Form 1 Deceased Donor Registration (DDR)

			Deceased Donor Registration (DDR)
			Fields to be completed by members
			Form Section	Field Label	Notes
			Donor Information	Donor ID	Display Only - Cascades from feedback
			Donor Information	OPO Center Code //OPO	Display Only - Cascades from feedback
			Donor Information	OPO Center Type //OPO	Display Only - Cascades from feedback
			Donor Information	Donor Hospital Provider Number	Display Only - Cascades from feedback
			Donor Information	Donor Hospital Name	Display Only - Cascades from Database
			Donor Information	Donor Hospital	Display Only - Cascades from Database
			Donor Information	Referral Date
			Donor Information	Recovered Outside the U.S.
			Donor Information	Country
			Donor Information	Last Name
			Donor Information	First Name
			Donor Information	MI	Not required
			Donor Information	DOB
			Donor Information	Age
			Donor Information	Age Unit
			Donor Information	Birth Sex
			Donor Information	Home City
			Donor Information	Home City //Status
			Donor Information	State
			Donor Information	Zip Code
			Donor Information	Ethnicity
			Donor Information	Race
			Donor Information	Was the donor born in a country currently classified as endemic for Chagas disease by the CDC?
			Donor Information	Citizenship
			Donor Information	Home Country
			Donor Information	Cause of Death
			Donor Information	Cause of Death //Specify
			Donor Information	Mechanism of Death
			Donor Information	Circumstances of Death
			Authorization	Did the OPO notify the medical examiner/coroner?
			Authorization	If yes, did the medical examiner/coroner accept the case?
			Authorization	If yes, were there any restrictions?
			Authorization	Was the patient declared legally brain dead?
			Authorization	Did the patient legally document their decision to be a donor?
			Authorization	Was authorization obtained for organ donation?
			Authorization	Method of authorization used:
			Authorization	Select the reason organ donation was not obtained:
			Authorization	Date and time consent obtained for organ donation
			Organ Recovery	Cardiac arrest since neurological event that led to declaration of brain death
			Organ Recovery	Duration of Resuscitation //If Yes, Duration of Resuscitation
			Organ Recovery	Duration of Resuscitation //Status	Value or status is reported, not both
			Organ Recovery	Date and time of pronouncement of death: (Complete for brain dead and DCD donors)
			Clinical Information	ABO Blood Group	Display Only - Cascades from feedback
			Clinical Information	Height in Ft//Height
			Clinical Information	Height in In//Height
			Clinical Information	Height in cm
			Clinical Information	Height in cm //Status	Value or status is reported, not both
			Clinical Information	Weight in Lbs//Weight
			Clinical Information	Weight in kg
			Clinical Information	Weight in kg //Status	Value or status is reported, not both
			Terminal Lab Data	Protein in Urine
			Terminal Lab Data	Serum Sodium
			Terminal Lab Data	Serum Sodium Status //Status	Value or status is reported, not both
			Terminal Lab Data	BUN
			Terminal Lab Data	BUN //Status	Value or status is reported, not both
			Terminal Lab Data	Serum Creatinine
			Terminal Lab Data	Serum Creatinine //Status	Value or status is reported, not both
			Terminal Lab Data	Total Bilirubin
			Terminal Lab Data	Total Bilirubin //Status	Value or status is reported, not both
			Terminal Lab Data	SGOT/AST
			Terminal Lab Data	SGOT/AST Status //Status	Value or status is reported, not both
			Terminal Lab Data	SGPT/ALT
