Kidney Paired Donation Donor Registration Field Descriptions
Home transplant center: Center code and center name. This field is required.
Is this a non-directed donor?: (Values: Yes, No). This is a required field.
KPD candidate ID: unique numeric value assigned by system when candidate is entered into KPD. This field is required if non-directed donor is set to no.
Donor name: Donor’s last name, first name, and middle initial (if applicable). This field is required.
SSN: Donor’s social security number. Numeric format XXXXXXXXX. This field is required.
Date of birth: Donor’s date of birth. MM/DD/YYYY format. This field is required.
Donor status: (Values: Active, Inactive). This field is required.
Home transplant center: Transplant center code and center name. This field is required.
Is this a non-directed donor?: (Values: Yes, No). This field is required.
Donor name: Donor's last name, first name and middle initial (if applicable). This field is required.
SSN: Donor's Social Security Number. Numeric format XXXXXXXXX. Do not use dashes. This field is required.
Date of birth: Donor's date of birth in MM/DD/YYYY format. This field is required.
Donor status: (Values: Active, Inactive). This field is required.
The Home transplant center displays. This field cannot be updated on this page.
Last name: The KPD donor's last name. Alphanumeric. This field is required for eligibility on the match run.
First name: The KPD donor's first name. Alphanumeric. This field is required for eligibility on the match run.
Middle initial: The KPD donor’s middle initial (if applicable).
SSN: The KPD donor's social security number. Numeric format XXXXXXXXX. Do not use dashes. This field is required.
Date of birth: The KPD donor's date of birth in MM/DD/YYYY format. This field is required.
Current age: The KPD donor's current age. The KPD donor's current age is calculated based on the date of birth and today's date. This field cannot be updated on this page.
Gender: KPD donor gender. (Values: Male, Female) This field is required for eligibility on the match run.
Center's patient ID: KPD donor's patient ID.
State of permanent residence: KPD donor's state of permanent residence.
Permanent zip code: Permanent zip code in which the KPD donor lives. Numeric format - XXXXX or XXXXX-XXXX.
Donor Summary Details
Demographic Information
Ethnicity/race: If the KPD candidate has an existing record in WaitlistSM, the KPD candidate's ethnicity or race is copied from WaitlistSM. Otherwise, select the KPD candidate's ethnicity or race from the available choices. This field is required for eligibility on the match run.
American Indian or Alaska Native: (Values: American Indian, Eskimo, Aleutian, Alaska Indian, American Indian or Alaska Native: Other, American Indian or Alaska Native: Not Specified/Unknown).
Asian: (Values: Asian Indian/Indian Sub-Continent, Chinese, Filipino, Japanese, Korean, Vietnamese, Asian: Other, Asian: Not Specified/Unknown).
Black or African American: (Values: African American, African (Continental), West Indian, Haitian, Black or African American: Other: Black or African American: Not Specified/Unknown).
Hispanic/Latino: (Values: Mexican, Puerto Rican (Mainland), Puerto Rican (Island), Cuban, Hispanic/Latino: Other, Hispanic/Latino: Not Specified/Unknown).
Native Hawaiian or Other Pacific Islander: (Values: Native Hawaiian, Guamanian or Chamorro, Samoan, Native Hawaiian or Other Pacific Islander: Other, Native Hawaiian or Other Pacific Islander: Not Specified/Unknown).
White: (Values: European Descent, Arab or Middle Eastern, North African (non-Black), White: Other, White: Not Specified/Unknown).
Donor Summary Details
ABO: KPD Donor ABO. (Values: O, A, A1, A2, B, AB, A1B, A2B). This field is required for eligibility on the match run. Once the ABO has been verified by a second user, this field cannot be updated.
Note: If the second user only verifies the "primary" blood type, the sub-types can be updated. Once the subtypes have been entered and verified, the ABO blood type can no longer be updated.
Height: KPD donor height. Format entered in feet and inches. This field is required for eligibility on the match run. The height also displays in centimeters.
