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

If I understand all this right we will not actually be coding Organ donor (organ/tissue donation by the donor) for deceased patients , since that will always happen elsewhere, and pt won't come back to us after, so not our dx. If I understand that right we should probably put a one-liner here to make that clear since it's a bit counter-intuitive. And likely at that page as well. 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.

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• Dispo DtTm: sent from ICU to the operating room or to another ICU (consistent with other Operating room visits
  • ie don't code the time of death

Discharge to OR (same or other site)

• Acquired Diagnosis: Brain death
  • Dx Date: Date brain death declared
• Dispo: Death - to OR
• Dispo DtTm: DtTm pt leaves to OR

Discharge to another site ICU for harvesting

Sending site

• Acquired Diagnosis: Brain death
  • Dx Date: Date brain death declared
• Dispo: Death - to other ICU
• Dispo DtTm: DtTm pt leaves to other ICU

Receiving site

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

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.

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

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

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" ?

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How they are treated in linking

• Populate linking pairs will not be affected since it only looks at PHINs and times

Cross checks that are affected

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 ? 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...)

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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 

• 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.

which of the many LOS? Will the same apply to the other Diagnosis implying death?

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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.

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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

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other fields that might be affected

Inter-facility transfers Critical Care Inter-facility Transfer Report if this looks at Dispo it will be affected, if it looks at Previous Location it would be fine; Julie, does this need to be reconsidered?

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Re-admission - based on how just plain transfers are exempted from this, it might be affected. Please see and fix page for more.

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As per Allan, "It’s necessary to avoid double counting the death for patients who transfer after brain death". Mortality and readmission report - that page has very limited information. Is this report still done? If so, can we update that and make sure this change won't mess with it? Are there other reports that count death rates or mortality? If so we should make a page for it and add it to Category:End-of-life related data and make sure it records how we will address this scenario. Ttenbergen 16:04, 2019 May 21 (CDT)

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transfer delays (Transfer Delay - currently says it's only for survivors. Is that still true? If so it will need to be adjusted. Is that actually right, to exclude deceased pt? They were still delayed while alive. Excluding them may be inconsistent with our definition of Transfer Ready as the first time they are ready.

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• 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.

Julie, which reports and what linking will be affected by this, so we can update the related wiki pages? 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?

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Related, but won't be affected:

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