Guideline for coding organ donation after death: Difference between revisions

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This page explains how we code organ donation after death; it has it's own page because may concepts tie together around this and the information should only live in one place.  
This page explains how we code organ donation after death; it has it's own page because many concepts tie together around this and the information should only live in one place. See also [[Guideline for coding living donor organ donation]]. 


{{Collapsable | always=Background | full= We usually encode death in [[Dispo]]; for patients with dx [[Brain death]] who are moved to a different location for [[Organ donor (organ/tissue donation by the donor)]] this means we lose either the info about their death or their new location. We needed a special case compromise to ensure this is dealt with consistently. }}
{{Collapsable | always=Background | full= We usually encode death in [[Dispo]]; for patients with dx [[Brain death]] who are moved to a different location for [[Organ donor (organ/tissue donation by the donor)]] this means we lose either the info about their death or their new location. We needed a special case compromise to ensure this is dealt with consistently. }}


== Instructions for coding these patients ==
== Instructions for coding these patients ==
[[Organ donor (organ/tissue donation by the donor)]]
* [[Dispo DtTm]]: '''sent from ICU to the operating room or to another ICU''' (consistent with other [[Visits to temporary locations]]
** ie '''not the time of death'''


* [[Dispo DtTm]]: '''sent from ICU to the operating room or to another ICU''' (consistent with other [[Operating room visits]]
=== Discharge to OR (same or other site) ===
** ie don't code the time of death
* [[Acquired Diagnosis]]: [[Brain death]], [[Organ donor (organ/tissue donation by the donor)]]
** [[Dx Date]]: Date brain death declared
* [[Dispo]]: '''Died - to OR'''
*[[Transfer Ready DtTm]]: no transfer ready time is required, as patient must stay in ICU until discharged to OR (check off box)


=== Harvesting at same hospital (discharge to OR) ===
=== Discharge to another site ICU for harvesting ===
'''Sending site'''
* [[Acquired Diagnosis]]: [[Brain death]]
* [[Acquired Diagnosis]]: [[Brain death]]
** [[Dx Date]]: {{DA | [[Dx Date]] - Under current rules that can't be after [[Dispo DtTm]].}}
** [[Dx Date]]: Date brain death declared
* [[Dispo]]:  
* [[Dispo]]: '''Died - to other ICU'''
* [[Dispo DtTm]]:
*[[Transfer Ready DtTm]]: no transfer ready time is required, as patient must stay in ICU until discharged to OR (check off box)
'''Receiving site'''
* [[Acquired Diagnosis]]: [[Organ donor (organ/tissue donation by the donor)]]
** [[Dx Date]]: use the Dispo Dt of the receiving site
* [[Admit Diagnosis]]: [[Brain death]] Code other relevant diagnoses and procedures with a priority lower than Brain death
* [[Previous Location]]: the previous ICU
* [[Dispo]]: Hopefully "Died - to OR", or "Died - to morgue" if transplant doesn't work out


*For a patient who is in one location (e.g. MICU), where he develops , and then stays in that location to be evaluated/optimized for being an organ donor
=== Donation after Cardiac Death (DCD) ===
**[[Brain death]] will be an acquired diagnosis.  [[LOS]] will only be the time from admit to [[Brain death]]. Time after [[Brain death]] will be counted towards occupancy but not [[LOS]]. 
*Donation after cardiac death (DCD) is where a donor who is not brain dead is dependent on life support and the family has decided to withdraw care. When the patient's heart stops beating, the organs are then recovered in the operating room. Withdrawal of care, and death usually will occur while still in the ICU.
**The dispo will be '''Death with transfer to OR''' for organ donation IF they go for donation and '''Death with transfer to morgue''' if not.
*For a patient who dies while in the ICU and goes on to donate organs, code the [[Dispo]] as '''Died - to OR''', with the time and date of the patient's death. These patients should have an acquired diagnosis of [[Organ donor (organ/tissue donation by the donor)]], with the corresponding date of the time of withdrawal of care. These patients will not have a transfer ready date, so the checkbox should be checked off. Patients that go on to donate organs should not have an acquired [[Palliative care]] diagnosis.
*For a patient who is a potential organ donor, but does not die within the time required for organ retrieval, do NOT include [[Organ donor (organ/tissue donation by the donor)]] as an acquired diagnosis. The [[Transfer Ready DtTm]] for these patients will be when they are deemed unsuitable for organ retrieval. Consider the usual rules about [[Palliative care]] and [[ACP-C]] coding.