Weight: KPD donor's weight in kilograms. This field is required for eligibility on the match run. The weight also displays in pounds.
BMI: Body Mass Index is a measure that adjusts body weight for height. The BMI is calculated by the system based on the ratio of the weight of the body in kilograms to the square of its height in meters. This field cannot be updated.
Is this a non-directed donor?: (Values: Yes, No). This field is required.
Intended KPD Candidate ID: This field is required if the non-directed donor field is set to No.
Candidate name: KPD paired candidate name from candidate record. This field is read-only and only displays if the donor is a non-directed donor.
Donor's relationship to candidate: This field is required. (Values: Biological, blood-related parent; Biological, blood-related child; Biological, blood-related identical twin; Biological, blood-related full sibling; Biological, blood-related half sibling; Biological, blood-related other relative: specify; Non Biol., spouse; Non Biol., life partner; Non Biol., socially related: specify; Non Biol., Other unrel. direct donation: specify).
Are you willing to start a chain that continues with a bridge donor?: (Values: Yes, No). This field is required for eligibility on the match run.
Does the donor have health insurance?: (Values: Yes, No, Unknown).
Yes, No). This field is required for eligibility on the match run.
Yes, No). This field is required for eligibility on the match run.
Has the donor signed a living donor consent form as outlined in the KPD Operational Guidelines?: (Values: Yes, No). This field is required for eligibility on the match run.
Has the donor undergone an evaluation as outlined in the KPD Operational Guidelines?: (Values: Yes, No). This field is required for eligibility on the match run.
Has the donor had all age appropriate cancer screenings as defined by the American Cancer Society?: (Values: Yes, No). This field is required for eligibility on the match run.
KPD status: (Values: Active, Inactive, Removed). This field is required.
Inactive reason: If KPD status is set to Inactive, the Inactive reason is required.
List of inactive reasons:
Temporarily Ineligibility: Donor currently ineligible for OPTN KPD Pilot Program (e.g. incomplete data, incomplete work-up, etc.)
Candidate Inactive: Donor is temporarily inactive because candidate is temporarily inactive
Medical Non-Compliance: Donor temporarily inactive due to medical non-compliance
Donor Choice: Donor temporarily inactive due to donor choice
Insurance Issues: Donor temporarily inactive due to insurance issues
Operational Issues: Donor temporarily inactive due to operational issues (e.g. physician/surgeon unavailable, heavy workload at centers, etc.)
Temporarily medically unsuitable: Donor temporarily inactive because of temporary medical ineligibility (e.g. illness, pregnancy)
Transplant Pending: OPTN KPD Pilot Program exchange pending
Transplant Pending: Other KPD program exchange pending
Transplant Pending: Non-KPD transplant pending
Limit on number of donors associated with a candidate: Donor temporarily inactive because two other donors associated with the candidate are active
Bridge donor on hold from participating in match runs
Other, specify
Specify: If the Inactive reason is set to Other, the Specify field is required.
Removal reason: If the KPD status is set to Removed, the Removal reason field is required.
List of inactive reasons:
Removed: Donor chose to withdraw from OPTN KPD Pilot Program
Removed: Donor removed because paired candidate removed from OPTN Pilot Program
Removed: Donor unable to complete work-up
Removed: Donor not suitable according to program criteria
Removed: Donor too sick
Removed: Donor expired
Transplant: Donated through OPTN KPD Pilot Program
Transplant: Donated through other KPD program
Transplant: Non-KPD donation
Other, Specify
Specify: If the Removal reason is set to Other, the Specify field is required.
Donor Summary Details
Comments – Up to 2,000 alphanumeric characters.
Home transplant center: The center code for the home transplant center. This field cannot be updated on this page.
