Guideline for coding organ donation after death: Difference between revisions

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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".
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".
{{Discuss | who = all, Allan, ... | question =
{{DA |
* 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)}}
* 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)}}



Revision as of 16:53, 2019 June 18

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.

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

Discharge to OR (same or other site)

Discharge to another site ICU for harvesting

Sending site

Receiving site

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".

  • 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?--LKolesar 08:03, 2019 June 5 (CDT)
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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

Cross checks that are affected

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

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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.


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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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other fields that might be affected

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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

Related articles

Related articles: