Donor Organ Disposition |
Fields to be completed by members |
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Form Section |
Field Label |
Notes |
Donor Organ Disposition |
OPO |
Display only - Cascades from database |
Donor Organ Disposition |
Donor hospital |
Display only - Cascades from database |
Donor Organ Disposition |
Histocompatibility lab |
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Donor Organ Disposition |
Donor name |
Display only - Cascades from database |
Donor Organ Disposition |
Date of referral call |
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Donor Organ Disposition |
Recovery date |
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Donor Organ Disposition |
Were any organs recovered? |
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Donor Organ Disposition |
Right Kidney Disposition (supply code) |
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Donor Organ Disposition |
Right Kidney Code |
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Donor Organ Disposition |
Right Kidney Match ID |
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Donor Organ Disposition |
Right Kidney Tx Center |
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Donor Organ Disposition |
Right Kidney Extra Vessel Sent |
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Donor Organ Disposition |
Left Kidney Disposition (supply code) |
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Donor Organ Disposition |
Left Kidney Code |
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Donor Organ Disposition |
Left Kidney Match ID |
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Donor Organ Disposition |
Left Kidney Tx Center |
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Donor Organ Disposition |
Left Kidney Extra Vessel Sent |
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Donor Organ Disposition |
Dual/En-bloc Kidney Disposition (supply code) |
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Donor Organ Disposition |
Dual/En-bloc Kidney Code |
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Donor Organ Disposition |
Dual/En-bloc Kidney Match ID |
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Donor Organ Disposition |
Dual/En-bloc Kidney Tx Center |
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Donor Organ Disposition |
Dual/En-bloc Kidney Extra Vessel Sent |
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Donor Organ Disposition |
Pancreas Disposition (supply code) |
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Donor Organ Disposition |
Pancreas Code |
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Donor Organ Disposition |
Pancreas Match ID |
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Donor Organ Disposition |
Pancreas Tx Center |
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Donor Organ Disposition |
Pancreas Extra Vessel Sent |
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Donor Organ Disposition |
Pancreas Segment 1 Disposition (supply code) |
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Donor Organ Disposition |
Pancreas Segment 1 Code |
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Donor Organ Disposition |
Pancreas Segment 1 Match ID |
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Donor Organ Disposition |
Pancreas Segment 1 Tx Center |
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Donor Organ Disposition |
Pancreas Segment 1 Extra Vessel Sent |
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Donor Organ Disposition |
Pancreas Segment 2 Disposition (supply code) |
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Donor Organ Disposition |
Pancreas Segment 2 Code |
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Donor Organ Disposition |
Pancreas Segment 2 Match ID |
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Donor Organ Disposition |
Pancreas Segment 2 Tx Center |
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Donor Organ Disposition |
Pancreas Segment 2 Extra Vessel Sent |
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Donor Organ Disposition |
Liver Disposition (supply code) |
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Donor Organ Disposition |
Liver Code |
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Donor Organ Disposition |
Liver Match ID |
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Donor Organ Disposition |
Liver Tx Center |
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Donor Organ Disposition |
Liver Extra Vessel Sent |
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Donor Organ Disposition |
Liver Segment 1 Disposition (supply code) |
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Donor Organ Disposition |
Liver Segment 1 Code |
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Donor Organ Disposition |
Liver Segment 1 Match ID |
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Donor Organ Disposition |
Liver Segment 1 Tx Center |
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Donor Organ Disposition |
Liver Segment 1 Extra Vessel Sent |
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Donor Organ Disposition |
Liver Segment 2 Disposition (supply code) |
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Donor Organ Disposition |
Liver Segment 2 Code |
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Donor Organ Disposition |
Liver Segment 2 Match ID |
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Donor Organ Disposition |
Liver Segment 2 Tx Center |
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Donor Organ Disposition |
Liver Segment 2 Extra Vessel Sent |
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Donor Organ Disposition |
Intestine Disposition (supply code) |
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Donor Organ Disposition |
Intestine Code |
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Donor Organ Disposition |
Intestine Match ID |
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Donor Organ Disposition |
Intestine Tx Center |
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Donor Organ Disposition |
Intestine Extra Vessel Sent |
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Donor Organ Disposition |
Intestine Segment 1 Disposition (supply code) |
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Donor Organ Disposition |
Intestine Segment 1 Code |
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Donor Organ Disposition |
Intestine Segment 1 Match ID |
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Donor Organ Disposition |
Intestine Segment 1 Tx Center |
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Donor Organ Disposition |
Intestine Segment 1 Extra Vessel Sent |
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Donor Organ Disposition |
Intestine Segment 2 Disposition (supply code) |
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Donor Organ Disposition |
Intestine Segment 2 Code |
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Donor Organ Disposition |
Intestine Segment 2 Match ID |
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Donor Organ Disposition |
Intestine Segment 2 Tx Center |
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Donor Organ Disposition |
Intestine Segment 2 Extra Vessel Sent |
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Donor Organ Disposition |
Heart Disposition (supply code) |
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Donor Organ Disposition |
Heart Code |
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Donor Organ Disposition |
Heart Match ID |
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Donor Organ Disposition |
Heart Tx Center |
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Donor Organ Disposition |
Heart Extra Vessel Sent |
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Donor Organ Disposition |
Right Lung Disposition (supply code) |
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Donor Organ Disposition |
Right Lung Code |
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Donor Organ Disposition |