History of diabetes: (Values: No, Yes 0-5 years, Yes 6-10 years, Yes > 10 years, Yes Duration Unknown, Unknown)
History of cancer: List of values
No
Skin-squamous, basal cell
Skin-Melanoma
CNS tumor- Astrocytoma
CNS tumor- Glioblastoma multiforme
CNS tumor – Medullablastoma
CNS tumor – Neuroblastoma
CNS tumor – Angioblastoma
CNS tumor – Meningioma
CNS tumor – Other
Genitourinary – Bladder
Genitourinary – Uterine cervix
Genitourinary – Uterine body endometrial
Genitourinary – Uterine body choriocarcinoma
Genitourinary – Vulva
Genitourinary – Ovarian
Genitourinary – Penis, testicular
Genitourinary – Prostate
Genitourinary – Kidney
Genitourinary – Unknown
Gastrointestinal – Esophageal
Gastrointestinal – Stomach
Gastrointestinal – Small intestine
Gastrointestinal – Colo-rectal
Gastrointestinal – Liver & biliary tract
Gastrointestinal – Pancreas
Breast
Thyroid
Tongue/Throat
Larynx
Lung (including bronchial)
Leukemia/Lymphoma
Unknown
Other, specify
Specify: Enter the specific type of cancer. If History of cancer field is set to Other, this field is required. Valid range: 1-100 alphanumeric characters.
History of hypertension: (Values: No, Yes 0-5 years, Yes 6-10 years, Yes > 10 years, Yes Duration Unknown, Unknown).
Compliant with treatment: (Values: Yes, No, Unknown).
Number of medications for hypertension that the donor is on: (Values: 0, 1, 2, 3, 4+). This field is required for eligibility on the match.
Please indicate the type of anti-hypertension medication and dosage: Alphanumeric. This field is required if the number of medications for hypertension is set to 1, 2, 3 or 4+.
Alphanumeric. This field is required if the number of medications for hypertension is set to 1, 2, 3, or 4+.
History of coronary artery disease (CAD): (Values: Yes, No, Unknown).
Previous gastrointestinal disease: (Values: Yes, No, Unknown).
Cigarette use (>20 pack years) ever: (Values: Yes, No, Unknown).
Cigarette use continued in last 6 months: (Values: Yes, No, Unknown).
Heavy alcohol use (2+ drinks/day): (Values: Yes, No, Unknown).
I.V. drug usage: (Values: Yes, No, Unknown).
Abdominal trauma/surgery: (Values: Yes, No, Unknown).
Number of arteries: Number of arteries. (Values: Whole number 1-9).
Number of veins: Number of veins. (Values: Whole number 1- 9).
Ureter: (Values: Single, Double, Triple, Unknown).
Vital Signs
Home transplant center: The center code for the home transplant center. This field cannot be updated on this page.
Was 24-hour blood pressure monitor used?: (Values: Yes, No). This field is required for eligibility on the match run.
If Yes is entered for Was 24-hour blood pressure monitor used?, the following fields are required:
Blood pressure systolic (average of 24-hour period): Whole number between 0 and 300. This field is required for eligibility on the match run.
Blood pressure diastolic (average of 24-hour period): Whole number between 0 and 200. This field is required for eligibility on the match run.
Blood pressure date start (start of 24-hour period): Date when the 24-hour period began. MM/DD/YYYY format. This field is required for eligibility on the match run.
Vital Signs
Vital Signs
If No is entered for Was 24-hour blood pressure monitor used?, the following fields are required:
Blood pressure systolic 1: Whole number between 0 and 300. This field is required for eligibility on the match run.
Blood pressure diastolic 1: Whole number between 0 and 200. This field is required for eligibility on the match run.
Blood pressure date 1: Date when the blood pressure was taken. Format: MM/DD/YYYY. This field is required for eligibility on the match run.
Blood pressure systolic 2: Whole number between 0 and 300. This field is required for eligibility on the match run.
Blood pressure diastolic 2: Whole number between 0 and 200. This field is required for eligibility on the match run.
Blood pressure date 2: Date when the blood pressure was taken. MM/DD/YYYY format. This field is required for eligibility on the match run.
Was a stress test performed?: (Values: Yes, No, Unknown).
Comments – Up to 2000 alphanumeric characters.
