See ISHLT Registration Data Elements for technical details for the registration fields.
Click here to view a sample of the 5-page Registration Record.
Note: All of the fields on the Donor page are optional.
DONOR INFORMATION |
Last Name: Enter the donor's last name.
First Name: Enter the donor's first name.
Gender: The donor's gender selected on the Patient Registration page will display.
Donor Age at Recovery: The donor's age at recovery will display. This entered on the Patient Registration page..
Age Unit: Indicate whether the donor's age is in Years or Months.
ABO Blood Group: The ABO selected on the Patient Registration page will display.
Height: Enter the height of the donor at the time of recovery in the appropriate space in centimeters. If the donor's height at the time of recovery is unavailable, select the appropriate status from the ST field.
Weight: Enter the weight of the donor at the time of recovery in the appropriate space in kilograms. If the donor's weight at the time of recovery is unavailable, select the appropriate status from the ST field.
Mechanism of Death: Select the donor's mechanism of death. If the mechanism of death is not listed, select None of the Above.
Cause of Death: Indicate the donor's cause of death. If the cause of death is not listed, select Other, Specify and specify in the space provided. ___________________________________________________________________________________________________________
Circumstances of Death: Select the donor's circumstances of death from the drop-down list. If the circumstance of death is not listed, select None of the Above.
MVA
Suicide
Homicide
Child-Abuse
Non-MVA
Death from Natural Causes
None of the Above
Unknown
Terminal Lab Data: For each of the laboratory tests enter the value, in the units indicated, from tests performed closest to the time of recovery. If a lab value is unavailable, select the reason from the status (ST) drop-down list (N/A, Not Done, Missing, Unknown).
Serum Creatinine mg/dl
BUN mg/dl
Total Bilirubin mg/dl
SGOT/AST u/L
SGPT/ALT u/L
Protein in Urine (Yes, No, UNK)
Last Serum Sodium Prior to Procurement meg/L
INR
Blood pH
Hematocrit %
Serology: For each of the tests listed, select the results from the drop-down lists (Cannot Disclose, Indeterminate, Negative, Not Done, Positive, or Unknown).
Anti-CMV
HBsAg
Anti-HBC
Anti-HCV
Anti-HIV I/II
Anti-HTLV I/II
RPR-VDRL
HBsAb
EBV (VCA) (lgG)
EBV (VCA) (lgM)
EBNA
Note: For Epstein-Barr Virus (EBV (VCA) (lgG), EBV (VCA) (lgM), and EBNA) serologies, a titer level of <1:10 is considered Negative.
Donor Management: (Any medication administered within 24 hours prior to crossclamp.) If any of the listed medications were given to the donor within 24 hours prior to crossclamp, select Yes. If not, select No. If unknown, select Unk. If one to three medications are not listed, enter the name of the medication in the Other/Specify field. You may enter up to 3 medications. If a medication falls under more than one category (antihypertensives and vasodilators) select Yes for both categories.
Steroids
Diuretics
T3
T4
Anticonvulsants
Antihypertensives
Vasodilators
DDAVP
Heparin
Arginine Vasopressin
Insulin
Other/Specify
Inotropic Medication at Time of Cross Clamp: If any inotropic agents were administered at the time of cross clamp, select Yes. If not, select No. If unknown, select Unk.
If Yes is selected, complete the following:
Medication: Select the medication from the drop-down list. . If the medication is not listed, select Other, specify. Enter the medication in the Specify field.
Dopamine
Dobutamine
Epinephrine
Levophed
Neosynephrine
Isoproterenol (Isuprel)
Other, specify
Number of transfusions during this (terminal) hospitalization: Select the number of units, from the drop-down list, for packed red cells or whole blood transfused prior to organ recovery for this hospitalization. If the number of transfusions is not known or it is not known if the donor received a transfusion, select Unknown.
None
1 - 5
6 - 10
Greater than 10
Unknown
Three or more inotropic agents at time of incision: If the donor received three or more inotropic agents at the time of incision, select Yes. If not, select No.
