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Key Terms and Definitions Compiled by Gift of Life Michigan Abdominal Organs Organs located in the abdomen, i.e., stomach, small and large intestines, pancreas, liver, gallbladder, kidneys and spleen. Allograft An organ or tissue that is transplanted from one person to another of the same species: i.e. human-to-human. Example: a transplanted kidney. Appropriate Requestor Rate Percentage of time that consent was requested by a designated requestor for all consents sought. Number of Times Approached by Appropriate Requestor divided by Number of Consents Sought. Association of Organ Procurement Organizations (AOPO) A national nonprofit organization of organ procurement organizations. AOPO is an OPTN member in the Medical Professional/ Scientific Organization category whose president serves on the OPTN Board of Directors. Best Practices Processes and activities that have been shown in practice to be the most effective. Brain Death Irreversible cessation of cerebral and brain stem function; characterized by absence of electrical activity in the brain, blood flow to the brain and brain function as determined by clinical assessment of responses. A brain dead person is dead, although his or her cardiopulmonary functioning may be artificially maintained for some time. Cardiac Death Death resulting from the cessation of heart function; an individual who suffers a cardiac death can donate organs if the organs can be promptly cooled. Centers for Medicare & Medicaid Services (CMS) Formerly titled the Health Care Financing Administration, CMS is an agency of the U.S. Department of Health and Human Services (HHS) responsible for administering the Medicare and Medicaid programs, which provide health care coverage to America’s elderly, disabled and indigent. Clinical Triggers Criteria for “imminent death” mutually established by the hospital and OPO which prompt the hospital to make a timely notification to the OPO. Cold Ischemia Time (CIT) The amount of time an organ spends being preserved after recovery from the donor. Deaths Reported Number of deaths referred to Gift of Life Michigan by hospitals, medical examiners and other health care providers. Designated Requestor A person who has completed an OPO course designed in conjunction with the tissue and eye bank community in the best ways to approach potential donor families to request permission for organ and/or tissue donation. Donate Life America Formerly the Coalition on Donation, Donate Life America is a national not-for-profit alliance of local affiliates and corporate partners that have joined forces to inspire all people to Donate Life® through organ, eye and tissue donation. Donation after Cardiac Death (DCD) Recovery of organs and/or tissues from a donor whose heart has irreversibly stopped beating, previously referred to as non-heart-beating or asystolic donation. “Potential” DCD is a patient 60 or younger, no UNOS medical rule outs, withdrawn from ventilator support and expired in less than 90 minutes. Donation Service Area (DSA) The geographic area designated by CMS that is served by one organ procurement organization (OPO), one or more transplant centers, and one or more donor hospitals. Formerly referred to as Local Service Area or OPO Service Area. Donor Someone from whom at least one organ or tissue is recovered for the purpose of transplantation. A deceased donor is a patient who has been declared dead using either brain death or cardiac death criteria, from whom at least one vascularized solid organ or tissue is recovered for the purpose of transplantation or research. A living donor is one who donates an organ or segment of an organ for the intent of transplantation. Expanded Criteria Donor (ECD) A brain dead donor older than 60; or from a donor older than 50 with two of the following: a history of hypertension, a terminal serum creatinine greater than or equal to 1.5 mg/dl, or death resulting from a cerebral vascular accident (stroke). First Person Consent Legislation Legislation that allows donor designation to be indicated on the state’s donor registry or other official donor document, which gives hospitals legal authority to proceed with organ procurement according to the patient’s wishes without consent from the family. Health Insurance Portability and Accountability Act (HIPAA) Passed in 1996, HIPAA requires employers to provide health insurance coverage to employees who lose or change jobs, and includes an administrative simplification section which deals with the standardization of healthcare-related information systems including data security, protection of patient confidentiality and privacy. The Act mandates standardized formats for all patient health, administrative, and financial data; unique identifiers (ID numbers) for each healthcare entity, including individuals, employers, health plans and health care providers; and security mechanisms to ensure confidentiality and data integrity for any information that identifies an individual. Health Resources and Services Administration (HRSA) The primary healthcare agency of the federal government that deals with health access issues. Its role is to make essential primary care service available to poor, uninsured and geographically underserved populations. HRSA is a division of the U.S. Department of Health and Human Services (HHS), and oversee the Office of Special Programs, which in turn provides oversight to the Division of Transplantation (DoT). HRSA provides funding for the OPTN contract. HRSA Conversion Rate All Organ Donors divided by Eligible Deaths + DCD Donors + Age > 70 Donors. HRSA Eligible Death Includes UNOS eligible deaths, DCD donors, and organ donors > 70 years old and/or with UNOS medical exclusions. Huddle Breakthrough Collaborative term. A structured multi-disciplinary meeting of hospital and OPO staff used to coordinate the Effective Request Process and to meet the unique needs of each eligible donor’s family. Human Leukocyte Antigen System (HLA) The name of the major histocompatibility complex in humans. Imminent Death Patient 70 or younger; brain injury, on a ventilator, missing three brain steam reflexes, no UNOS medical rule-outs and cardiac death occurred. Informed Consent A person's voluntary agreement, based upon adequate knowledge and understanding of relevant information, to participate in research or to undergo a diagnostic, therapeutic, or preventive procedure. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) An independent, nonprofit organization that evaluates and accredits health care organizations and programs in the United States including hospitals, nursing homes and home health agencies. The commission establishes guidelines for the operation of hospitals and other health facilities and conducts survey and accreditation programs. MELD Score The Model for End-Stage Liver Disease is a scoring system for assessing the severity of chronic liver disease. Organ Donation and Recovery Improvement Act Passed by Congress in 2004, the Organ Donation and Recovery Improvement Act established programs to increase organ donation through public awareness campaigns and education projects, and provided grants programs for individual States supporting use of hospital-based organ procurement coordinators, research and demonstration projects, and reimbursement to living donors for travel related expenses. Organ Donation Breakthrough Collaborative The HRSA program launched in 2003 as part of the HHS' Gift of Life Donation Initiative, to 1) identify and promote the best practices in organ donation and procurement for hospitals and OPOs achieving the highest donation rates in the country, and 2) raise the overall donor consent rate to 75 percent among participating hospitals and OPOs. An increase in deceased donors by 4.3 percent occurred from 2002 to 2003 with the donor consents increasing by five percent. The model for the Breakthrough Collaborative was based upon the best-practice strategies developed by HRSA and the Institute for Healthcare Improvement. The Department of Health and Human Services joined with key national leaders and practitioners from the Nation's transplantation and hospital communities in April 2003 to launch the Organ Donation Breakthrough Collaborative. The Collaborative is intended to dramatically increase access to transplantable organs. The purpose of this initiative is clear, measurable, ambitious, and achievable: Committed to saving or enhancing thousands of lives a year by spreading known best practices to the nation's largest hospitals to achieve organ donation rates of 75 percent or higher in these hospitals. Organ Preservation Methods used to preserve organs while they are out of the body, between procurement from a donor and transplantation into a recipient. Organ Procurement The removal or retrieval of organs from a donor for transplantation. Organ Procurement and Transplantation Network (OPTN) In 1987, Congress passed the National Organ Transplant Act that mandated the establishment of the OPTN and Scientific Registry of Transplant Recipients. The purpose of the OPTN is to improve the effectiveness of the nation's organ procurement, donation and transplantation system by increasing the availability of and access to donor organs for patients with end-stage organ failure. The Act stipulated that the Network be a non-profit, private sector entity comprised of all U.S. transplant centers, organ procurement organizations and histocompatibility laboratories. These members along with professional and voluntary healthcare organizations and the representatives of the general public are governed by a Board of Directors which reports to the Division of Transplantation, HRSA and ultimately HHS. UNOS holds the OPTN contract. Organ Procurement Organization (OPO) An organization designated by the Centers for Medicare and Medicaid Services (CMS) and responsible for the procurement of organs for transplantation and the promotion of organ donation. OPOs serve as the vital link between the donor and recipient and are responsible for the identification of donors, and the retrieval, preservation and transportation of organs for transplantation. They are also involved in data follow-up regarding deceased organ donors. As a resource to the community OPOs engage in public education on the critical need for organ donation. See also Donation Service Area (DSA). Organ Transplant Breakthrough Collaborative (OTBC) An extension of the ODBC, the focus is to increase organ utilization. Specifically, the aim of this collaborative is to increase the mean number of recipients transplanted per donor from 3.06 (2004 U.S. mean) to 3.75 or higher. Success in this initiative is wholly dependent on the active participation of three estates: Transplant Programs, Donor Hospitals, and Organ Procurement Organizations. PELD Score Pediatric Model for End-Stage Liver Disease is a disease severity scoring system for children younger than 12. This score is used by the United Network for Organ Sharing for prioritizing allocation of liver transplants. Perfusion The passage of a fluid (blood or other) through the vessels of organs or tissues. Deceased organs are perfused with synthetic cold preservation fluid to keep them viable for transplant. Placement The process of allocating donated organs to waiting recipients via the match system. Plan-Do-Study-Act (PDSA) The four steps used in the Model for Improvement developed to enhance organization performance; a cycle of developing, testing, measuring and implementing changes that result in improvement: The steps are as follows: PLAN - State objective (what needs to be improved) and identify metric for measuring accomplishment of the objective; make predictions, hypotheses and develop a plan to carry out cycle DO - Carry out the test, collect data or other info/ input needed; document problems, unexpected observations; and begin analysis of data STUDY - Complete analysis of data; compare data to predictions; and summarize what was learned ACT - Determine what changes are to be made, identify remaining and new questions and repeat the PDSA to continue exploring and implementing changes that result in progress toward stated objectives The PDSA cycle was proven effective by the Organ Donation Breakthrough Collaborative and is being