Guideline for coding organ donation after death: Difference between revisions

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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.  
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]]. 


{{Collapsable | always=Background | full= 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. }}
{{Collapsable | always=Background | full= 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 ==
== Instructions for coding these patients ==
{{DA |
* [[Dispo DtTm]]: '''sent from ICU to the operating room or to another ICU''' (consistent with other [[Visits to temporary locations]]
* 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.}} 
 
* [[Dispo DtTm]]: '''sent from ICU to the operating room or to another ICU''' (consistent with other [[Operating room visits]]
** ie '''not the time of death'''
** ie '''not the time of death'''


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* [[Acquired Diagnosis]]: [[Brain death]]
* [[Acquired Diagnosis]]: [[Brain death]]
** [[Dx Date]]: Date brain death declared
** [[Dx Date]]: Date brain death declared
* [[Dispo]]: '''Death - to OR'''
* [[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 ===
=== Discharge to another site ICU for harvesting ===
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* [[Acquired Diagnosis]]: [[Brain death]]
* [[Acquired Diagnosis]]: [[Brain death]]
** [[Dx Date]]: Date brain death declared
** [[Dx Date]]: Date brain death declared
* [[Dispo]]: '''Death - to other ICU'''
* [[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'''
'''Receiving site'''
* [[Admit Diagnosis]]: [[Brain death]]
* [[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
* [[Previous Location]]: the previous ICU
* [[Dispo]]: Hopefully "Death - to OR", or "Death - to morgue" if transplant doesn't work out
* [[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) ===
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.  
*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".  
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".
**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 [[User:Mlagadi|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 ===
Medical Assistance in Dying ([[MAID]]) is where a person who undergoes MAID has made arrangements in advance for organ harvesting after death. 


{{DA | 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" ?  }}
=== 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 ==
== How they are treated in linking ==
* [[Populate linking pairs]] will not be affected since it only looks at PHINs and times
* [[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))


== Cross checks that are affected ==
== Cross checks that are affected ==
{{DT |
{{Data Integrity Check List|}}
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 [[Category:Diagnosis implying death]]?
* [[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...)
}}
 
== 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.
 
{{DA |
* which of the many [[LOS]]? Will the same apply to the other [[:Category:Diagnosis implying death|Diagnosis implying death]]? }}
 
{{DA |
* 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. }}
 
{{DT |
* 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 ===
{{Discuss | who = Julie | question = 
* 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?
}}
 
{{Discuss | who = Julie | question = 
*[[Re-admission]] - based on how just plain transfers are exempted from this, it might be affected. Please see and fix page for more.
}}
 
{{Discuss | who = Julie | question=
* 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)}}
 
{{Discuss | who = Julie | question=
* 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 DtTm | Transfer Ready]] as the first time they are ready.  }}
 
* 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.
 
{{Discuss | who = Allan| question =
*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? }}
}}


Related, but won't be affected:
== How reports/indicators are affected ==
* [[Bed occupancy]]; LOS will not include brain deads, but bed occ. would
=== 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


== Related articles ==  
== Related articles ==  

Latest revision as of 09:17, 2023 January 6

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

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 "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

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))

Cross checks that are affected

Data Integrity Checks (automatic list)

 AppStatus
Link suspect dead then alive queryCentralized data front end.accdbimplemented
Link suspect mismatch to ours incomplete queryCentralized data front end.accdbimplemented

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

Related articles

Related articles:
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