Home transplant center: The center code for the home transplant center. This field cannot be updated on this page.
Enter either the donor's GFR or Creatinine Clearance value.
Date: MM/DD/YYYY format. This field is required for eligibility on the match run.
Creatinine clearance (24 hours urine collection) (mL/min): Whole number between 50 and 200. This field is required for eligibility on the match run.
Date: Date in MM/DD/YYYY format. This field is required for eligibility on the match run.
GFR (isotopic method) (mL/min/1.73m2): Whole number. This field is required for eligibility on the match run.
HbA1c (%): Number between 2 and 15 and its corresponding date in MM/DD/YYYY format.
Oral glucose tolerance test (OGTT): Whole number between 5 and 500.
Method: Method by which the OGTT was administered. (Values: Fasting, 1-hour, 2-hour).
Date: Oral glucose tolerance test date in MM/DD/YYYY format.
Microalbumin: Number between 15 and 300 and corresponding date in MM/DD/YYYY format.
Urine protein-to-creatinine ratio: Number between 0 and 3 and corresponding date in MM/DD/YYYY format.
24 hour urine protein: Number between 0 and 3000 and corresponding date in MM/DD/YYYY format.
Date: Date of the urinalysis in MM/DD/YYYY format.
Color: KPD donor urine color. Alphanumeric field.
Appearance: KPD donor urine appearance. Alphanumeric field.
pH: Whole number between 5 and 10.
Specific gravity: Number between 1 and 1.5.
Protein: (Values: Positive, Negative).
Glucose: (Values: Positive, Negative).
Blood: (Values: Positive, Negative).
RBC: (Values: Positive, Negative).
WBC: (Values: Positive, Negative).
Epith (%): (Values: Positive, Negative).
Casts: (Values: Positive, Negative).
Bacteria: (Values: Positive, Negative).
Leukocyte esterase: (Values: Positive, Negative).
Date: Date in MM/DD/YYYY format.
Na (mEq/L): Whole number between 0 and 99999.
K+ (mmol/L): Number between 0 and 999.
Cl (mmol/L): Whole number between 0 and 9999.
CO2 (mmol/L): Number between 0 and 999.
BUN (mg/dL): Whole number between 0 and 9999.
Creatinine (mg/dL): Number between 0 and 999.
Glucose (mg/dL): Whole number between 0 and 9999.
Total bilirubin (mg/dL): Number between 0 and 9999.
Direct bilirubin (mg/dL): Number between 0 and 9999.
Indirect bilirubin (mg/dL): Number between 0 and 9999.
SGOT AST (u/L): Whole number between 1 and 36000.
SGPT ALT (u/L): Whole number between 1 and 50000.
Alkaline phosphatase (u/L): Whole number between 0 and 9999.
GGT (u/L): Whole number between 0 and 9999.
LDH (u/L): Whole number between 0 and 99999.
Albumin (g/dL): Number between 0 and 999.
Total protein (g/dL): Number between 0 and 999.
Prothrombin (PT) (seconds): Number between 0 and 9999.
INR: Number between 0 and 999.
PTT (seconds): Number between 0 and 9999.
Serum amylase (u/L): Number between 0 and 9999.
Serum lipase (u/L): Number between 0 and 9999.
Date: Date in MM/DD/YYYY format. If you enter a date, you must enter CBC values.
WBC (thous/mcL): Number between 1 and 99.
RBC (mill/mcL): Number between 1 and 99.
HgB (g/dL): Number between 1 and 99.
Hct (%): Number between 0 and 99.
Plt (thous/mcL): Whole number between 0 and 999.
Bands (%): Whole number between 0 and 99.
Comments: Up to 2,000 alphanumeric characters.
For a donor to be eligible for matches, required serologies must be either Positive or Negative.
Anti-CMV: (Values: Positive, Negative, Unknown, Not Done, Indeterminate, Pending). This field is required for eligibility on the match run.
EBV (VCA) (IgG): (Values: Positive, Negative, Unknown, Not Done, Indeterminate, Pending). This field is required for eligibility on the match run.
