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.

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

• 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

Discharge to OR (same or other site)

• Acquired Diagnosis: Brain death
  • Dx Date: Date brain death declared
• Dispo: Death - 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

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
• Previous Location: the previous ICU
• Dispo: Hopefully "Death - to OR", or "Death - 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 "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

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

Cross checks that are affected

_dev_CFE 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

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? Interfacility transfers involved survived patients only, not expired. so this will not be affected.--JMojica 10:30, 2019 July 5 (CDT)

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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. Readmission is 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.--JMojica 10:30, 2019 July 5 (CDT)

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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? The effect on mortality rate will be negligible if we include or exclude these cases, so it was decided that there is no need to make any change at all in the calculation of the rates. --JMojica 10:30, 2019 July 5 (CDT) 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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• 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.