Guideline for coding organ donation after death: Difference between revisions

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{{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. }}

~~== Transition to new 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))

== Instructions for coding these patients ==

* [[Dispo DtTm]]: '''sent from ICU to the operating room or to another ICU''' (consistent with other [[~~Operating room visits~~]]

* [[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'''

=== Discharge to OR (same or other site) ===

* [[Acquired Diagnosis]]: [[Brain death]]

* [[Acquired Diagnosis]]: [[Brain death]], [[Organ donor (organ/tissue donation by the donor)]]

** [[Dx Date]]: Date brain death declared

* [[Dispo]]: '''~~Death~~ - to OR'''

* [[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)

=== Discharge to another site ICU for harvesting ===

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* [[Acquired Diagnosis]]: [[Brain death]]

** [[Dx Date]]: Date brain death declared

* [[Dispo]]: '''~~Death~~ - to other ICU'''

* [[Dispo]]: '''Died - to other ICU'''

*[[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]]

* [[Admit Diagnosis]]: [[Brain death]] Code other relevant diagnoses and procedures with a priority lower than Brain death

* [[Previous Location]]: the previous ICU

* [[Dispo]]: Hopefully "~~Death~~ - to OR", or "~~Death~~ - to morgue" if transplant doesn't work out

* [[Dispo]]: Hopefully "Died - to OR", or "Died - to morgue" if transplant doesn't work out

=== 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.

*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.

~~These would be coded~~ with [[~~Dispo~~]] ~~as the OR where they are going~~. ~~They are not dead when they leave~~, ~~so they are~~ '''~~not~~''' ~~"Death -~~ to OR".

=== [[MAID]] with Organ Donation ===

~~{{DA | 2 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.

* I had one patient ~~where they withdrew care~~ in the unit ~~then went directly~~ to the OR ~~to harvest the organs.~~ ~~What~~ do we do in ~~this case~~?--[[User:~~LKolesar~~|~~LKolesar~~]] 08:03, ~~2019 June 5~~ (~~CDT~~)}}

{{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)

~~=== MAID ===~~

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)

~~Medical Assistance in Dying~~ ([[~~MAID~~]]) ~~is where a person who undergoes MAID has made arrangements in advance for organ harvesting after death.~~

~~{{DA~~ | ~~2 Organ Donation~~

* 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)

~~What~~ are the ~~instructions for this? Would they go through~~ the ~~exercise of declaring such~~ a ~~patient's [[Brain death]] or would we capture~~ them as [[~~Acquired Diagnosis]] [[MAID]] and [[Dispo~~]] ~~"Death - to OR" or more problematically "Death - to other ICU" ?~~ }}

** 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)

}}

== How they are treated in linking ==

* [[Populate linking pairs]] will not be affected since it only looks at PHINs and times

== 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 ==

{{DT | ~~_dev_CFE~~

~~The following in [[Correcting suspect links]] will need to be updated for this:~~

* [[Link suspect dead then alive query]]

** would it be right to say that these are allowed so long as the [[Admit Diagnosis]] is [[Brain death]]? How about other [[Category:Diagnosis implying death]]?

* [[Link suspect mismatch to ours incomplete query]]

** would it be right to say that these are allowed so long as '''any''' diagnosis is [[Brain death]]? (not just acquired, since mayyyyybe the pt came from a third site and it's the admit...)

}}

== How reports are affected ==

== How reports/indicators are affected ==

=== other fields/indicators/reports that might be affected ===

* [[~~Critical Care Inter-facility Transfer Report]] - won't be affected because it looks at survived patients only, not expired.~~

* [[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.

* [[Re-admission]] - 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

@@ Line 2: / Line 2: @@
 {{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. }}
-== Transition to new 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))
 == Instructions for coding these patients ==
-* [[Dispo DtTm]]: '''sent from ICU to the operating room or to another ICU''' (consistent with other [[Operating room visits]]
+* [[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'''
 === Discharge to OR (same or other site) ===
-* [[Acquired Diagnosis]]: [[Brain death]]
+* [[Acquired Diagnosis]]: [[Brain death]], [[Organ donor (organ/tissue donation by the donor)]]
 ** [[Dx Date]]: Date brain death declared
-* [[Dispo]]: '''Death - to OR'''
+* [[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)
 === Discharge to another site ICU for harvesting ===
@@ Line 21: / Line 17: @@
 * [[Acquired Diagnosis]]: [[Brain death]]
 ** [[Dx Date]]: Date brain death declared
-* [[Dispo]]: '''Death - to other ICU'''
+* [[Dispo]]: '''Died - to other ICU'''
+*[[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]]
+* [[Admit Diagnosis]]: [[Brain death]] Code other relevant diagnoses and procedures with a priority lower than Brain death
 * [[Previous Location]]: the previous ICU
-* [[Dispo]]: Hopefully "Death - to OR", or "Death - to morgue" if transplant doesn't work out
+* [[Dispo]]: Hopefully "Died - to OR", or "Died - to morgue" if transplant doesn't work out
 === 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.
+*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.
-These would be coded with [[Dispo]] as the OR where they are going. They are not dead when they leave, so they are '''not''' "Death - to OR".
+=== [[MAID]] with Organ Donation ===
-{{DA | 2 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.
-* I had one patient where they withdrew care in the unit then went directly to the OR to harvest the organs.  What do we do in  this case?--[[User:LKolesar|LKolesar]] 08:03, 2019 June 5 (CDT)}}
+{{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)
-=== MAID ===
+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)
-Medical Assistance in Dying ([[MAID]]) is where a person who undergoes MAID has made arrangements in advance for organ harvesting after death.
-{{DA | 2 Organ Donation
+* 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)
- What are the instructions for this? Would they go through the exercise of declaring such a patient's [[Brain death]] or would we capture them as [[Acquired Diagnosis]] [[MAID]] and [[Dispo]] "Death - to OR" or more problematically "Death - to other ICU" ?  }}
+** 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)
+}}
 == How they are treated in linking ==
 * [[Populate linking pairs]] will not be affected since it only looks at PHINs and times
+== 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 ==
-{{DT | _dev_CFE
+{{Data Integrity Check List|}}
-The following in [[Correcting suspect links]] will need to be updated for this:
-* [[Link suspect dead then alive query]]
-** would it be right to say that these are allowed so long as the [[Admit Diagnosis]] is [[Brain death]]? How about other [[Category:Diagnosis implying death]]?
-* [[Link suspect mismatch to ours incomplete query]]
-** would it be right to say that these are allowed so long as '''any''' diagnosis is [[Brain death]]? (not just acquired, since mayyyyybe the pt came from a third site and it's the admit...)
-}}
-== How reports are affected ==
+== How reports/indicators are affected ==
 === other fields/indicators/reports that might be affected ===
-* [[Critical Care Inter-facility Transfer Report]] - won't be affected because it looks at survived patients only, not expired.
+* [[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.
-* [[Re-admission]] - 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