57 Kidney Paired Donation Match Offer Management_Form.xlsx

Data System for Organ Procurement and Transplantation Network

Kidney Paired Donation Match Offer Management_Form.xlsx

Kidney Paired Donation Match Offer Management

OMB: 0915-0157

Document [xlsx]
Download: xlsx | pdf



Kidney Paired Donation Match Offer Management Form



Fields to be completed by members







Form Section Field Label Notes



Match Response Match Run Number System generated each time match is executed. This field is read-only



Match Response Match Run Date This field is read-only



Match Response Exchange Number System generated. This field is read-only



Match Response Match ID System generated. This field is read-only



Match Response Matched donor ID System generated. This field is read-only



Match Response Donor name This field is read-only



Match Response KPD candidate ID System generated. This field is read-only



Match Response Candidate name This field is read-only



Match Response Candidate center This field is read-only



Match Response Paired donor at the end of a chain The value is determined by the system. This field is read-only



Match Response Match state System determined. This field is read-only



Match Response Preliminary Response Preliminary response



Match Response (preliminary acceptance) Crossmatch Results Crossmatch results



Match Response (preliminary acceptance) Crossmatch Results Crossmatch date



Match Response (preliminary acceptance) Crossmatch Results Match status



Match Response (preliminary refuse) Match status (match did not result in a transplant) Match status



Match Response (preliminary refuse) Match status (match did not result in a transplant) Primary reason This field only displays if the preliminary response is set to Refuse



Match Response (preliminary refuse) Match status (match did not result in a transplant) Secondary reason This field is optional



Match Response (preliminary refuse) Match status (match did not result in a transplant) Future matching: Would your candidate be willing to match to this donor in a future match run?



Match Response (preliminary refuse) Match status (match did not result in a transplant) Primary reason – Other, specify



Match Response (preliminary refuse) Match status (match did not result in a transplant) Secondary reason – Other, specify



Select Exchange Ending Donor Match run number System generated each time match is executed. This field is read-only



Select Exchange Ending Donor Match run date This field is read-only



Select Exchange Ending Donor Exchange number System generated. This field is read-only



Select Exchange Ending Donor Selected



Select Exchange Ending Donor KPD donor ID



Select Exchange Ending Donor Donor name



Select Exchange Ending Donor Age



Select Exchange Ending Donor BMI



Select Exchange Ending Donor ABO



Select Exchange Ending Donor Bridge



Select Exchange Ending Donor Kidney choice



Select Exchange Ending Donor Number of arteries



Select Exchange Ending Donor Number of veins



Exchange ending donor donating to the Waitlist (refusal) Preliminary response



Exchange ending donor donating to the Waitlist (refusal) Match status



Enter the reason(s) the match did not result in a transplant Primary reason



Enter the reason(s) the match did not result in a transplant Secondary reason



Exchange ending donor donating to the Waitlist (preliminary acceptance) Preliminary response



Exchange ending donor donating to the Waitlist (preliminary acceptance) Match status



Exchange Message Board Exchange Information Match run number System generated each time match is executed. This field is read-only



Exchange Message Board Exchange Information Match run date This field is read-only



Exchange Message Board Exchange Information Exchange number System generated. This field is read-only



Exchange Message Board Exchange Information Match ID System generated. This field is read-only



Exchange Message Board Exchange Information Matched donor ID System generated. This field is read-only



Exchange Message Board Exchange Information Donor name This field is read-only



Exchange Message Board Exchange Information Donor center This field is read-only



Exchange Message Board Exchange Information KPD candidate ID System generated. This field is read-only



Exchange Message Board Exchange Information Candidate name This field is read-only



Exchange Message Board Exchange Information Candidate center This field is read-only



Exchange Message Board Exchange activity dates Match state This field is read-only



Exchange Message Board Exchange activity dates When will crossmatches will be performed?



Exchange Message Board Exchange activity dates When were donor records available to the candidate hospital?



Exchange Message Board Exchange activity dates Crossmatch results This field is read-only



Exchange Message Board Exchange activity dates When was donor acceptance confirmed?



Exchange Message Board Exchange activity dates Surgery scheduled for: This field is read-only



Exchange Message Board Message History Alert me by email when new messages are posted



Exchange Message Board Message History Add message



Exchange Message Board Message History # This field is read-only and generated by the system each time a message post is created



Exchange Message Board Message History Date/time This field is read-only and generated by the system each time a message post is created



Exchange Message Board Message History Posted by This field is read-only and generated by the system



Exchange Message Board Message History Center code This field is read-only and generated by the system each time a message is created



Exchange Message Board Message History Exchange name This field is read-only and generated by the system each time an exchange is created



Exchange Message Board Message History Message text This field is read-only





















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].








































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