left Lung://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Left Lung //Specify
			Organ Disposition	Back Table Flush Solution - Left Lung://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Left Lung //Specify
			Organ Disposition	Final Flush Solution - Left Lung://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Left Lung //Specify
			Organ Disposition	OPO sent vessels with organ: LUR	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: LUR	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: LUR	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Double/En-bloc Lung://Organ	Display Only - Cascades from feedback
			Organ Disposition	If DCD, date and time double/en-bloc lung recovered/removed from donor
			Organ Disposition	Recipient: DLU	Display Only - Cascades from Database
			Organ Disposition	SSN: DLU	Display Only - Cascades from Database
			Organ Disposition	TX Center: DLU	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Double/En-bloc Lung://Reason Code
			Organ Disposition	Reason Code/Specify - DoubleEn-bloc Lung //Specify
			Organ Disposition	Reason organ not transplanted -Double/En-bloc Lung://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Double/En-bloc Lung //Specify
			Organ Disposition	Recovery Team# - Double/En-bloc Lung://Recovery Team#
			Organ Disposition	Initial Flush Solution - Double/En-bloc Lung://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Double/En-bloc Lung //Specify
			Organ Disposition	Back Table Flush Solution - Double/En-bloc Lung://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Double/En-bloc Lung //Specify
			Organ Disposition	Final Flush Solution Specify - Double/En-bloc Lung //Specify
			Organ Disposition	Final Flush Solution - Double/En-bloc Lung://Final Flush/Storage Solution
			Organ Disposition	OPO sent vessels with organ: DLU	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: DLU	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: DLU	Display Only - Cascades from Database
			PUBLIC BURDEN STATEMENT:
			The private, non-profit Organ Procurement and Transplantation Network (OPTN) collects this information in order to perform the following OPTN functions: to assess whether applicants meet OPTN Bylaw requirements for membership in the OPTN; and to monitor compliance of member organizations with OPTN Obligations. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this information collection is 0915-0157 and it is valid until XX/XX/202X. This information collection is required to obtain or retain a benefit per 42 CFR §121.11(b)(2). All data collected will be subject to Privacy Act protection (Privacy Act System of Records #09-15-0055). Data collected by the private non-profit OPTN also are well protected by a number of the Contractor’s security features. The Contractor’s security system meets or exceeds the requirements as prescribed by OMB Circular A-130, Appendix III, Security of Federal Automated Information Systems, and the Departments Automated Information Systems Security Program Handbook. The public reporting burden for this collection of information is estimated to average 0.7 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or [email protected].