Clinical Infection: Indicate whether the donor had a clinical infection by selecting YES, NO or UNK. If YES is selected, indicate whether a Blood, Lung, Urine or Other Culture was performed by selecting YES or NO.
Cigarette Use (>20 pack years)-Ever: Indicate if the donor has ever used cigarettes for more than 20 pack years. Pack years refers to the number of packs of cigarettes the donor smoked per day multiplied by the number of years. For example, a donor smoking 2 packs of cigarettes per day for 10 years would equal 20 pack years.
AND continued in last 6 months: Indicate if the donor continued using cigarettes for more than 20 pack years within the last 6 months.
Cocaine Use - Ever: Indicate if the donor has ever abused or had a dependency to cocaine.
AND continued in last 6 months: Indicate if the donor abused or had a dependency to cocaine within the last 6 months.
Other Drug Use (non-IV) - Ever: If the donor has ever abused or had a dependency to Non-IV street drugs, such as crack, marijuana or prescription narcotics, sedatives, hypnotics or stimulants, select Yes. If not, select No. If drug use is unknown, select Unk.
AND continued in last 6 months: If the donor abused or had a dependency to non-IV street drugs, such as crack, marijuana or prescription narcotics, sedatives, hypnotics or stimulants within the last 6 months, select Yes. If not, select No. If drug use is unknown, select Unk.
Heavy Alcohol Use (heavy = 2+ drinks/day): Indicate if the donor has a history of having two or more alcoholic drinks per day.
Tattoos: Indicate if the donor has any tattoos.
Does the Donor meet "High Risk" guidelines for an organ donation: Indicate if the donor meets CDC guidelines for "high Risk" for an organ donation.
History of Diabetes: Select Yes if the donor has a documented history of diabetes mellitus prior to this hospitalization, along with the appropriate duration period. If the donor does not have a documented history of diabetes mellitus prior to this hospitalization, select No. If unknown, select Unknown. If Yes is selected, select one duration category to indicate the number of years the donor has a documented history of diabetes. If the duration is unknown, select Yes, Duration Unknown.
No
Yes, 0-5 Years
Yes, 6-10 Years
Yes, > 10 Years
Yes, Duration Unknown
Unknown
Insulin Dependent: If the donor has a history of diabetes and is insulin dependent, select Yes. If the donor has a history of diabetes but is not insulin dependent, select No. If the donor is insulin dependent, select one duration category to indicate the number of years the donor has been taking insulin. If the duration is unknown, select Yes, Duration Unknown.
No
Yes, 0-5 Years
Yes, 6-10 Years
Yes, > 10 Years
Yes, Duration Unknown
Unknown
History of Hypertension: Select Yes if the donor has a documented history of hypertension prior to this hospitalization. If the donor does not have a documented history of hypertension prior to this hospitalization, select No. If unknown, select Unknown. If the duration is unknown, select Yes, Unknown Duration. If Yes is selected, indicate the method of hypertension control through Diet, Diuretics and/or other Hypertensive medication.
No
Yes, 0-5 Years
Yes, 6-10 Years
Yes, > 10 Years
Yes, Duration Unknown
Unknown
___________________________________________________________________________________________________________
History of Cancer: If the donor has a documented history of any type of cancer prior to this hospitalization, select the primary cancer site from the list provided. If the donor has no documented history of any type of cancer prior to this hospitalization, select No. If the primary cancer site is not listed, select Other, specify and enter the site in the space provided.
Cancer Free Interval: If the donor has a documented history of cancer, enter the number of years the donor has been free of any sign of cancer. If this information is unavailable , select:
Intracranial: Indicate if the donor exhibited documented clinical signs of Intracranial, cancer at the time of recovery. If the donor did not exhibit documented clinical signs of intracranial cancer at the time of recovery for any listed category, select No. If unknown, select UNK.
Extracranial: Indicate if the donor exhibited documented clinical signs of Extracranial, cancer at the time of recovery. If the donor did not exhibit documented clinical signs of extracranial cancer at the time of recovery for any listed category, select No. If unknown, select UNK.