			Terminal Lab Data	SGPT/ALT //Status	Value or status is reported, not both
			Terminal Lab Data	INR
			Terminal Lab Data	INR //Status	Value or status is reported, not both
			Terminal Lab Data	Hematocrit
			Terminal Lab Data	Hematocrit //Status	Value or status is reported, not both
			Terminal Lab Data	Serum Amylase
			Terminal Lab Data	Serum Amylase //Status	Value or status is reported, not both
			Terminal Lab Data	Serum Lipase
			Terminal Lab Data	Serum Lipase //Status	Value or status is reported, not both
			Terminal Lab Data	HbA1c
			Terminal Lab Data	HbA1c//Status	Value or status is reported, not both
			Infectious Disease Testing	HIV
			Infectious Disease Testing	HIV Antigen/Antibody
			Infectious Disease Testing	HTLV
			Infectious Disease Testing	RPR-VDRL
			Infectious Disease Testing	Anti-CMV
			Infectious Disease Testing	HBsAg
			Infectious Disease Testing	Anti-HBc
			Infectious Disease Testing	Anti-HCV
			Infectious Disease Testing	HBsAb
			Infectious Disease Testing	EBV (VCA) (lgG)
			Infectious Disease Testing	EBV (VCA) (lgM)
			Infectious Disease Testing	EBNA
			Infectious Disease Testing	T.cruzi Ab Screen
			Infectious Disease Testing	West Nile
			Infectious Disease Testing	Toxoplasma (IgG)
			Infectious Disease Testing	Strongyloides Ab
			Infectious Disease Testing	HIV NAT
			Infectious Disease Testing	HBV DNA
			Infectious Disease Testing	HCV NAT
			Infectious Disease Testing	HTLV NAT
			Infectious Disease Testing	West Nile NAT
			Donor Management	Steroids
			Donor Management	Diuretics
			Donor Management	T3
			Donor Management	T4
			Donor Management	Antihypertensives
			Donor Management	Vasodilators
			Donor Management	DDAVP
			Donor Management	Heparin
			Donor Management	Arginine Vasopressin
			Donor Management	Insulin
			Donor Management	Donor Management Medication Other/Specify (1)	Not required
			Donor Management	Donor Management Medication Other/Specify (2)	Not required
			Donor Management	Donor Management Medication Other/Specify (3)	Not required
			Donor Management	Inotropic medications at time of cross clamp or at time of withdrawal of life-sustaining medical support
			Donor Management	Medication
			Donor Management	Medication //Specify
			Donor Management	Medication
			Donor Management	Medication //Specify
			Donor Management	Medication
			Donor Management	Medication //Specify
			Donor Management	Transfusions prior to ABO determination
			Donor Management	Total Number
			Donor Management	Total Volume
			Donor Management	Transfusions following ABO determination
			Donor Management	Total Number
			Donor Management	Total Volume
			Support Therapies	Were any support therapies initiated?
			Support Therapies	Support therapy
			Support Therapies	Begin date
			Support Therapies	Begin time
			Support Therapies	End date
			Support Therapies	End time
			Clinical Infection	Clinical Infection Confirmed by Culture
			Clinical Infection	Source
			Clinical Infection	Blood
			Clinical Infection	Lung
			Clinical Infection	Urine
			Clinical Infection	Other
			Clinical Infection	Other, specify
			Lifestyle Factors	Cigarette Use (> 20 pack years) - Ever
			Lifestyle Factors	Cigarette Use //AND continued in last six months
			Lifestyle Factors	Ever use or take drugs, such as steroids, cocaine, heroin, amphetamines, or opioids?
			Lifestyle Factors	Type of drug
			Lifestyle Factors	Type of drug //Specify
			Lifestyle Factors	How often:
			Lifestyle Factors	How long was it used?
			Lifestyle Factors	How long was it used? Month/Years
			Lifestyle Factors	When was it last used?