HBsAg: (Values: Positive, Negative, Unknown, Not Done, Indeterminate,
Pending). This field is required for eligibility on the match run.
Anti-HBcAb: (Values: Positive, Negative, Unknown, Not Done, Indeterminate, Pending). This field is required for eligibility on the match run.
HBsAb: (Values: Positive, Negative, Unknown, Not Done, Indeterminate, Pending).
Anti-HCV: (Values: Positive, Negative, Unknown, Not Done, Indeterminate, Pending).
Anti-HIV I/II: (Values: Positive, Negative, Unknown, Not Done, Indeterminate, Pending).
Anti-HTLV I/II: (Values: Positive, Negative, Unknown, Not Done, Indeterminate, Pending).
RPR/VDRL: (Values: Positive, Negative, Unknown, Not Done, Indeterminate, Pending).
EBNA: (Values: Positive, Negative, Unknown, Not Done, Indeterminate, Pending).
EBV (VCA) (IgM): (Values: Positive, Negative, Unknown, Not Done, Indeterminate, Pending).
Comments: Up to 2000 alphanumeric characters.
Please select test or attachment: (Values: Test, Attachment). This field is required.
Test type: This field is required. Values:
Test date: Date of the test in MM/DD/YYYY format.
Diagnostic evaluation/comments: Alphanumeric. 1- 5000 characters.
Attach medical image: (Values: Yes, No).
Description: Enter a description of the image. This field is required.
Select file: Click Browse to search for the file on your computer and select it. This field is required.
All fields in the Tests and Diagnoses table are read-only.
Please select test or attachment: (Values: Test, Attachment). This field is required.
Description: Description of the attachment you wish to attach. Alphanumeric format. This field is required.
Select File: This field is required if Attachment is selected for Please select test or attachment field.
All fields in the Attachments table are read-only.
Reason deleted: Reason the attachment was deleted. Alphanumeric. This field is required when deleting an attachment.
Home transplant center: The center code for the home transplant center displays. This field cannot be updated on this page.
A: KPD Donor A antigens. Values for both fields are required for eligibility on the match run.
B: KPD Donor B antigens. Values for both fields are required for eligibility on the match run.
BW4: KPD Donor BW4 antigen. This field is required for eligibility on the match run.
BW6: KPD Donor BW6 antigen. This field is required for eligibility on the match run.
C: KPD Donor C antigens. Values for both fields are required for eligibility on the match run.
DR: KPD donor DR antigens. Values for both fields are required for eligibility on the match run.
DR51: KPD donor DR51 antigen. This field is required for eligibility on the match run if corresponding unacceptable antigens are reported.
DR52: KPD donor DR52 antigen. This field is required for eligibility on the match run if corresponding unacceptable antigens are reported.
DR53: KPD donor DR53 antigen. This field is required for eligibility on the match run if corresponding unacceptable antigens are reported.
DQB1: KPD donor DQB1 antigens. Values for both fields are required for eligibility on the match run.
DQA1: KPD donor DQA1 antigens from both drop-down lists. Values for both fields are
required for eligibility on the match run.
DPB1: KPD donor DPB1 antigens. Values for both fields are required for eligibility on the match run.
Note: For ambiguities involving “G” alleles, you should report the lowest member of the “G” allele string. For example, if your lab receives a 04:02/105:01 typing result, you should report 04:02.
Comments: Up to 2000 alphanumeric characters.
Home transplant center: The center code for the home transplant center. This field cannot be updated on this page.
Donor willing to travel?: (Values: Yes, No). This field is required for eligibility on the match run.
If Yes, to which center(s) is the donor willing to travel?: This field is required if Donor willing to travel field is set to Yes.
Is the donor willing to have his or her kidney shipped?: (Values: Yes, No). This field is
required for eligibility on the match run.
This donor can ONLY donate his or her following kidney: (Values: Right kidney, Left kidney, Either kidney). This field is required for eligibility on the match run.
