Potential Transplant Recipient

Data System for Organ Procurement and Transplantation Network

Potential Transplant Recipient_PTR_Instructions

Potential Transplant Recipient

OMB: 0915-0157

Document [docx]
Download: docx | pdf

Potential Transplant Recipient (PTR)

Organ offer responses for potential transplant recipients are entered on matches by either the transplant center or OPOs. This information includes whether the organ was accepted or the offer was refused and the primary reason that the organ offer was refused by the center. Transplant centers evaluate the donor organ information and can respond to the offer at the individual candidate level or enter a response for multiple candidates at once. The OPOs can enter responses to organ offers on behalf of transplant centers.

Match Results

Transplant center contacted?: Indicate if the transplant center was contacted.


Yes, response received

Yes, notified of offer

No, bypassed


Contact last name: If the transplant center was contacted, enter the last name of the person you spoke with at the transplant center. This field is required.

Contact first name: If the transplant center was contacted, enter the first name of the person you spoke with at the transplant center.

Respond date: If the transplant center was contacted, enter the date the transplant center responded to the offer. This field is required.

Respond Time: If the transplant center was contacted, enter the time the transplant center responded to the offer.

Respond time zone: If the transplant center was contacted, the time zone drop-down will be auto-filled with the time zone of the device.

Offer response: Enter the response to the organ offer. If Accept is selected, indicate what organ/segment was placed. If Refuse is selected, enter the refusal codes. This field is required.

Accept

Refuse

Provisional Yes

Primary refusal reason: Select the primary reason for refusal from the dropdown menu. This field is required.

Primary specify: If a code with a “specify” option is selected, enter the information here.

Secondary refusal reason: Select the secondary reason for refusal from the dropdown menu. The secondary refusal code cannot be the same as the primary refusal code.

Secondary specify: If a code with a “specify” option is selected, enter the information here.

If the organ was accepted, complete the following fields, as applicable.

Lungs placed:

None

Both

Left

Right

Segments placed:

None

Both

Left

Right

Liver placed:

Whole

Segment

Pancreas placed:

None

Whole

Islet

Kidney placed:

None

Both

Left

Right

Intestine placed:

Whole

Segment

Abdominal wall placed: No selection required.

External male genitalia placed:

Penis

Scrotum

Head and neck placed:

Face

Larynx

Scalp

Trachea

Vascularized parathyroid gland

Vascularized thyroid

Lower limb placed:

Unilateral: left

Unilateral: right

Bilateral

Musculoskeletal composite graft segment placed:

Chest wall

Spine axis

Composite graft of vascularized muscle, bone, nerve, or skin

Other genitourinary organ placed:

Internal male genitalia

External and internal female genitalia (other than uterus, cervix, and vagina)

Urinary bladder

Spleen placed: No selection required.

Upper limb placed:

Unilateral: left

Unilateral: right

Bilateral

Uterus placed:

Uterus

Cervix

Vagina

Vascularized gland placed:

Vascularized adrenal

Vascularized thymus


Comments: Enter any comments.



Verify Organ Offer Info – Update Offer

Primary TXC refusal code: Select the primary reason for refusal from the dropdown menu.

Primary refusal code – specify other: If a code with a “specify” option is selected, enter the information here.

Secondary TXC refusal code: Select the secondary reason for refusal from the dropdown menu. The secondary refusal code cannot be the same as the primary refusal code.

Secondary refusal code – specify other: If a code with a “specify” option is selected, enter the information here.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorLyna Cherikh
File Modified0000-00-00
File Created2023-07-29

© 2024 OMB.report | Privacy Policy