			Lifestyle Factors	Route:
			Lifestyle Factors	Heavy Alcohol Use (heavy= 2+ drinks/day)
			Lifestyle Factors	According to the OPTN policy in effect, does the donor have risk factors for blood-borne disease transmission
			Lifestyle Factors	Sex (i.e., any method of sexual contact, including vaginal, anal, and oral) with a person known or suspected to have HIV, HBV, or HCV infection
			Lifestyle Factors	Man who has had sex with another man
			Lifestyle Factors	Sex in exchange for money or drugs
			Lifestyle Factors	Sex with a person who had sex in exchange for money or drugs
			Lifestyle Factors	Drug injection for nonmedical reasons
			Lifestyle Factors	Sex with a person who injected drugs for nonmedical reasons
			Lifestyle Factors	Incarceration (confinement in jail, prison, or juvenile correction facility) for ≥72 consecutive hours
			Lifestyle Factors	Child breastfed by a mother with HIV infection
			Lifestyle Factors	Child born to a mother with HIV, HBV, or HCV infection
			Lifestyle Factors	Unknown medical or social history
			Lifestyle Factors	History of Diabetes
			Lifestyle Factors	Insulin Dependent
			Lifestyle Factors	History of Hypertension
			Lifestyle Factors	Diet
			Lifestyle Factors	Diuretics
			Lifestyle Factors	Other anti-hypertensive medication
			Lifestyle Factors	History of Cancer
			Lifestyle Factors	History of Cancer //Specify
			Lifestyle Factors	Intracranial
			Lifestyle Factors	Type (Intracranial):
			Lifestyle Factors	Other Type/ Specify
			Lifestyle Factors	Extracranial
			Lifestyle Factors	Type (for Extracranial):
			Lifestyle Factors	Other Type/ Specify
			Lifestyle Factors	Skin
			Lifestyle Factors	Type (for Skin):
			Lifestyle Factors	Other Type/ Specify
			Lifestyle Factors	Chagas History
			Lifestyle Factors	TB History
			Organ Recovery	Recovery Date (donor to OR)
			Organ Recovery	Was this donor recovered under DCD protocol
			Organ Recovery	If Yes, Controlled
			Organ Recovery	Date and time of withdrawal of support
			Organ Recovery	Date and time of withdrawal of support (Status)	Value or status is reported, not both
			Organ Recovery	Cessation of circulation (status)	Value or status is reported, not both
			Organ Recovery	Cessation of circulation, (date)
			Organ Recovery	Cessation of circulation, (time)
			Organ Recovery	Date and time agonal phase begins (systolic BP < 80 mmHg or O2 sat. < 80% sustained)
			Organ Recovery	Date and time agonal phase begins (systolic BP < 80 mmHg or O2 sat. < 80% sustained) (status)	Value or status is reported, not both
			Organ Recovery	Normothermic regional perfusion (NRP) (status)
			Organ Recovery	Initiation of NRP (status)	Value or status is reported, not both
			Organ Recovery	If yes, Initiation of NRP (date)
			Organ Recovery	If yes, Initiation of NRP (time)
			Organ Recovery	Core cooling with flush
			Organ Recovery	Date and time of abdominal aorta core cooling
			Organ Recovery	Date and time of abdominal aorta core cooling://Status	Value or status is reported, not both
			Organ Recovery	Date and time of thoracic aorta core cooling
			Organ Recovery	Date and time of thoracic aorta core cooling://Status	Value or status is reported, not both
			Organ Recovery	Date and time of portal vein core cooling
			Organ Recovery	Date and time of portal vein core cooling://Status	Value or status is reported, not both
			Organ Recovery	Date and time of pulmonary artery core cooling
			Organ Recovery	Date and time of pulmonary artery core cooling://Status	Value or status is reported, not both
			Organ Recovery	If No, Was this a consented DCD donor that progressed to brain death?
			Organ Recovery	Clamp Date
			Organ Recovery	Clamp Time: (Military Time)
			Organ Recovery	Clamp Time //Status	Value or status is reported, not both
			Organ Recovery	Clamp Time Zone
			Organ Recovery	History of previous MI
			Organ Recovery	LV ejection fraction (%)
			Organ Recovery	LV Ejection Fraction % //Status	Value or status is reported, not both
			Organ Recovery	Method
			Organ Recovery	Structural Abnormalities //Valves
			Organ Recovery	Structural Abnormalities //Congenital
			Organ Recovery	Structural Abnormalities //LVH
			Organ Recovery	Wall Abnormalities //Segmental
			Organ Recovery	Wall Abnormalities //Global
			Organ Recovery	Heart machine perfusion
			Organ Recovery	Coronary Angiogram
			Organ Recovery	If Abnormal, # of Vessels with > 50% Stenosis
			Organ Recovery	ABG Results	Display Only
			Organ Recovery	Blood pH
			Organ Recovery	PH //Status	Value or status is reported, not both
			Organ Recovery	PCO<sub>2
			Organ Recovery	PCO2 //Status	Value or status is reported, not both
			Organ Recovery	PO2
			Organ Recovery	PO2//Status	Value or status is reported, not both
			Organ Recovery	FiO2
			Organ Recovery	FiO2//Status	Value or status is reported, not both
			Organ Recovery	PEEP
			Organ Recovery	PEEP//Status	Value or status is reported, not both
			Organ Recovery	Ventilator Mode
			Organ Recovery	Ventilator Mode//Other Specify
			Organ Recovery	Were advanced hemodynamic parameter data obtained?
