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 these, 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.

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

Harvesting at same hospital (discharge to OR)

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 for harvesting

Sending site

Receiving site

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

For a patient who develops Brain death in location A, and then transfers to location B for further evaluation for organ donation
- In location A the patient will have an acquired diagnosis of Brain death, and their dispo will be Death with transfer to another ICU. The LOS in location A will be time from admit to Brain death. Any time spent in location A after Brain death will be counted towards occupancy but not LOS.
- In location B the patient will have admit diagnosis of Brain death, and their dispo will be Death with transfer to OR for organ donation IF they go for donation and Death with transfer to morgue if not. While all of this time will be included in occupancy, none of it will be included in LOS (since the person was not alive).
- In the unusual situation where the patient goes directly from location A (an ICU) to the OR of another/different hospital for organ harvesting, the dispo for location A will be Death with transfer to OR for organ donation
- Regarding death rates in these records
  - It’s necessary to avoid double counting the death in location A and location B.

	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

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

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

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

	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.

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

	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.

	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

	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.

	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?