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UNOS_Employees
PATIENT REGISTRATION
PRE-TX
TRANSPLANT
DONOR
DISCHARGE
TRANSPLANT CLINICAL INFORMATION
Patient Status:
LIVING
DEAD
RETRANSPLANTED
LIVING
Date of: Report or Death:
7/10/2013
Primary Cause of Death:
UNKNOWN
OTHER SPECIFY
GRAFT FAILURE: PRIMARY FAILURE
GRAFT FAILURE: REJECTION- HYPERACUTE
GRAFT FAILURE: REJECTION- ACUTE
GRAFT FAILURE: REJECTION- CHRONIC
GRAFT FAILURE: TECHNICAL
GRAFT FAILURE: GRAFT INFECTION
GRAFT FAILURE: RECURRENT DISEASE
GRAFT FAILURE: NON-SPECIFIC
INFECTION: BACTERIAL SEPTICEMIA
INFECTION: BACTERIAL PNEUMONIA
INFECTION: BACTERIAL- OTHER SPECIFY
INFECTION: VIRAL- CYTOMEGALOVIRUS (CMV)
INFECTION: VIRAL- HEPATITIS
INFECTION: VIRAL-SEPTICEMIA
INFECTION: VIRAL- OTHER SPECIFY
INFECTION: FUNGAL- ASPERGILLUS
INFECTION: FUNGAL- OTHER SPECIFY
INFECTION: PROTOZOAL
INFECTION: MIXED OTHER SPECIFY
INFECTION: OTHER SPECIFY
CARDIOVASCULAR: MYOCARDIAL INFARCTION
CARDIOVASCULAR: CARDIAC ARREST
CARDIOVASCULAR: ARTERIAL EMBOLISM
CARDIOVASCULAR: VENTRICULAR FAILURE
CARDIOVASCULAR: CORONARY ARTERY DISEASE
CARDIOVASCULAR: ATHEROSCLEROSIS
CARDIOVASCULAR: RHYTHM DISORDER
CARDIOVASCULAR: CARDITIS
CARDIOVASCULAR: AORTIC ANEURYSM
CARDIOVASCULAR: CARDIOGENIC SHOCK
CARDIOVASCULAR: OTHER SPECIFY
PULM: DEHISCENCE
PULM: BRONCHIOLITIS
PULM: PRIMARY PULMONARY HYPERTENSION
PULM: PULMONARY EMBOLISM
PULM: RESPIRATORY FAILURE
PULM: ACUTE RESPIRATORY DISTRESS DISEASE
PULM: OTHER SPECIFY
CEREBROVASCULAR: STROKE
CEREBROVASCULAR: HEMORRHAGE (NON-STROKE)
CEREBROVASCULAR: BRAIN ANOXIA
CEREBROVASCULAR: DEGENERATIVE BRAIN DISEASE
CEREBROVASCULAR: OTHER SPECIFY
HEMORRHAGE: GASTROINTESTINAL
HEMORRHAGE: INTRAOPERATIVE
HEMORRHAGE: DISSEMINATED INTRAVAS COAGULATION
HEMORRHAGE: POST-OPERATIVE
HEMORRHAGE: RESPIRATORY
HEMORRHAGE: OTHER SPECIFY
MALIG: METASTATIC OTHER SPECIFY
MALIG: PRIMARY OTHER SPECIFY
MALIG: POST-TX LYMPHOPROLIFERATIVE DISORDER
MALIG: LYMPHOMA
MALIG: SKIN
MALIG: OTHER SPECIFY
DIABETES MELLITUS
INTRAOP: NOT HEMORRHAGE - OTHER SPECIFY
PANCREATITIS
RENAL FAILURE
LIVER FAILURE
MULTIPLE ORGAN FAILURE
FLUID/ELECTROLYTE DISORDER
ACID/BASE DISORDER
AMYLOIDOSIS
HEMATOLOGIC OTHER SPECIFY
IMMUNOSUPPRESSIVE DRUG RELATED - HEMATOLOGIC
IMMUNOSUPPRESSIVE DRUG RELATED - NON-HEMATOLOGIC
NON-IMMUNO DRUG RELATED - HEMATOLOGIC
NON-IMMUNO - NON-HEMATOLOGIC, SPECIFY DRUG
MOTOR VEHICLE ACCIDENT
SUICIDE
NON-COMPLIANCE
TRAUMA OTHER SPECIFY