Skin: Indicate if the donor exhibited documented clinical signs of Skin, cancer at the time of recovery. If the donor did not exhibit documented clinical signs of skin cancer at the time of recovery for any listed category, select No. If unknown, select UNK.
___________________________________________________________________________________________________________
Was this a non-heartbeating donor? Select No if the donor was not a non-heartbeating donor. If the donor was a non-heartbeating donor, select Yes. If this information is unknown, select Unknown.
No, Brain-Dead
Yes, Controlled
Yes, Uncontrolled
Yes, Control Unknown
Unknown
If Yes, Controlled: If this was a DCD donor and the DCD donor was controlled, select Yes. If the DCD donor was not controlled, select No. If unknown, select Unk. If Yes is selected for DCD donor, this field is optional.
A controlled DCD donor is a donor whose life support will be withdrawn and whose family gave written consent for organ donation in the controlled environment of the operating room.
An uncontrolled DCD donor is a patient who expires in the emergency room or elsewhere in the hospital before consent for organ donation is obtained and catheters are placed in the femoral vessels and peritoneum to cool organs until consent can be obtained. Also, an uncontrolled DCD donor is a patient who is consented for organ donation but suffers a cardiac arrest requiring CPR during procurement of the organs.
If Yes, Date and time of withdrawal of support: Withdrawal of Support is the withdrawal of life sustaining treatments; the actual point where the patient’s attending physician or designee begins the process of removing life sustaining treatments and not when the order is written. Enter the date, using the standard 8-digit format of MM/DD/YYYY format, and military time of the withdrawal of support. The date must be between the referral date and the date and time of death.
If Yes, Date and time agonal phase
begins (systolic BP < 80 or O2 sat. < 80%): Agonal
Phase begins when one of the following conditions is met and sustained
for a minimum of five (5) minutes:
a. Newborn up to 28 days old, with a systolic blood pressure less than
60 mm Hg, OR
b. 29 days old up to 12 months old, with a systolic blood pressure less
than 70 mm Hg, OR
c. 1 year old up to 10 years old, with a systolic blood pressure less than
70 mm Hg, plus 2 times the age of the patient in years, not to exceed
79 mm Hg, OR
d. 11 years or older, with a systolic blood pressure less than 80 mm Hg,
OR when the oxygen saturation is less than 80% at any age.
Enter the date, using the standard 8-digit format of MM/DD/YYYY format, and military time when the agonal phase begins. The date and time must be up to 60 minutes prior to the date and time of withdrawal of support, but not later than the day after the recovery day.
If DCD, Total urine output during OR recovery phase: Total urine output is measured from the point at which life sustaining treatment is withdrawn to the initiation of cold perfusion in situ. Enter the total urine output (cc).
Measures Between Withdrawal of Support and Cardiac Death. Provide Serial Data Every 15 Minutes Between Withdrawal of Support and Start of Agonal Phase, and Every 5 Minutes Between Start of Agonal Phase and Cardiac Death.
Date: Enter the date using the standard 8-digit numeric format of (MM/DD/YYYY format).
Time (military time): Enter the time.
Systolic blood pressure: Enter the systolic blood pressure.
Systolic Blood Pressure - The top number in the blood pressure (the 120 in a blood pressure of 120/80) measures the maximum pressure exerted on the vessel wall when the heart contracts.
Diastolic blood pressure: Enter the diastolic blood pressure.
Diastolic Blood Pressure - The bottom number in the blood pressure measurement (80 in a blood pressure of 120/80), indicating the pressure in the arteries when the heart is at rest.
Mean arterial pressure: Enter the mean arterial pressure.
O2 Saturation: Enter the O2 saturation.
If Yes, Core Cooling Used: If this was a DCD donor, select Yes if core cooling was used. If core cooling was not used for the DCD donor, select No.
Core Cooling: the initiation of cold perfusion in situ.