			Organ Recovery	Method
			Organ Recovery	MAP (initial) // MAP: (mm Hg)
			Organ Recovery	MAP (initial) //Status	Value or status is reported, not both
			Organ Recovery	MAP (final) // MAP: (mm Hg)
			Organ Recovery	MAP (final) //Status	Value or status is reported, not both
			Organ Recovery	CVP (initial) // CVP: (mm Hg)
			Organ Recovery	CVP (initial) //Status	Value or status is reported, not both
			Organ Recovery	CVP (final) // CVP: (mm Hg)
			Organ Recovery	CVP (final) //Status	Value or status is reported, not both
			Organ Recovery	PCWP (initial) // PCWP: (mm Hg)
			Organ Recovery	PCWP (initial) //Status	Value or status is reported, not both
			Organ Recovery	PCWP (final) // PCWP: (mm Hg)
			Organ Recovery	PCWP (final) //Status	Value or status is reported, not both
			Organ Recovery	SVR (initial) //SVR: ((dynes/sec/cm)^5)
			Organ Recovery	SVR (initial) //Status	Value or status is reported, not both
			Organ Recovery	SVR (final) //SVR
			Organ Recovery	SVR (final) //Status	Value or status is reported, not both
			Organ Recovery	PA Systolic (initial) // PA Systolic: (mm Hg)
			Organ Recovery	PA Systolic (initial) //Status	Value or status is reported, not both
			Organ Recovery	PA Systolic (final) // PA Systolic: (mm Hg)
			Organ Recovery	PA Systolic (final) //Status	Value or status is reported, not both
			Organ Recovery	PA Diastolic (initial) // PA Diastolic: (mm Hg)
			Organ Recovery	PA Diastolic (initial) //Status	Value or status is reported, not both
			Organ Recovery	PA Diastolic (final) // PA Diastolic: (mm Hg)
			Organ Recovery	PA Diastolic (final) //Status	Value or status is reported, not both
			Organ Recovery	CO (initial) (L/min) //CO: (L/min)
			Organ Recovery	CO (initial) //Status	Value or status is reported, not both
			Organ Recovery	CO (final) (L/min) //CO
			Organ Recovery	CO (final) //Status	Value or status is reported, not both
			Organ Recovery	Cardiac Index (initial) //Cardiac Index: (L/min/sq.m)
			Organ Recovery	Cardiac Index (initial) //Status	Value or status is reported, not both
			Organ Recovery	Cardiac Index (final) //Cardiac Index
			Organ Recovery	Cardiac Index (final) //Status	Value or status is reported, not both
			Organ Recovery	Left Kidney Biopsy
			Organ Recovery	Biopsy type
			Organ Recovery	Tissue preparation technique
			Organ Recovery	Interstitial fibrosis and tubular atrophy (IFTA)
			Organ Recovery	Vascular disease (Percent luminal narrowing of the most severely involved vessel)
			Organ Recovery	Number of globally sclerotic glomeruli
			Organ Recovery	Number of globally sclerotic glomeruli //Status	Value or status is reported, not both
			Organ Recovery	Number of glomeruli
			Organ Recovery	Number of glomeruli//Status	Value or status is reported, not both
			Organ Recovery	% Globally sclerotic glomeruli	Display Only- Calculated
			Organ Recovery	Nodular mesangial glomerulosclerosis
			Organ Recovery	Arteriolar hyalinosis
			Organ Recovery	Cortical necrosis
			Organ Recovery	% Cortical necrosis
			Organ Recovery	% Cortical necrosis //Status	Value or status is reported, not both
			Organ Recovery	Fibrin thrombi
			Organ Recovery	% Fibrin thrombi
			Organ Recovery	% Fibrin thrombi //Status	Value or status is reported, not both
			Organ Recovery	Pump (Left Kidney) //Pump
			Organ Recovery	Final Resistance Prior to Shipping (left) //Final Resistance Prior to Shipping
			Organ Recovery	Final Resistance Prior to Shipping (left) //Status	Value or status is reported, not both
			Organ Recovery	Transferred on pump (left):// Transferred to transplant center on pump
			Organ Recovery	Type of Left Kidney Pump/Machine
			Organ Recovery	Type of Left Kidney Pump/Machine//Specify
			Organ Recovery	Kidney Biopsy (right)://Right Kidney Biopsy
			Organ Recovery	Biopsy type
			Organ Recovery	Tissue Preparation Technique
			Organ Recovery	Interstitial fibrosis and tubular atrophy (IFTA)
			Organ Recovery	Vascular disease (Percent luminal narrowing of the most severely involved vessel)
			Organ Recovery	Number of globally sclerotic glomeruli
			Organ Recovery	Number of globally sclerotic glomeruli //Status	Value or status is reported, not both
			Organ Recovery	Number of glomeruli
			Organ Recovery	Number of glomeruli//Status	Value or status is reported, not both
			Organ Recovery	% Globally sclerotic glomeruli	Display Only- Calculated
			Organ Recovery	Nodular mesangial glomerulosclerosis
			Organ Recovery	Arteriolar hyalinosis
			Organ Recovery	Cortical necrosis
			Organ Recovery	% Cortical necrosis
			Organ Recovery	% Cortical necrosis //Status	Value or status is reported, not both
			Organ Recovery	Fibrin thrombi
			Organ Recovery	% Fibrin thrombi
			Organ Recovery	% Fibrin thrombi //Status	Value or status is reported, not both
			Organ Recovery	Pump (Right Kidney) //Pump
			Organ Recovery	Final Resistance Prior to Shipping (right) //Final Resistance Prior to Shipping
			Organ Recovery	Final Resistance Prior to Shipping (right) //Status	Value or status is reported, not both
			Organ Recovery	Transferred on pump (right):// Transferred to transplant center on pump
			Organ Recovery	Type of Right Kidney Pump/Machine
			Organ Recovery	Type of Right Kidney Pump/Machine//Specify
			Organ Recovery	Liver Biopsy
			Organ Recovery	Type of Liver Biopsy
			Organ Recovery	Type of Liver Biopsy//Specify
			Organ Recovery	Fibrosis
			Organ Recovery	Portal Infiltrates