=== Discharge to another site for harvesting ===
=== [[MAID]] with Organ Donation ===
'''Sending site'''
*A person undergoing Medical Assistance in Dying ([[MAID]]) may be able to make arrangements in advance for organ harvesting after death. 
* [[Acquired Diagnosis]]:
*If a MAID patient who dies in ICU or ward becomes a (planned) donor, then the dispo is '''Died - to OR''', i.e. no need to code [[brain death]]. If MAID is provided in the OR, then handle this like DCD (see above) BUT also code [[Medical Assistance In Dying]] as an [[Acquired Diagnosis]] in ICU.
** [[Dx Date]]:
* [[Dispo]]:
* [[Dispo DtTm]]:


'''Receiving site'''
{{Discuss | For a patient who intend to be an organ donor and died in the unit or ward but the organ donor did not happen for some reason (e.g. family changed their mind, or some other circumstance occurred, and they did not end up going to the OR), do we still need to code [[Organ donor (organ/tissue donation by the donor)]] in admit or acquired? maybe not and the  Dispo entry is just - '''Died to morgue''' ?  Or if we want to keep the organ donor code, we need a code telling it did not happen, is that possible? --[[User:JMojica|JMojica]] 16:58, 18 November 2025 (CST)
* [[Admit Diagnosis]]:
* [[Previous Location]]:
* [[Dispo]]: Hopefully the OR, or "Death - to morgue" if transplant doesn't work out
* [[Dispo DtTm]]:
{{DA |  
* What date in the [[Acquired Diagnosis]] do you put for this code?  Do you use the date that they decide the pt will be an organ donor?  Or would you prefer the date the patient goes to the OR (which would be the same as the discharge date?
** These patients go to a different ward after transplant, right? So we would likely not currently track the CCI for this. Maybe transplants are something we should track if they are at the end of stay. I'll flag this for Allan.
***I am referring to an organ donor (not a transplant recipient). Most donors go to the morgue after donating their organs in the OR. I am not asking about CCI, just the date for the acquire ICD10 code.  I am not sure who wrote the above comment.}} 


We will not have a separate code for cadaver donations. Instead also code the following as appropriate
Another scenario - For a patient who has an acquired diagnosis of [[Organ donor (organ/tissue donation by the donor)]] and [[brain death]] and the harvesting done during the same ICU admission and did not go to OR, then the dispo is '''Died to morgue''' , is this correct? --[[User:JMojica|JMojica]] 16:58, 18 November 2025 (CST)
*After brain death:  '''[[Brain death]]'''
*Donation after Medical Assistance in Dying ([[MAID]]) -- where a person who undergoes MAID has made arrangements in advance for organ harvesting after death. 
We do not have a special code for:  
*Donation after cardiac death (DCD) -- where a donor who is not brain dead is dependent on life support and the family has decided to withdraw care. When the patient's heart stops beating, the organs are then recovered in the operating room.


Some organ donors have a '''bronchscopy''' done, but not all do, so don't automatically assume and code it. The only time it is done is if there are considering the lungs. This is according to a Respirologist from STB ICU.
* Question is under the MAID heading in here but does not necessarily seem to be related to MAID... or is it? [[User:Ttenbergen|Ttenbergen]] 23:20, 18 November 2025 (CST)
* I have a feeling this question comes with context - what were you looking for? [[User:Ttenbergen|Ttenbergen]] 23:20, 18 November 2025 (CST)


=== Donation after Cardiac Death (DCD) ===
** the two items listed here are general questions about organ donor and how to know if the donor happened or not.  i just inserted the discussions after the MAID but not meant to be related to MAID. Sorry, I notice how the two comments came out , one with a box and another under it. I tried to change but unsuccessful so I leave them as is.  The main goal is to add them to the instruction if making sense. --[[User:JMojica|JMojica]] 09:05, 19 November 2025 (CST)
*For a braindead donor, or a DCD (donation after cardiac death = almost dead in ICU but decision made to donate by taking patient or OR, removing life support until dead, then harvest organs) it almost always will be an acquired diagnosis.  For those the date of that acquired diagnosis should be.... we still need to decide, see: [[Deceased patients]].
}}


