GLOSSARY OF KEY TERMS AND DEFINITIONS
Compiled by LifeSource
GENERAL TERMS
Brain Death (BD): Total and irreversible loss of brain function but maintained on cardiopulmonary support system. Potential types of donation: heart, lung, liver, pancreas, kidneys, and intestines, along with eyes, skin, bone, veins, connective tissues, heart for valves.
Catastrophic Brain Injury Guideline (CBIGs): Management guidelines based on the Surviving Sepsis Campaign with the goal to save more lives and preserve the opportunity for donation.
Certified Designated Requestor (CDR): A hospital staff member who has completed the designated organ procurement organization training course, subsequent OPO recertification training, and is qualified to discuss donation with the legal next of kin and obtain verbal authorization for donation.
Donation after Circulatory Death (DCD): The recovery of organs after the irreversible cessation of all cardiopulmonary function.
Donor Designation (DD): The patient’s indication of intent to donate at the time of death as expressed in a document of gift; e.g. driver’s license indication, donor card, advanced directive, will.
Donor Management Goals (DMGs):
Donor Registry: A confidential electronic database in which individuals can enter and store their wish to be an organ and tissue donor. Most registries are for a single state, but a few serve more than one state. Most registries have enrollment capacity through the motor vehicle offices and many also have online registry portals. Because registry information is accessible on a 24/7 basis to authorized procurement personnel, it is the safest and quickest way to determine if a deceased individual wanted to be a donor.
Organ Procurement Organization (OPO): Local organizations throughout the U.S. designated by the Centers for Medicare and Medicaid Services (CMS) are responsible for increasing the number of registered donors in their service areas, and for coordinating the donation process when actual donors become available. OPOs evaluate potential donors, discuss donation with surviving family members, and arrange for the surgical removal and transport of donated organs. To increase donor registration, OPOs implement community outreach strategies to encourage people to sign up in their State donor registry.
Physician Champion: The physician champion will be an engaged physician who is willing to be an agent of change for the hospital donation program. The physician champion will be actively involved in the donation process, participating in huddles with staff from the hospital and LifeSource, taking phone calls and answering questions from LifeSource donation coordinators and calling LifeSource when questions arise.
Vascularized Composite Allotransplantation (VCA): Graft composed of a variety of tissue including skin, muscle, bone, tendon, nerve, vessels. Includes hand, face, lower extremity and larynx.
DONATION DATA TERMS
Conversion Rate - Comprehensive: Defined by LifeSource as the number of organ donors divided by all BD + appears BD + DCD donors.
Conversion Rate – Eligible: Defined by UNOS as the number of eligible deaths that become organ donors divided by the number of eligible deaths.
Conversion Rate – OPTN: Defined by UNOS as the number of organ donors divided by the number of eligible deaths + non-eligible donors. Adjusted to include non-eligible donors; basis for HRSA Medal of Honor Awards; used in hospital reporting.
Donation after Circulatory Death (DCD): Organ donors not declared BD, recovered under a DCD protocol.
Eligible Death: Defined by OPTN, “Although it is recognized that this definition does not include all potential donors, for reporting purposes for DSA performance assessment, aneligible death for organ donation is defined as the death of a patient 70 years old or younger who ultimately is legally declared brain dead according to hospital policy independent of family decision regarding donation or availability of next-of-kin, independent of medical examiner or coroner involvement in the case, and independent of local acceptance criteria or transplant center practice, who exhibits none of the following:
Active infections (specific diagnoses)
Bacterial:
-Active Bacterial encephalitis or meningitis
-Gangrenous bowel or perforated bowel and/or intra-abdominal sepsis
-Tuberculosis
Fungal:
-Active candidemia or invasive yeast infection
-Active Fungal encephalitis or meningitis
-Active infection with Cryptococcus, Aspergillus, Histoplasma, Coccidioides
General:
-Aplastic Anemia
-Agranulocytosis
-Extreme Immaturity (<500 grams or gestational age of <32 weeks)
-Current malignant neoplasms except non-melanoma skin cancers such as basal
cell and squamous cell cancer and primary CNS tumors without evident metastatic disease
-History of melanoma
-Hematologic malignancies: Leukemia, Hodgkin's Disease, Lymphoma, Multiple Myeloma
-Multi-system organ failure (MSOF) – Defined as 3 or more systems in simultaneous failure for a period of 24 hours or more without response to treatment or resuscitation.
-Previous malignant neoplasms with current evident metastatic disease
Parasites:
-Active infection with Trypanosoma cruzi (Chagas')
-Active Parasitic encephalitis or meningitis
-Leishmania, Strongyloides, or Malaria (Plasmodium sp.)
Prion:
-Creutzfeldt-Jacob Disease
Viral:
-Active Herpes simplex, varicella zoster, or cytomegalovirus viremia or pneumonia
-Active Viral Encephalitis or Meningitis
-Acute Epstein Barr Virus (mononucleosis)
-HIV infection by serologic or molecular detection
-Rabies
-Reactive Hepatitis B Surface Antigen
-Retroviral infections including HTLV I/II
-Severe Acute Respiratory Syndrome (SARS)
-West Nile Virus infection
Expanded Criteria Donor (ECD):Those over 60 years of age or those between 50 and 59 years of age with 2 of the following co-morbidities: CVA as cause of death; history of hypertension anytime;Creatinine > 1.5.
Hospital Dashboard: Compilation of donation-related data for each of the hospitals in the LifeSource service area, enabling hospital professionals to compare with other like hospitals. Dashboard data points are developed based on the national goals of 75% conversion rate, 3.75 organs transplanted per donor and 10% of total donors will bedonation after circulatory deaths.
Organs Transplanted per Donor (OTPD): Total organs transplanted divided by the total number of donors.
Scientific Registry of Transplant Recipients (SRTR):An ever-expanding national database of transplantation statistics. Founded in 1987, the registry exists to support the ongoing evaluation of the scientific and clinical status of solid organ transplantation, including kidney, heart, liver, lung, intestine, and pancreas. Data in the registry are collected by the Organ Procurement and Transplantation Network (OPTN) from hospitals and organ procurement organizations (OPOs) across the country. The SRTR contains current and past information about the full continuum of transplant activity, from organ donation and waiting list candidates to transplant recipients and survival statistics. This information is used to help develop evidence-based policy, to support analysis of transplant programs and OPOs, and to encourage research on issues of importance to the transplant community.
Standard Criteria Donor (SCD): Donors after BD not meeting the expanded criteria definition.
Timely Referral: Referral call is made within one hour of the patient meeting clinical triggers for imminent death and before life-sustaining therapies are withdrawn, or, within one hour after cardiac death.
DONATION AND TRANSPLANTATION ORGANIZATIONS
Association of Organ Procurement Organizations (AOPO): The non-profit organization recognized as the national representative of fifty-eight federally-designated organ procurement organizations (OPOs).
Donate Life America: Formerly known as the Coalition on Donation, a 501(c)3 not-for-profit alliance of national organizations and state teams across the United States committed to increasing organ, eye and tissue donation. Donate Life America manages and promotes the national brand for donation, Donate Life, and assists Donate Life State Teams and national partners in facilitating high-performing donor registries; developing and executing effective multi-media donor education programs; and motivating the American public to register now as organ, eye and tissue donors.
Organ Procurement and Transplantation Network (OPTN): helps ensure the success and efficiency of the U.S. organ transplant system by matching donor organs with waiting recipients. Under federal law, all U.S. transplant centers and organ procurement organizations must be members of the OPTN.
United Network for Organ Sharing (UNOS): The private, non-profit organization that manages the nation's organ transplant system under contract with the federal government.