			Organ Recovery	% Macro vesicular fat
			Organ Recovery	% Macro vesicular fat //Status	Value or status is reported, not both
			Organ Recovery	% Micro/intermediate vesicular fat
			Organ Recovery	% Micro/intermediate vesicular fat //Status	Value or status is reported, not both
			Organ Recovery	Liver Machine Perfusion
			Organ Recovery	Type of Liver Machine Perfusion
			Organ Recovery	Type of Liver Machine Perfusion//Specify
			Organ Recovery	Left Lung Bronchoscopy
			Organ Recovery	Left Lung Bronchoscopy //Specify
			Organ Recovery	Left Lung Machine Perfusion
			Organ Recovery	Right Lung Bronchoscopy
			Organ Recovery	Right Lung Bronchoscopy //Specify
			Organ Recovery	Right Lung Machine Perfusion
			Organ Recovery	Chest X-ray
			Organ Disposition	Disposition of Organ - Right Kidney://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date and time right kidney recovered/removed from donor
			Organ Disposition	Recipient: RKI	Display Only - Cascades from Database
			Organ Disposition	TX Center: RKI	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Right Kidney://Reason Code
			Organ Disposition	Reason Code Right Kidney //Specify
			Organ Disposition	Reason organ not transplanted - Right Kidney://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Right Kidney //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Right Kidney://Initial Flush Solution
			Organ Disposition	Initial Flush - Right Kidney //Specify
			Organ Disposition	Back Table Flush Solution - Right Kidney://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Right Kidney //Specify
			Organ Disposition	chest X-ray
			Organ Disposition	Final Flush Right Kidney //Specify
			Organ Disposition	OPO sent vessels with organ: RKI	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: RKI	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: RKI	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Left Kidney://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date and time left kidney recovered/removed from donor
			Organ Disposition	Recipient: LKI	Display Only - Cascades from Database
			Organ Disposition	TX Center: LKI	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Left Kidney://Reason Code
			Organ Disposition	Reason Code Left Kidney //Specify
			Organ Disposition	Reason organ not transplanted - Left Kidney://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Left Kidney //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Left Kidney://Initial Flush Solution
			Organ Disposition	Initial Flush - Left Kidney //Specify
			Organ Disposition	Back Table Flush Solution - Left Kidney://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Left Kidney //Specify
			Organ Disposition	Final Flush Solution - Left Kidney://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Left Kidney //Specify
			Organ Disposition	OPO sent vessels with organ: LKI	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: LKI	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: LKI	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Double/En-bloc Kidney://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date and time double/en-bloc kidney recovered/removed from donor
			Organ Disposition	Recipient: EKI	Display Only - Cascades from Database
			Organ Disposition	TX Center: EKI	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Double/En-bloc Kidney://Reason Code
			Organ Disposition	Reason Code - Double/En-bloc Kidney //Specify
			Organ Disposition	Reason organ not transplanted -Double/En-bloc Kidney://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted - Double/En-bloc Kidney //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Double/En-bloc Kidney://Initial Flush Solution
			Organ Disposition	Initial Flush - Double/En-bloc Kidney //Specify
			Organ Disposition	Back Table Flush Solution - Double/En-bloc Kidney://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Double/En-bloc Kidney //Specify
			Organ Disposition	Final Flush Solution - Double/En-bloc Kidney://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Double/En-bloc Kidney //Specify
			Organ Disposition	OPO sent vessels with organ: EKI	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: EKI	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: EKI	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Pancreas://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date and time whole pancreas recovered/removed from donor
			Organ Disposition	Recipient: PA	Display Only - Cascades from Database
			Organ Disposition	TX Center: PA	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Pancreas://Reason Code
			Organ Disposition	Reason Code - Pancreas //Specify
			Organ Disposition	Reason organ not transplanted -Pancreas://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Pancreas //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Pancreas://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Pancreas //Specify
			Organ Disposition	Back Table Flush Solution - Pancreas://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Pancreas //Specify
			Organ Disposition	Final Flush Solution - Pancreas://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Pancreas //Specify