== How they are treated in linking ==
== How they are treated in linking ==
{{DT|
* [[Populate linking pairs]] will not be affected since it only looks at PHINs and times
* [[Correcting suspect links]]}}


*'''for records which contain the diagnosis of [[Brain death]], Julie will change her algorithm for linking successive records such that no linking will be done:
== Transition to post-2019-June-4 organ donor dispo field use ==
**'''in the forward time direction for a record where that diagnosis was NOT an admission diagnosis'''
* We are going to ''keep'' the old entries (died - donor and died - not a donor) available, and you don't need to change them for patients you have already entered
**'''in the backward time direction for a record where that diagnosis was either an admission diagnosis or a comorbid diagnosis'''
** Main office will run a query to change all the old entries to the new version. We need to do this anyway and it is quicker than collectors doing it manually, so '''don't waste the time''' to change these to the new format
 
* For all new patients, please use the new fields (will be rolled later on today. Ttenbergen 09:00, 2019 June 4 (CDT))
* [[Populate linking pairs]])  
* ([[Pre-linking checks]]


== Cross checks that are affected ==
== Cross checks that are affected ==
{{DT|
{{Data Integrity Check List|}}
* [[Check dx implying death must be dispo deceased]]}}
 
== How reports are affected ==
=== LOS ===
''This should live in [[LOS]] when it's all settled since it's not unique to organ donors. leaving it here for now just to keep questions together ''
{{DT | confirm these are right }}
* Redefine [[LOS]].  From now on, for patients who experience [[Brain death]], [[LOS]] will include time from admission to [[Brain death]].  Time in ICU spent after [[Brain death]] being evaluated/optimized for being an organ donor will not be included in [[LOS]]. 
* [[Bed occupancy]]- But, of course, that time will be included in calculations of bed occupancy.
 
{{DA |
* which of the many [[LOS]]? Will the same apply to the other [[:Category:Diagnosis implying death|Diagnosis implying death]]? }}
 
{{DA |
* People have expressed concern about the that there might be significant interventions listed on TISS in the time between Brain death and pt leaving the unit; will we continue to do TISS for this, and how will TISS scores for this time affect any reporting? If we exclude the time from LOS it will mess with the N for this. }}
{{DT |
* once decided we may need to adjust cross checks, namely
** [[Query TISS Errors NrTISSDays NE LOS]]; [[Query TISS Errors missing days]]; [[Query TISS Errors TISS date out of admission]] }}
 
=== other fields that might be affected ===
{{DT |  
* [[Bed occupancy]]; LOS will not include brain deads, but bed occ. would.}}
* Inter-facility transfers ([[Critical Care Inter-facility Transfer Report]]
*[[Re-admission]]
* mortality ([[Mortality and readmission report]]?)
* transfer delays ([[Transfer Delay]]?),
*occupancy [[Bed occupancy]]?)
* regular CC ([[Annual report]]? If so we should change the name)
* Med reports (I can't even find a link for that) reports. For ICU patient, this rule will only affect the SAS linking check program which can be modified so it will not show up as an error.


{{Discuss | who = Julie | Julie, which reports and what linking will be affected by this, so we can update the related wiki pages?
== How reports/indicators are affected ==
Firstly, Medicine is the only one which report linked admissions during a hospitalization.  If a medicine patient happens to go to an ICU,  died, an organ donor and move to another ICU , this rule is saying do not consider the second ICU. what will be the LOS of that hospitalization - I presume this rule will exclude the second ICU stay, is that correct? }}
=== other fields/indicators/reports that might be affected ===
* [[Readmission Rate to ICU]] - not affected because it involves those survived who went to ward or home and came back to ICU or ward, not expired who went to OR or another ICU.
* [[Mortality and readmission report]] - The effect on mortality rate will be negligible if we include or exclude these cases, so it was decided to treat them as all other patients


== Related articles ==  
== Related articles ==  

Latest revision as of 09:05, 19 November 2025

This page explains how we code organ donation after death; it has it's own page because many concepts tie together around this and the information should only live in one place. See also Guideline for coding living donor organ donation.