Specify:
Contributory Cause of Death:
UNKNOWN
OTHER SPECIFY
GRAFT FAILURE: PRIMARY FAILURE
GRAFT FAILURE: REJECTION- HYPERACUTE
GRAFT FAILURE: REJECTION- ACUTE
GRAFT FAILURE: REJECTION- CHRONIC
GRAFT FAILURE: TECHNICAL
GRAFT FAILURE: GRAFT INFECTION
GRAFT FAILURE: RECURRENT DISEASE
GRAFT FAILURE: NON-SPECIFIC
INFECTION: BACTERIAL SEPTICEMIA
INFECTION: BACTERIAL PNEUMONIA
INFECTION: BACTERIAL- OTHER SPECIFY
INFECTION: VIRAL- CYTOMEGALOVIRUS (CMV)
INFECTION: VIRAL- HEPATITIS
INFECTION: VIRAL-SEPTICEMIA
INFECTION: VIRAL- OTHER SPECIFY
INFECTION: FUNGAL- ASPERGILLUS
INFECTION: FUNGAL- OTHER SPECIFY
INFECTION: PROTOZOAL
INFECTION: MIXED OTHER SPECIFY
INFECTION: OTHER SPECIFY
CARDIOVASCULAR: MYOCARDIAL INFARCTION
CARDIOVASCULAR: CARDIAC ARREST
CARDIOVASCULAR: ARTERIAL EMBOLISM
CARDIOVASCULAR: VENTRICULAR FAILURE
CARDIOVASCULAR: CORONARY ARTERY DISEASE
CARDIOVASCULAR: ATHEROSCLEROSIS
CARDIOVASCULAR: RHYTHM DISORDER
CARDIOVASCULAR: CARDITIS
CARDIOVASCULAR: AORTIC ANEURYSM
CARDIOVASCULAR: CARDIOGENIC SHOCK
CARDIOVASCULAR: OTHER SPECIFY
PULM: DEHISCENCE
PULM: BRONCHIOLITIS
PULM: PRIMARY PULMONARY HYPERTENSION
PULM: PULMONARY EMBOLISM
PULM: RESPIRATORY FAILURE
PULM: ACUTE RESPIRATORY DISTRESS DISEASE
PULM: OTHER SPECIFY
CEREBROVASCULAR: STROKE
CEREBROVASCULAR: HEMORRHAGE (NON-STROKE)
CEREBROVASCULAR: BRAIN ANOXIA
CEREBROVASCULAR: DEGENERATIVE BRAIN DISEASE
CEREBROVASCULAR: OTHER SPECIFY
HEMORRHAGE: GASTROINTESTINAL
HEMORRHAGE: INTRAOPERATIVE
HEMORRHAGE: DISSEMINATED INTRAVAS COAGULATION
HEMORRHAGE: POST-OPERATIVE
HEMORRHAGE: RESPIRATORY
HEMORRHAGE: OTHER SPECIFY
MALIG: METASTATIC OTHER SPECIFY
MALIG: PRIMARY OTHER SPECIFY
MALIG: POST-TX LYMPHOPROLIFERATIVE DISORDER
MALIG: LYMPHOMA
MALIG: SKIN
MALIG: OTHER SPECIFY
DIABETES MELLITUS
INTRAOP: NOT HEMORRHAGE - OTHER SPECIFY
PANCREATITIS
RENAL FAILURE
LIVER FAILURE
MULTIPLE ORGAN FAILURE
FLUID/ELECTROLYTE DISORDER
ACID/BASE DISORDER
AMYLOIDOSIS
HEMATOLOGIC OTHER SPECIFY
IMMUNOSUPPRESSIVE DRUG RELATED - HEMATOLOGIC
IMMUNOSUPPRESSIVE DRUG RELATED - NON-HEMATOLOGIC
NON-IMMUNO DRUG RELATED - HEMATOLOGIC
NON-IMMUNO - NON-HEMATOLOGIC, SPECIFY DRUG
MOTOR VEHICLE ACCIDENT
SUICIDE
NON-COMPLIANCE
TRAUMA OTHER SPECIFY
Specify:
Contributory Cause of Death:
UNKNOWN
OTHER SPECIFY
GRAFT FAILURE: PRIMARY FAILURE
GRAFT FAILURE: REJECTION- HYPERACUTE
GRAFT FAILURE: REJECTION- ACUTE
GRAFT FAILURE: REJECTION- CHRONIC
GRAFT FAILURE: TECHNICAL