			Organ Disposition	OPO sent vessels with organ: PA	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: PA	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: PA	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Pancreas Segment 1://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date, and time pancreas segment 1 recovered/removed from donor
			Organ Disposition	Recipient: PAS1	Display Only - Cascades from Database
			Organ Disposition	TX Center: PAS1	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Pancreas Segment 1://Reason Code
			Organ Disposition	Reason Code/Specify - Pancreas Segment 1 //Specify
			Organ Disposition	Reason organ not transplanted -Pancreas Segment 1://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Pancreas Segment 1 //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Pancreas Segment 1://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Pancreas Segment 1 //Specify
			Organ Disposition	Back Table Flush Solution - Pancreas Segment 1://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Pancreas Segment 1 //Specify
			Organ Disposition	Final Flush Solution - Pancreas Segment 1://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Pancreas Segment 1 //Specify
			Organ Disposition	OPO sent vessels with organ: PAS1	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: PAS1	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: PAS1	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Pancreas Segment 2://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date and time pancreas segment 2 recovered/removed from donor
			Organ Disposition	Recipient: PAS2	Display Only - Cascades from Database
			Organ Disposition	TX Center: PAS2	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Pancreas Segment 2://Reason Code
			Organ Disposition	Reason Code/Specify - Pancreas Segment 2 //Specify
			Organ Disposition	Reason organ not transplanted -Pancreas Segment 2://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Pancreas Segment 2 //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Pancreas Segment 2://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Pancreas Segment 2 //Specify
			Organ Disposition	Back Table Flush Solution - Pancreas Segment 2://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Pancreas Segment 2 //Specify
			Organ Disposition	Final Flush Solution - Pancreas Segment 2://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Pancreas Segment 2 //Specify
			Organ Disposition	OPO sent vessels with organ: PAS2	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: PAS2	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: PAS2	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Liver://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date and time whole liver recovered/removed from donor
			Organ Disposition	Recipient: LI	Display Only - Cascades from Database
			Organ Disposition	TX Center: LI	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Liver://Reason Code
			Organ Disposition	Reason Code/Specify - Liver //Specify
			Organ Disposition	Reason organ not transplanted -Liver://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Liver //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Liver://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Liver //Specify
			Organ Disposition	Back Table Flush Solution - Liver://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Liver //Specify
			Organ Disposition	Final Flush Solution - Liver://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Liver //Specify
			Organ Disposition	OPO sent vessels with organ: LI	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: LI	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: LI	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Liver Segment 1://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date and time liver segment 1 recovered/removed from donor
			Organ Disposition	Recipient: LIS1	Display Only - Cascades from Database
			Organ Disposition	TX Center: LIS1	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Liver Segment 1://Reason Code
			Organ Disposition	Reason Code/Specify - Liver Segment 1 //Specify
			Organ Disposition	Reason organ not transplanted -Liver Segment 1://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Liver Segment 1 //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Liver Segment 1://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Liver Segment 1 //Specify
			Organ Disposition	Back Table Flush Solution - Liver Segment 1://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Liver Segment 1 //Specify
			Organ Disposition	Final Flush Solution - Liver Segment 1://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Liver Segment 1 //Specify
			Organ Disposition	OPO sent vessels with organ: LIS1	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: LIS1	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: LIS1	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Liver Segment 2://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date and time liver segment 2 recovered/removed from donor
			Organ Disposition	Recipient: LIS2	Display Only - Cascades from Database
			Organ Disposition	TX Center: LIS2	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Liver Segment 2://Reason Code
			Organ Disposition	Reason Code/Specify - Liver Segment 2 //Specify
			Organ Disposition	Reason organ not transplanted -Liver Segment 2://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Liver Segment 2 //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Liver Segment 2://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Liver Segment 2 //Specify
			Organ Disposition	Back Table Flush Solution - Liver Segment 2://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Liver Segment 2 //Specify
			Organ Disposition	Final Flush Solution - Liver Segment 2://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Liver Segment 2 //Specify
			Organ Disposition	OPO sent vessels with organ: LIS2	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: LIS2	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: LIS2	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Intestine://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date and time whole intestine recovered/removed from donor
			Organ Disposition	Recipient: IN	Display Only - Cascades from Database
			Organ Disposition	TX Center: IN	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Intestine://Reason Code
			Organ Disposition	Reason Code/Specify - Intestine //Specify
			Organ Disposition	Reason organ not transplanted -Intestine ://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Intestine //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Intestine://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Intestine //Specify
			Organ Disposition	Back Table Flush Solution - Intestine://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Intestine //Specify
			Organ Disposition	Final Flush Solution - Intestine://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Intestine //Specify
			Organ Disposition	OPO sent vessels with organ: IN	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: IN	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: IN	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Intestine Segment 1://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date and time intestine segment 1 recovered/removed from donor
			Organ Disposition	Recipient: INS1	Display Only - Cascades from Database
			Organ Disposition	TX Center: INS1	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Intestine Segment 1://Reason Code
			Organ Disposition	Reason Code/Specify - Intestine Segment 1 //Specify
			Organ Disposition	Reason organ not transplanted -Intestine Segment 1://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Intestine Segment 1 //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Intestine Segment 1://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Intestine Segment 1 //Specify
			Organ Disposition	Back Table Flush Solution - Intestine Segment 1://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Intestine Segment 1 //Specify
			Organ Disposition	Final Flush Solution - Intestine Segment 1://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Intestine Segment 1 //Specify
			Organ Disposition	OPO sent vessels with organ: INS1	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: INS1	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: INS1	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Intestine Segment 2://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date and time intestine segment 2 recovered/removed from donor
			Organ Disposition	Recipient: INS2	Display Only - Cascades from Database
			Organ Disposition	TX Center: INS2	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Intestine Segment 2://Reason Code
			Organ Disposition	Reason Code/Specify - Intestine Segment 2 //Specify
			Organ Disposition	Reason organ not transplanted -Intestine Segment 2://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Intestine Segment 2 //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Intestine Segment 2://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Intestine Segment 2 //Specify
			Organ Disposition	Back Table Flush Solution - Intestine Segment 2://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Intestine Segment 2 //Specify
			Organ Disposition	Final Flush Solution - Intestine Segment 2://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Intestine Segment 2 //Specify
			Organ Disposition	OPO sent vessels with organ: INS2	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: INS2	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: INS2	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Heart://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date and time heart recovered/removed from donor
			Organ Disposition	Recipient: HR	Display Only - Cascades from Database
			Organ Disposition	TX Center: HR	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Heart://Reason Code
			Organ Disposition	Reason Code/Specify - Heart //Specify
			Organ Disposition	Reason organ not transplanted -Heart://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Heart //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Heart://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Heart //Specify
			Organ Disposition	Back Table Flush Solution - Heart://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Heart //Specify
			Organ Disposition	Final Flush Solution - Heart://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Heart //Specify
			Organ Disposition	OPO sent vessels with organ: HR	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: HR	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: HR	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Right Lung://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date and time left lung recovered/removed from donor