Right Lung Match ID |
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Donor Organ Disposition |
Right Lung Tx Center |
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Donor Organ Disposition |
Right Lung Extra Vessel Sent |
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Donor Organ Disposition |
Left Lung Disposition (supply code) |
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Donor Organ Disposition |
Left Lung Code |
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Donor Organ Disposition |
Left Lung Match ID |
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Donor Organ Disposition |
Left Lung Tx Center |
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Donor Organ Disposition |
Left Lung Extra Vessel Sent |
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Donor Organ Disposition |
Double/En bloc Lung Disposition (supply code) |
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Donor Organ Disposition |
Double/En bloc Lung Code |
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Donor Organ Disposition |
Double/En bloc Lung Match ID |
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Donor Organ Disposition |
Double/En bloc Lung Tx Center |
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Donor Organ Disposition |
Double/En bloc Extra Vessel Sent |
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Donor Organ Disposition |
Was authorization for VCA organs requested? |
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Donor Organ Disposition |
If no, specify Authorization Not Requested Code |
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Donor Organ Disposition |
Abdominal Wall Disposition (supply code) |
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Donor Organ Disposition |
Abdominal Wall Code |
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Donor Organ Disposition |
Abdominal Wall Match ID |
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Donor Organ Disposition |
Abdominal Wall Tx Center |
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Donor Organ Disposition |
Abdominal Wall Extra Vessels Sent |
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Donor Organ Disposition |
External Male Genitalia Disposition (supply code) |
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Donor Organ Disposition |
External Male Genitalia Code |
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Donor Organ Disposition |
External Male Genitalia Match ID |
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Donor Organ Disposition |
External Male Genitalia Tx Center |
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Donor Organ Disposition |
External Male Genitalia Extra Vessels Sent |
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Donor Organ Disposition |
Head and Neck Disposition (supply code) |
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Donor Organ Disposition |
Head and Neck Code |
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Donor Organ Disposition |
Head and Neck Match ID |
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Donor Organ Disposition |
Head and Neck Tx Center |
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Donor Organ Disposition |
Head and Neck Extra Vessels Sent |
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Donor Organ Disposition |
Lower Limb Disposition (supply code) |
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Donor Organ Disposition |
Lower Limb Code |
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Donor Organ Disposition |
Lower Limb Match ID |
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Donor Organ Disposition |
Lower Limb Tx Center |
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Donor Organ Disposition |
Lower Limb Extra Vessels Sent |
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Donor Organ Disposition |
Musculoskeletal Composite Graft Segment Disposition (supply code) |
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Donor Organ Disposition |
Musculoskeletal Composite Graft Segment Code |
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Donor Organ Disposition |
Musculoskeletal Composite Graft Segment Match ID |
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Donor Organ Disposition |
Musculoskeletal Composite Graft Segment Tx Center |
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Donor Organ Disposition |
Musculoskeletal Composite Graft Segment Extra Vessels Sent |
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Donor Organ Disposition |
Other Genitourinary Organ Disposition (supply code) |
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Donor Organ Disposition |
Other Genitourinary Organ Code |
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Donor Organ Disposition |
Other Genitourinary Organ Match ID |
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Donor Organ Disposition |
Other Genitourinary Organ Tx Center |
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Donor Organ Disposition |
Other Genitourinary Organ Extra Vessels Sent |
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Donor Organ Disposition |
Spleen Disposition (supply code) |
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Donor Organ Disposition |
Spleen Code |
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Donor Organ Disposition |
Spleen Match ID |
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Donor Organ Disposition |
Spleen Tx Center |
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Donor Organ Disposition |
Spleen Extra Vessels Sent |
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Donor Organ Disposition |
Upper Limb Disposition (supply code) |
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Donor Organ Disposition |
Upper Limb Code |
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Donor Organ Disposition |
Upper Limb Match ID |
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Donor Organ Disposition |
Upper Limb Tx Center |
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Donor Organ Disposition |
Upper Limb Extra Vessels Sent |
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Donor Organ Disposition |
Uterus Disposition (supply code) |
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Donor Organ Disposition |
Uterus Code |
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Donor Organ Disposition |
Uterus Match ID |
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Donor Organ Disposition |
Uterus Tx Center |
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Donor Organ Disposition |
Uterus Extra Vessels Sent |
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Donor Organ Disposition |
Vascularized Gland Disposition (supply code) |
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Donor Organ Disposition |
Vascularized Gland Code |
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Donor Organ Disposition |
Vascularized Gland Match ID |
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Donor Organ Disposition |
Vascularized Gland Tx Center |
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Donor Organ Disposition |
Vascularized Gland Extra Vessels Sent |
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Donor Organ Disposition |
Organ accompanied |
Read only - cascades from database |
Donor Organ Disposition |
Reporting facility |
Read only - cascades from database |
Donor Organ Disposition |
Vessel Disposition |
Read only - cascades from database |
Donor Organ Disposition |
Recovering facility |
Read only - cascades from database |
Donor Organ Disposition |
Disposition date |
Read only - cascades from database |
Donor Organ Disposition |
Reporting date |
Read only - cascades from database |
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PUBLIC BURDEN STATEMENT: |
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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 0.27 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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