If Yes, Date and time abdominal aorta cannulation: If Yes, Date and time abdominal aorta cannulation: Enter the date and time of the initiation of abdominal aorta core cooling (the date and time of the initiation of cold perfusion in situ). Enter the date, using the standard 8-digit format of MM/DD/YYYY format, and military time of abdominal aorta cannulation. The value entered cannot be more than 60 minutes after the cross clamp time. If unavailable, select the reason from the status (ST) drop-down list (N/A, Not Done, Missing, Unknown).
If Yes, Date and time thoracic aorta cannulation: Enter the date and time of the initiation of thoracic aorta core cooling (the date and time of the initiation of cold perfusion in situ). Enter the date, using the standard 8-digit format of MM/DD/YYYY format, and military time of thoracic aorta cannulation. The value entered cannot be more than 60 minutes after the cross clamp time. If unavailable, select the reason from the status (ST) drop-down list (N/A, Not Done, Missing, Unknown).
If Yes, Date and time portal vein cannulation: Enter the date and time of the initiation of portal vein core cooling (the date and time of the initiation of cold perfusion in situ). Enter the date, using the standard 8-digit format of MM/DD/YYYY format, and military time of portal vein cannulation. The value entered cannot be more than 60 minutes after the cross clamp time. If unavailable, select the reason from the status (ST) drop-down list (N/A, Not Done, Missing, Unknown).
If Yes, Date and time pulmonary artery cannulation: If Yes, Date and time pulmonary artery cannulation: Enter the date and Time of the initiation of pulmonary artery core cooling (the date and time of the initiation of cold perfusion in situ). Enter the date, using the standard 8-digit format of MM/DD/YYYY format, and military time of pulmonary artery cannulation. The value entered cannot be more than 60 minutes after the cross clamp time. If unavailable, select the reason from the status (ST) drop-down list (N/A, Not Done, Missing, Unknown).
Estimated Warm Ischemic Time: If the donor is a DCD donor, the warm ischemic time is the time from: The time of Agonal Phase onset to the time when core cooling is initiated. If unavailable, select the reason from the status (ST) drop-down list (N/A, Not Done, Missing, Unknown).
If DCD, Date and time heart recovered/removed from donor: (when the heart is placed in the basin): Enter the date, using the standard 8-digit format of MM/DD/YYYY format, and military time of organ recovery/removal.
If DCD, Date and time right lung recovered/removed from donor: (when the right lung is placed in the basin): Enter the date, using the standard 8-digit format of MM/DD/YYYY format, and military time of organ recovery/removal.
If DCD, Date and time left lung recovered/removed from donor: (when the left lung is placed in the basin): Enter the date, using the standard 8-digit format of MM/DD/YYYY format, and military time of organ recovery/removal.
If DCD, Date and time double/en-bloc lung recovered/removed from donor: (when the double/en-bloc lung is placed in the basin): Enter the date, using the standard 8-digit format of MM/DD/YYYY format, and military time of organ recovery/removal.
If No, was this a consented DCD donor that progressed to brain death?: If this was a consented DCD donor that progressed to brain death, select Yes. If not, select No.
Cardiac arrest since neurological event that lead to declaration of brain death: If cardiac arrest occurred between a fatal brain injury event and organ recovery, select Yes. If cardiac arrest did not occur, select No
Note: With DCD donors, if cardiac arrest occurred during donor management, then select Yes. Otherwise, select No for DCD donors.
If Yes, Duration of Resuscitation: If cardiac arrest occurred between a fatal brain injury event and organ recovery, enter the total minutes of cardiac resuscitation. If unavailable, select the reason from the status (ST) drop-down list (N/A, Not Done, Missing, Unknown).
History of previous MI: Select YES if the donor had a history of myocardial infarction. If the donor did not have a history of myocardial infarction, select NO. If this information is unknown, select UNK.
LV ejection fraction (%): Provide the left ventricular ejection fraction, if known. If the left ventricular ejection fraction is unavailable, select the appropriate status from the ST field.
Method: Indicate whether the left ventricular ejection method was an Echocardiogram, MUGA scan or Angiogram.
