(No longer counted as an OPO metric under CMS OPO Final Rule)
Definition as of January 2017: – download detailed report here. (Organ Toolbox Workgroup , 2018 & Community Hospital Resource Guide Workgroup, 2019)
Eligible deaths represent patients who have been declared brain dead in accordance with state and local laws and have no exclusionary criteria as defined in current OPTN Policy.
New definition starting January 2017:
For reporting purposes of DSA performance assessments, an eligible death for deceased organ donation is defined as the death of a patient who meets the following characteristics:
Is 75 years old or less
Is legally declared dead by neurologic criteria according to state or local law
Has body weight of 5 kg or greater
Has a body mass index (BMI) of 50 kg/m2 or less
Has at least one kidney, liver, heart or lung that is deemed to meet the eligible data definition as defined below
The kidney would initially meet the eligible data definition unless the donor meets of the following criteria:
Greater than 70 years old
Age 50-69 years with history of type 1 diabetes for more than 20 years
Polycystic kidney disease
Glomerulosclerosis greater than or equal to 20% by kidney biopsy
Terminal serum creatinine greater than 4.0 mg/dL
Chronic renal failure
No urine output for 24 hours or longer
The liver would initially meet the eligible data definition unless the donor meets any of the following criteria:
Cirrhosis
Terminal total bilirubin greater than or equal to 4 mg/dL
Portal hypertension
Macrosteatosis greater than or equal to 50% or fibrosis greater than or equal to stage II
Fulminant hepatic failure
Terminal AST/ALT greater than 700 U/L
The heart would initially meet the eligible data definition unless the donor meets any of the following criteria:
Greater than 60 years old
45 years old or older with a history of 10 or more years of HTN or 10 or more years of type 1 diabetes
History of coronary artery bypass graft (CABG)
History of coronary stent/intervention
Current or past medical history of myocardial infarction (MI)
Severe vessel diagnosis as supported by cardiac catheterization (that is more than 50 percent occlusion or 2+ vessel disease)
Acute myocarditis or endocarditis, or both
Heart failure due to cardiomyopathy
Internal defibrillator or pacemaker
Moderate to severe single valve or 2-valve disease documented by echo or cardiac catheterization, or previous valve repair
Serial echo results showing severe global hypokinesis
Myxoma
Congenital defects (surgically corrected or not)
The lung would initially meet the eligible data definition unless the donor meets any of the following criteria:
Greater than 65 years old
Diagnosed with COPD
Terminal PaO2/FiO2 less than 250 mmHg
Asthma (with daily prescription)
Asthma is the cause of death
Pulmonary fibrosis
Previous lobectomy
Multiple blebs documented on computed axial tomography (CAT) scan
Pneumonia as indicated on computed tomography (CT), X-ray, bronchoscopy, or cultures
Bilateral severe pulmonary contusions as per CT
If a deceased patient meets the above criteria they would be classified as an eligible death unless the donor meets any of the following criteria:
The donor goes to the operating room with intent to recover organs for transplant and all organs are deemed not medically suitable for transplant
The donor exhibits any of the following active infections (with a specific diagnosis):
Bacterial: tuberculosis, gangrenous bowel or perforated bowel or intra-abdominal sepsis
Viral: HIV infection by serologic or molecular detection, rabies, reactive hepatitis B surface antigen, retroviral infections including viral encephalitis or meningitis, active herpes simplex, varicella zoster, or cytomegalovirus viremia or pneumonia, acute epstein barr virus
(mononucleosis), West Nile virus infection, or SARS. However, an HIV positive organ procured for transplantation into an HIV positive recipient at a transplant hospital that meets the requirements in Policy 15.7: Open Variance for the Recovery and Transplantation of
Organs from HIV Positive Donors would still meet the requirements of an eligible death, according to the OPTN Final Rule.
Fungal: active infection with cryptococcus, aspergillus, histoplasma, coccidioides, active candidemia or invasive yeast infection
Parasites: active infection with trypanosoma cruzi (Chagas’), Leishmania, strongyloides, or malaria (plasmodium sp.)
Prion: Creutzfeldt-Jacob disease
The following are general exclusions:
Aplastic anemia, agranulocytosis
Current malignant neoplasms, except non-melanoma skin cancers such as basal cell and squamous cell cancer and primary CNS tumors without evident metastatic disease
Previous malignant neoplasms with current evident metastatic disease
A history of melanoma
Hematologic malignancies: leukemia, Hodgkin’s disease, lymphoma, multiple myeloma
Active fungal, parasitic, viral, or bacterial meningitis or encephalitis
No discernible cause of death
Definition until end 2016: Is a death of a person aged 70 years or younger who is legally declared brain dead and does not exhibit any of the CMS exclusionary criteria.
OPOs are required to report all eligible deaths to the Organ Procurement and Transplantation Network (OPTN).” (Alliance Terminology & Data Resources May 2021)