Pair and center willing to participate in a 3-way match?: (Values: Yes, No). This field is required for eligibility on the match run.
If matched with an opportunity to be a bridge donor, does the donor consent and the center agree to continue the chain as a bridge donor?: (Values: Yes, No). This field is required for eligibility on the match run.
The ABO must be verified by a second user before the donor can be eligible for KPD match runs.
Home transplant center: This field cannot be updated on this page.
Last name: KPD donor last name. This field is read-only.
First name: KPD donor first name. This field is read-only.
Middle initial: KPD donor middle initial. This field is read-only.
ABO: KPD donor ABO. (Values: O, A, A1, A2, B, AB, A1B, A2B). This field is required.
Age: KPD donor age. This field is read-only.
Gender: KPD donor gender. (Values: Male, female). This field is read-only.
First user ABO entry: - The name of the first person to enter the KPD donor’s ABO displays. This field is read-only.
IF a living donor is subtyped and is found to be A2 or A2B, then a second subtype test must be completed. If the ABO subtype is successfully verified, the verified ABO subtype will be used for match runs. If the ABO subtype is unverified, the verified primary ABO will be used for match runs.
Home transplant center: This field cannot be updated on this page.
Last name: KPD donor last name. This field is read-only.
First name: KPD donor first name. This field is read-only.
Middle initial: KPD donor middle initial. This field is read-only.
ABO: KPD donor ABO. Values (O, A, A1, A2, B, AB, A1B, A2B) – This field is required.
Age: KPD donor age. This field is read-only.
Gender: KPD donor gender. (Values: Male, Female). This field is read-only.
First ABO subtype user: - The name of the first person to enter the KPD donor’s ABO displays. This field is read-only.
Home transplant center: KPD donor’s home transplant center code and name. This field is required.
KPD donor ID: Unique identifier for the KPD donor generated by the system. This field is read-only.
Donor name: KPD donor name. This field is read-only.
Match run date donor became a bridge donor: Date value determined by system. Format: MM/DD/YYYY. This field is read-only.
Bridge donor on hold: If box is checked the donor will not be included in match runs. If box is unchecked, the donor will be included in match runs. This field is optional.
Access bridge donor record: link
Exchange number: Unique identifier for the exchange. System generated. This field is read-only.
Home transplant center: Transplant center code and name. This field is required.
KPD donor ID: Unique identifier for KPD donor generated by the system. This field is read-only.
Donor name: KPD donor name. This field is read-only.
Bridge donor status: (Values: Pending Bridge Donor, Pending Exchange Accepted, Donating to WaitlistSM, Declined to Donate). This field is required.
Bridge donor status date: Pre-filled with current date. If bridge donor status field is changed, the bridge donor status date must be reentered. Date cannot be a future date. Date must not be prior to Match Run date, when donor became a bridge donor. This field is required.
Bridge donor on hold: If box is checked, the donor will not be included in match runs. If box is unchecked, the donor will be included in match runs. This field is optional.
KPD donor status: (Values: Active, Inactive, Removed). This field is read-only.
Match run date donor became a bridge donor: Date value determined by system. This field is read-only.
Exchange number: Unique identifier for the exchange generated by system. This field is read-only.
Bridge donor status: Declined to donate reason
Bridge donor status declined to donate reasons: This field is required if bridge donor status is set to decline to donate.
Life circumstances have changed: (Values: Employment, School, Social, Family Situation, Other).
Medical condition has changed: (Values: Pregnancy, Hypertension, Diabetes/pre-diabetes, Increase in BMI, Kidney Diseases/Stones, Cancer, Other).
Other reasons: (Values: Paired recipient had a poor transplant outcome, Wait was too long after paired recipient was transplanted, Unknown donor did not disclose, Other).
Enter Comments: This field is required if Other or Unknown is selected. Alphanumeric format.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Kidney Paired Donation Donor Registration_Instructions |
| File Modified | 0000-00-00 |
| File Created | 2022-02-18 |