GRAFT FAILURE: GRAFT INFECTION
GRAFT FAILURE: RECURRENT DISEASE
GRAFT FAILURE: NON-SPECIFIC
INFECTION: BACTERIAL SEPTICEMIA
INFECTION: BACTERIAL PNEUMONIA
INFECTION: BACTERIAL- OTHER SPECIFY
INFECTION: VIRAL- CYTOMEGALOVIRUS (CMV)
INFECTION: VIRAL- HEPATITIS
INFECTION: VIRAL-SEPTICEMIA
INFECTION: VIRAL- OTHER SPECIFY
INFECTION: FUNGAL- ASPERGILLUS
INFECTION: FUNGAL- OTHER SPECIFY
INFECTION: PROTOZOAL
INFECTION: MIXED OTHER SPECIFY
INFECTION: OTHER SPECIFY
CARDIOVASCULAR: MYOCARDIAL INFARCTION
CARDIOVASCULAR: CARDIAC ARREST
CARDIOVASCULAR: ARTERIAL EMBOLISM
CARDIOVASCULAR: VENTRICULAR FAILURE
CARDIOVASCULAR: CORONARY ARTERY DISEASE
CARDIOVASCULAR: ATHEROSCLEROSIS
CARDIOVASCULAR: RHYTHM DISORDER
CARDIOVASCULAR: CARDITIS
CARDIOVASCULAR: AORTIC ANEURYSM
CARDIOVASCULAR: CARDIOGENIC SHOCK
CARDIOVASCULAR: OTHER SPECIFY
PULM: DEHISCENCE
PULM: BRONCHIOLITIS
PULM: PRIMARY PULMONARY HYPERTENSION
PULM: PULMONARY EMBOLISM
PULM: RESPIRATORY FAILURE
PULM: ACUTE RESPIRATORY DISTRESS DISEASE
PULM: OTHER SPECIFY
CEREBROVASCULAR: STROKE
CEREBROVASCULAR: HEMORRHAGE (NON-STROKE)
CEREBROVASCULAR: BRAIN ANOXIA
CEREBROVASCULAR: DEGENERATIVE BRAIN DISEASE
CEREBROVASCULAR: OTHER SPECIFY
HEMORRHAGE: GASTROINTESTINAL
HEMORRHAGE: INTRAOPERATIVE
HEMORRHAGE: DISSEMINATED INTRAVAS COAGULATION
HEMORRHAGE: POST-OPERATIVE
HEMORRHAGE: RESPIRATORY
HEMORRHAGE: OTHER SPECIFY
MALIG: METASTATIC OTHER SPECIFY
MALIG: PRIMARY OTHER SPECIFY
MALIG: POST-TX LYMPHOPROLIFERATIVE DISORDER
MALIG: LYMPHOMA
MALIG: SKIN
MALIG: OTHER SPECIFY
DIABETES MELLITUS
INTRAOP: NOT HEMORRHAGE - OTHER SPECIFY
PANCREATITIS
RENAL FAILURE
LIVER FAILURE
MULTIPLE ORGAN FAILURE
FLUID/ELECTROLYTE DISORDER
ACID/BASE DISORDER
AMYLOIDOSIS
HEMATOLOGIC OTHER SPECIFY
IMMUNOSUPPRESSIVE DRUG RELATED - HEMATOLOGIC
IMMUNOSUPPRESSIVE DRUG RELATED - NON-HEMATOLOGIC
NON-IMMUNO DRUG RELATED - HEMATOLOGIC
NON-IMMUNO - NON-HEMATOLOGIC, SPECIFY DRUG
MOTOR VEHICLE ACCIDENT
SUICIDE
NON-COMPLIANCE
TRAUMA OTHER SPECIFY
Specify:
Date of Admission to Tx Center:
Date of Discharge from Tx Center:
Was patient hospitalized during the last 90 days prior to the transplant admission:
YES
NO
UNK
Previous Transplant:
YES
NO
NO
Number:
Date:
Kidney:
Liver:
Pancreas (whole):
Pancreas (islet cells):
Heart:
Lung:
Intestine:
Bone Marrow:
VIRAL DETECTION
Have any of the following viruses ever been tested for: (HIV, CMV, HBV, HCV, EBV):
YES
NO
HIV:
YES
NO
