Guideline for coding organ donation after death

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

• 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
  • 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)

Discharge to another site ICU for harvesting

Sending site

• Acquired Diagnosis: Brain death
  • Dx Date: Date brain death declared
• 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 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

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 "Died - to OR".
  • In the few instances of DCD that I have seen, withdrawal of care and death do occur in the ICU. The patient is then transported to the OR if they die within the acceptable window of time. In these cases, the patient is not considered transfer ready, as they must remain in ICU until they die, therefore they will not have a transfer ready time, and the box should be checked. If the patient is a potential organ donor and then deemed not to be, the Transfer Ready DtTm will be when that determination is made. Palliative care should be added as an acquired diagnosis on the date that the patient was made ACP C Mlagadi 08:17, 2023 January 6 (CST)
• In the rare case that they withdrew while still in ICU then moved directly to OR for organ harvest, code the death in the ICU with the time being the actual time of death and the dispo as Died - to OR

MAID with Organ Donation

• Medical Assistance in Dying (MAID) is where a person who undergoes MAID has made 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 bring up brain death. If MAID is provided in the OR, then handle this like DCD (see above) BUT also do list the ICD10 code for MAID as an acquired dx in ICU

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))

Data Integrity Checks (automatic list)

	App	Status
Link suspect dead then alive query	Centralized data front end.accdb	implemented
Link suspect mismatch to ours incomplete query	Centralized data front end.accdb	implemented

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