Structual Abnormalities: If LV, Ejection Fraction < 50% indicate whether the Structural Abnormalities were Valves, Congenital and/or LVH by selecting YES or NO.
Wall Abnormalities: Indicate also whether the Wall Abnormalities were Segmental and/or Global by selecting Yes or No.
Coronary Angiogram: If the donor did not have a coronary angiogram, select No. If the donor had a coronary angiogram, select Yes, indicating if the results were normal or abnormal.
If Abnormal, # Vessels with > 50% Stenosis: If the results of the coronary angiogram were abnormal, select the number of vessels with more than 50% stenosis. If this information is unknown, select Unknown.
Lung - Was p02 done: Select YES if a pO2 was done. If not, select NO. If unknown, select UNK. If YES is selected, enter the Lung pO2 in mm/Hg and indicate the percent of Lung pO2 was on FiO2 (i.e. 40%) in the spaces provided. Report terminal values.
pCO2: Enter the pCO2 in mm/Hg in the space provided. Report terminal values. If unavailable, select the status from the ST field.
Was a pulmonary artery catheter placed: Select Yes if a pulmonary artery catheter was placed. If not, select No.
If a pulmonary artery catheter was placed, enter the Initial (baseline) and Final measurements for the following:
MAP (mm/Hg)=Mean arterial pressure
CVP (mm/Hg) = Central Venous Pressure
PCWP (mm/Hg) = Pulmonary Capillary Wedge Pressure
SVR (dynes/sec/cm)^5=Systemic vascular resistance
PA Systolic (mm/Hg) = Pulmonary Artery Pressure Systolic (initial)
PA Diastolic (mm/Hg)= Pulmonary Artery Pressure Diastolic
CO (L/min) =Cardiac output
Cardiac Index (L/min/sq. m)=Cardiac Index
Biopsy (hearth donors only): For heart donors, indicate whether a biopsy was performed. If a biopsy was performed, select Yes, along with the type of result. If Yes, Other Diagnosis Specify was selected, enter the diagnosis in the space provided. If a biopsy was not performed, select No.
Left Lung Bronchoscopy: Indicate the results of the bronchoscopy procedure. If the results were normal, select Bronchoscopy, Results Normal. If the results were abnormal, select Abnormal along with the type of abnormality. If a bronchopscopy was not performed, select No Bronchoschopy. If unknown, select Unknown if bronchoscopy performed.
Right Lung Bronchoscopy: Indicate the results of the bronchoscopy procedure. If the results were normal, select Bronchoscopy, Results Normal. If the results were abnormal, select Abnormal along with the type of abnormality. If a bronchopscopy was not performed, select No Bronchoschopy. If unknown, select Unknown if bronchoscopy performed.
Chest X-ray: Indicate whether abnormalities were found on the chest x-ray. If the results are normal, select Normal. If the results are abnormal, select abnormal along with the location where the abnormality was found. If this information was unknown, select Unknown if chest x-ray performed. If a chest x-ray was performed and the results are unknown, select Results Unknown. If no chest x-ray was performed, select No chest x-ray.
DONOR HLA TYPING |
Typing Method Class I and Typing Method Class II: Select whether the typing method for Class I and Class II antigens was Serology and/or DNA.
Select the antigen from the list. When known, it is preferable to enter the split of an antigen rather than the parent. If the second antigen at a locus is blank, select No second antigen detected. Only select Not tested when the locus is not tested.
DONOR PROCUREMENT AND CONSENT |
Date and time of pronouncement of death (Complete for brain dead and DCD donors): Enter the date, using the standard 8-digit numeric format of MM/DD/YYYY, and military time of pronouncement of death of the donor.
Date and time consent obtained for first organ: Enter the date, using the standard 8-digit numeric format of MM/DD/YYYY, and military time consent was obtained for first organ.
ORGAN RECOVERY |
Recovery Date (donor to OR): Enter the date the donor entered the operating room for the purpose of organ recovery. Use the standard 8-digit numeric format of MM/DD/YYYY. If the operation began in the evening and concluded the next day, enter the date the operation began.