Death Notification Registration

Death Notification Registration

The purpose of the Death Notification Registration form is to collect demographic information regarding all imminent neurological and eligible deaths reported to an OPO.

Status: This field is read-only and displays Incomplete. It will only change to Complete once the record is successfully validated.

Donor ID: Enter the unique Donor ID and click Search. If this 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. If the candidate is a referral only (no Donor ID), all fields need to be completed.

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 read-only. This excludes referral-only donors (donors 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.

Referral Classification: Select the classification of death. This field is required.

Eligible

Imminent

Did the patient legally document their decision to be a donor?: If the patient had written documentation of their intent to be a donor, select Yes. If not, select No. If unknown, select Unknown. This field is required.

Has authorization been obtained for organ donation?: If the patient is designated as a donor/signed up to be a donor in a state registry – select Registry-yes. If the patient is not a designated donor and the family was approached for authorization – select Yes if authorization was given, No if declined. If the patient is not a designated donor and the family was not approached for authorization – select Authorization Not Requested. This field is required.

Method of authorization used:

First person

Hierarchy

Select the reason organ donation was not obtained:

Declined

Not requested

Did the OPO notify the medical examiner/coroner?: If the donor's death was reported to the medical examiner/coroner, select Yes. If the donor's death was not reported to the medical examiner/coroner, select No. If unknown, select Unknown. This field is required.

Did the medical examiner/coroner accept the case?:

Yes

No

Were there any restrictions?: Select all that apply.

Kidney

Pancreas

Kidney/pancreas

Intestine

Liver

Heart

Lung

Heart/lung

Organ Restrictions: Select all that apply.

Left Kidney

Right Kidney

Left Lung

Right Lung

Pancreas

Liver

Intestine

Heart

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, report donor sex (Male or Female), based on biologic and physiologic traits at birth. If sex at birth is unknown, report sex at time of donation as reported by donor or documented in medical record. The intent of this data collection field is to capture physiologic characteristics that may have an impact on recipient size matching or graft outcome. 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.

Patient's Home ZIP code: 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: If this is a donor, the selection from the donor record displays. This field is read-only. If this is a referral only, indicate the donor's ethnicity.

The Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity (Office of Management and Budget (OMB) Statistical Policy Directive No. 15) define the minimum standards for collecting and presenting data on race and ethnicity for all Federal reporting. The OPTN collection of ethnicity is aligned to this standard. 

OMB defines ethnicity to be whether or not a person self-identifies as Hispanic or Latino. For this reason, ethnicity is broken out into two categories, (1) Hispanic or Latino or (2) Not Hispanic or Latino. Select one ethnicity category or select 'Ethnicity Not Reported' if a category was not self-identified by the person. 

This field is required. 

Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. 

Not Hispanic or Latino

Ethnicity Not Reported – Select if person did not self-identify an ethnicity category.

Race: If this is a donor, the selection from the donor record displays. This field is read-only. If this is a referral only, indicate the donor's race.

The Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity (Office of Management and Budget (OMB) Statistical Policy Directive No. 15) define the minimum standards for collecting and presenting data on race and ethnicity for all Federal reporting. The OPTN collection of race is aligned to this standard. OMB defines race as a person’s self-identification with one or more social groups. 

An individual can select one or more race categories (1) White, (2) Black or African American, (3) Asian, (4) American Indian or Alaska Native, (5) Native Hawaiian or Other Pacific Islander, or Race Not Reported.

This field is required.

Select one or more race sub-categories or origins.  Select 'Other Origin' if origin is not listed. Select 'Origin Not Reported' if the origin was not self-identified by the person.

White – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

European Descent

Arab or Middle Eastern

North African (non-Black)

Other Origin

Origin Not Reported

Black or African American – A person having origins in any of the Black racial groups of Africa.

African American 

African (Continental)

West Indian

Haitian

Other Origin

Origin Not Reported 

American Indian or Alaska Native – A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.

American Indian

Eskimo

Aleutian

Alaska Indian 

Other Origin

Origin Not Reported

Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Asian Indian/Indian Sub-Continent

Chinese

Filipino

Japanese

Korean

Vietnamese

Other Origin

Origin Not Reported 

Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Origin

Origin Not Reported

Race Not Reported – Select if person did not self-identify a race category or origin.

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