Guideline for coding organ donation after death

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.

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

Organ donor (organ/tissue donation by the donor)

Harvesting at same hospital (discharge to OR)

• Acquired Diagnosis:

what actually, can't be Organ donor (organ/tissue donation by the donor) because that doesn't happen until after they leave us.

• SMW

• Cargo

• Categories

• • Dx Date:

Dx Date - Under current rules that can't be after Dispo DtTm.

• SMW

• Cargo

• Categories

• Dispo:
• Dispo DtTm:

Discharge to another site for harvesting

Sending site

• Acquired Diagnosis:
  • Dx Date:
• Dispo:
• Dispo DtTm:

Receiving site

• Admit Diagnosis:
• Previous Location:
• Dispo: Hopefully the OR, or "Death - to morgue" if transplant doesn't work out
• Dispo DtTm:

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.

• SMW

• Cargo

• Categories

We will not have a separate code for cadaver donations. Instead also code the following as appropriate

• 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.

Donation after Cardiac Death (DCD)

• 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

Correcting suspect links

• SMW

• Cargo

• Categories

• 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:
  • in the forward time direction for a record where that diagnosis was NOT an admission diagnosis
  • in the backward time direction for a record where that diagnosis was either an admission diagnosis or a comorbid diagnosis

Cross checks that are affected

Check dx implying death must be dispo deceased

• SMW

• Cargo

• Categories

How reports are affected

LOS - dead people need to be excluded from LOS, but which LOS of the many? (sp exclude dead people) and Brain death (sp time used) in this.

• SMW

• Cargo

• Categories

Bed occupancy; LOS will not include brain deads, but bed occ. would.

• SMW

• Cargo

• Categories

• LOS
• 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.
• Populate linking pairs)
• (Pre-linking checks