Was there clinical disease (ARC, AIDS):
YES
NO
UNK
Antibody:
Positive
Negative
Not Done
UNK/Cannot Disclose
RNA:
Positive
Negative
Not Done
UNK/Cannot Disclose
CMV:
YES
NO
HIV Serostatus:
Positive
Negative
Not Done
UNK/Cannot Disclose
CMV IgG:
Positive
Negative
Not Done
UNK/Cannot Disclose
CMV IgM:
Positive
Negative
Not Done
UNK/Cannot Disclose
HBV:
YES
NO
HBV Core Antibody:
Positive
Negative
Not Done
UNK/Cannot Disclose
HBV Surface Antigen:
Positive
Negative
Not Done
UNK/Cannot Disclose
HCV Serostatus:
Positive
Negative
Not Done
UNK/Cannot Disclose
EBV Serostatus:
Positive
Negative
Not Done
UNK/Cannot Disclose
HCV:
YES
NO
Was there clinical disease:
YES
NO
UNK
Liver Histology:
Positive
Negative
Not Done
UNK/Cannot Disclose
Antibody:
Positive
Negative
Not Done
UNK/Cannot Disclose
RIBA:
Positive
Negative
Not Done
UNK/Cannot Disclose
HCV RNA:
Positive
Negative
Not Done
UNK/Cannot Disclose
EBV:
YES
NO
Was there clinical disease:
YES
NO
UNK
IgG:
Positive
Negative
Not Done
UNK/Cannot Disclose
IgM:
Positive
Negative
Not Done
UNK/Cannot Disclose
EBV DNA:
Positive
Negative
Not Done
UNK/Cannot Disclose
Chronic Steroid Use:
YES
NO
UNK
Transfusions:
YES
NO
UNK
Infection Requiring IV Therapy within 2 wks prior to Tx:
YES
NO
UNK
Cerebrovascular Event:
YES
NO
UNK
Episode of Ventilatory Support:
YES
NO
UNK
If yes, indicate most recent timeframe:
At time of transplant
Within 3 months of transplant
>3 months prior to transplant
Tracheostomy:
YES
NO
UNK
Previous Pregnancies:
NO PREVIOUS PREGNANCY
1 PREVIOUS PREGNANCY
2 PREVIOUS PREGNANCIES
3 PREVIOUS PREGNANCIES
4 PREVIOUS PREGNANCIES
5 PREVIOUS PREGNANCIES
MORE THAN 5 PREVIOUS PREGNANCIES
YES
NO
NOT APPLICABLE: < 10 years old
UNKNOWN
Multiple Organ Transplant:
YES
NO
Kidney
Pancreas
Liver
Intestine
Pancreas Islet
Bone Marrow
Procedure Type:
Ortho Heart
Hetero Heart
Heart Lung
Single Left Lung
Single Right Lung
Bilateral Sequential Lung
En-Bloc Double Lung
Lobe, Right
Lobe, Left
Single Left Lung, Right Lobe
Single Right Lung, Left Lobe
Lobe, Other Specify
Split Left Lung
Split Right Lung
Ortho Heart
Heart Procedure:
Orthotopic Bicaval
Orthotopic Traditional
Orthotopic Total (Bicaval, PV)
Heterotopic
Total Ischemia Time:
Heart, Heart-Lung:
162.00
min
ST=
Missing
Unknown
N/A
Not Done
Left Lung:
min
ST=
Missing
Unknown
N/A
Not Done
Right Lung:
min
ST=
Missing
Unknown
N/A
Not Done
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