Background   

We usually encode death in Dispo; for patients with dx Brain death who are moved to a different location for Organ donor (organ/tissue donation by the donor) this means we lose either the info about their death or their new location. We needed a special case compromise to ensure this is dealt with consistently.

Instructions for coding these patients

Discharge to OR (same or other site)

Discharge to another site ICU for harvesting

Sending site

Receiving site

Donation after Cardiac Death (DCD)

  • Donation after cardiac death (DCD) is where a donor who is not brain dead is dependent on life support and the family has decided to withdraw care. When the patient's heart stops beating, the organs are then recovered in the operating room. Withdrawal of care, and death usually will occur while still in the ICU.
  • For a patient who dies while in the ICU and goes on to donate organs, code the Dispo as Died - to OR, with the time and date of the patient's death. These patients should have an acquired diagnosis of Organ donor (organ/tissue donation by the donor), with the corresponding date of the time of withdrawal of care. These patients will not have a transfer ready date, so the checkbox should be checked off. Patients that go on to donate organs should not have an acquired Palliative care diagnosis.
  • For a patient who is a potential organ donor, but does not die within the time required for organ retrieval, do NOT include Organ donor (organ/tissue donation by the donor) as an acquired diagnosis. The Transfer Ready DtTm for these patients will be when they are deemed unsuitable for organ retrieval. Consider the usual rules about Palliative care and ACP-C coding.

MAID with Organ Donation

  • A person undergoing Medical Assistance in Dying (MAID) may be able to make arrangements in advance for organ harvesting after death.
  • If a MAID patient who dies in ICU or ward becomes a (planned) donor, then the dispo is Died - to OR, i.e. no need to code brain death. If MAID is provided in the OR, then handle this like DCD (see above) BUT also code Medical Assistance In Dying as an Acquired Diagnosis in ICU.
For a patient who intend to be an organ donor and died in the unit or ward but the organ donor did not happen for some reason (e.g. family changed their mind, or some other circumstance occurred, and they did not end up going to the OR),  do we still need to code Organ donor (organ/tissue donation by the donor) in admit or acquired? maybe not and the  Dispo entry is just - Died to morgue ?  Or if we want to keep the organ donor code, we need a code telling it did not happen, is that possible? --JMojica 16:58, 18 November 2025 (CST)

Another scenario - For a patient who has an acquired diagnosis of Organ donor (organ/tissue donation by the donor) and brain death and the harvesting done during the same ICU admission and did not go to OR, then the dispo is Died to morgue , is this correct? --JMojica 16:58, 18 November 2025 (CST)

  • Question is under the MAID heading in here but does not necessarily seem to be related to MAID... or is it? Ttenbergen 23:20, 18 November 2025 (CST)
  • I have a feeling this question comes with context - what were you looking for? Ttenbergen 23:20, 18 November 2025 (CST)
    • the two items listed here are general questions about organ donor and how to know if the donor happened or not. i just inserted the discussions after the MAID but not meant to be related to MAID. Sorry, I notice how the two comments came out , one with a box and another under it. I tried to change but unsuccessful so I leave them as is. The main goal is to add them to the instruction if making sense. --JMojica 09:05, 19 November 2025 (CST)
  • SMW


  • Cargo


  • Categories

How they are treated in linking

Transition to post-2019-June-4 organ donor dispo field use

  • We are going to keep the old entries (died - donor and died - not a donor) available, and you don't need to change them for patients you have already entered
    • Main office will run a query to change all the old entries to the new version. We need to do this anyway and it is quicker than collectors doing it manually, so don't waste the time to change these to the new format
  • For all new patients, please use the new fields (will be rolled later on today. Ttenbergen 09:00, 2019 June 4 (CDT))

Cross checks that are affected

Data Integrity Checks (automatic list)

 AppStatus
Link suspect dead then alive queryCentralized data front end.accdbimplemented
Link suspect mismatch to ours incomplete queryCentralized data front end.accdbimplemented

How reports/indicators are affected

other fields/indicators/reports that might be affected

  • Readmission Rate to ICU - not affected because it involves those survived who went to ward or home and came back to ICU or ward, not expired who went to OR or another ICU.
  • Mortality and readmission report - The effect on mortality rate will be negligible if we include or exclude these cases, so it was decided to treat them as all other patients

Related articles

Related articles:
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