			Organ Disposition	Recipient: LUL	Display Only - Cascades from Database
			Organ Disposition	TX Center: LUL	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Right Lung://Reason Code
			Organ Disposition	Reason Code/Specify - Right Lung //Specify
			Organ Disposition	Reason organ not transplanted -Right Lung://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Right Lung //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Right Lung://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Right Lung //Specify
			Organ Disposition	Back Table Flush Solution - Right Lung://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Right Lung //Specify
			Organ Disposition	Final Flush Solution - Right Lung://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Right Lung //Specify
			Organ Disposition	OPO sent vessels with organ: LUL	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: LUL	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: LUL	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Left Lung://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date and time right lung recovered/removed from donor
			Organ Disposition	Recipient: LUR	Display Only - Cascades from Database
			Organ Disposition	TX Center: LUR	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Left Lung://Reason Code
			Organ Disposition	Reason Code/Specify - Left Lung //Specify
			Organ Disposition	Reason organ not transplanted -Left Lung://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Left Lung //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Left Lung://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Left Lung //Specify
			Organ Disposition	Back Table Flush Solution - Left Lung://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Left Lung //Specify
			Organ Disposition	Final Flush Solution - Left Lung://Final Flush/Storage Solution
			Organ Disposition	Final Flush Solution Specify - Left Lung //Specify
			Organ Disposition	OPO sent vessels with organ: LUR	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: LUR	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: LUR	Display Only - Cascades from Database
			Organ Disposition	Disposition of Organ - Double/En-bloc Lung://Organ	Display Only - Cascades from feedback
			Organ Disposition	Date and time double/en-bloc lung recovered/removed from donor
			Organ Disposition	Recipient: DLU	Display Only - Cascades from Database
			Organ Disposition	TX Center: DLU	Display Only - Cascades from Database
			Organ Disposition	Reason Code - Double/En-bloc Lung://Reason Code
			Organ Disposition	Reason Code/Specify - Double/En-bloc Lung //Specify
			Organ Disposition	Reason organ not transplanted -Double/En-bloc Lung://Reason organ not transplanted
			Organ Disposition	Reason organ not transplanted Other Specify - Double/En-bloc Lung //Specify
			Organ Disposition	Did the recipient transplant center recover the organ?
			Organ Disposition	If no, did another transplant center recover the organ?
			Organ Disposition	If no, did the Donor OPO provide a recovery team?
			Organ Disposition	If no, recovery center:
			Organ Disposition	Initial Flush Solution - Double/En-bloc Lung://Initial Flush Solution
			Organ Disposition	Initial Flush Other Specify - Double/En-bloc Lung //Specify
			Organ Disposition	Back Table Flush Solution - Double/En-bloc Lung://Back Table Flush Solution
			Organ Disposition	Back Table Flush Solution Specify - Double/En-bloc Lung //Specify
			Organ Disposition	Final Flush Solution Specify - Double/En-bloc Lung //Specify
			Organ Disposition	Final Flush Solution - Double/En-bloc Lung://Final Flush/Storage Solution
			Organ Disposition	OPO sent vessels with organ: DLU	Display Only - Cascades from Database
			Organ Disposition	Were extra vessels used in the transplant procedure: DLU	Display Only - Cascades from Database
			Organ Disposition	Vessel Donor ID: DLU	Display Only - Cascades from Database
			OMB No. 0915-0157; Expiration Date: XX/XX/20XX
			PUBLIC BURDEN STATEMENT:
			The private, non-profit Organ Procurement and Transplantation Network (OPTN) collects this information in order to perform the following OPTN functions: to assess whether applicants meet OPTN Bylaw requirements for membership in the OPTN; and to monitor compliance of member organizations with OPTN Obligations. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this information collection is 0915-0157 and it is valid until XX/XX/202X. This information collection is required to obtain or retain a benefit per 42 CFR §121.11(b)(2). All data collected will be subject to Privacy Act protection (Privacy Act System of Records #09-15-0055). Data collected by the private non-profit OPTN also are well protected by a number of the Contractor’s security features. The Contractor’s security system meets or exceeds the requirements as prescribed by OMB Circular A-130, Appendix III, Security of Federal Automated Information Systems, and the Departments Automated Information Systems Security Program Handbook. The public reporting burden for this collection of information is estimated to average 0.27 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Information Collection Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, Maryland, 20857 or paperwork@hrsa.gov.