implemented throughout OPTN programs and polices. It is based on The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, by Gerald J. Langley, Kevin M. Nolan, Thomas W. Nolan, Clifford L. Norman and Lloyd P. Provist. Published by Jossey-Bass. Potential Donor A patient who meets the criteria for brain death or a patient who is being removed from life-sustaining therapies (ventilator support, pharmaceutical support, etc) with no absolute contraindications to organ donation. Preservation Method used to keep organs viable between procurement and transplantation. The length of time organs and tissues can be kept outside the body vary depending on the organ, the type of preservation fluid, and the preservation method (pump or cold storage). Procurement The surgical procedure of removing an organ from a donor. Also referred to as recovery. Pump An apparatus for forcing a gas or liquid from or to any part. In organ preservation, pump is a reference to the mechanical perfusion pump that is used to continuously perfuse a recovered organ with a chilled preservation solution. Pump Time The number of hours between the time the organ is connected to the preservation pump and cold preservation fluid circulates through the organ, and the time the organ is removed from the pump. Referral Rate Percentage of time Gift of Life notified of patient meeting imminent death criteria. Organ Referral Calls Placed divided by Organ Referral Calls Placed + Missed Referral Calls (Total number of calls that should have been placed) Referred Death All deaths or imminent deaths reported by a hospital to the OPO within the Designated Service Area (DSA). Regions For the administration of organ allocation and appropriate geographic representation within the OPTN policy structure, the membership is divided into 11 geographic regions. Members belong to the region in which they are located. Rejection A phenomenon that occurs when a recipient’s immune system attacks a transplanted organ, tissue, or cell. Immunosuppressive drugs help prevent or treat rejection. Routine Notification Notification made to Gift of Life by a hospital, medical examiner or other health care provider on any patient death. Goal is within 60 mins. Routine Notification Rate Number of deaths reported divided by total of deaths. Hospital goal is 100 percent. Routine Referral Hospitals are required on or before each death to call the OPO in order to determine suitability for organ, eye and tissue donation. The OPO, in consultation with the patient’s attending physician or his or her designee, will determine the suitability for donation. If the patient is a candidate for anatomical donation, only personnel from the OPO or a designated requestor from the hospital can request donation from the next-of-kin. Split liver A split liver transplant occurs when the donor liver is divided into segments and then transplanted. These segments may be transplanted into more than one recipient, or a segment could be transplanted into a child for whom an entire adult liver would be too large. Standard Criteria Donor (SCD) A donor who does not meet the criteria for DCD or ECD. Status An indication of the degree of medical urgency for patients awaiting heart or liver transplants. Examples: status 1A, status 1B, or status 2. Survival Rates Survival rates indicate the percentage of patients that are alive and the grafts (organs) that are still functioning after a certain amount of time. Survival rates are used in developing OPTN policy. Thoracic Organs Organs in the chest, i.e., the heart and lungs. Timely Notification Rate Percentage of time that calls where placed to Gift of Life within one hour of patient meeting clinical triggers. Timely Referral Calls divided by Total Organ Referrals Calls Placed + Missed Referral Calls (Total number of calls that should have been placed). Time to Transplant (TT) The time from wait-listing to transplantation. Time to transplant considers all candidates who are initially registered on the waiting list, and measures the time between waiting list registration and transplant date. See also Waiting Time (WT). Tissue An organization of a great many similar cells that perform a special function. Examples of tissues that can be transplanted are blood, bones, bone marrow, corneas, heart valves, ligaments, saphenous veins and tendons. Tissue Type An individual’s combination of HLA antigens. Matching for tissue type is used in the allocation system for kidney and pancreas transplantation. Tissue Typing A blood test that helps evaluate how closely the tissues of the donor match those of the recipient. Transplant Center A hospital that performs transplants, including qualifying patients for transplant, registering patients on the national waiting list, performing transplant surgery and providing care before and after transplant. Transplant Program The organ-specific facility within a transplant center. A transplant center may have programs for the transplantation of hearts, lungs, livers, kidneys, pancreas, pancreas islets and/or intestines. Transplant Team The diverse group of professionals at the transplant center who work to make a transplant successful. Each person on the transplant team is an expert in a different area of transplantation. Uniform Anatomical Gift Law (UAGL) The Revised Uniform Anatomical Gift Law (UAGL) brings the organ, tissue and eye donation process in Michigan into conformity with most other states and into line with federal requirements, such as those of the Centers for Medicare and Medicaid Services (CMS). The revised law took effect May 1, 2008. Uniform Brain Death Act Enacted in 1978, the Uniform Brain Death Act expanded the traditional definition of death (cardiopulmonary) to include brain death. Uniform Determination of Death Act (UDDA) The 1981 Uniform Determination of Death Act is a model statute defining "brain death." Versions of this Act have been adopted in 39 states and the District of Columbia. The act states that an individual who has sustained either (a) irreversible cessation of circulatory or respiratory functions or (b) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards. United Network for Organ Sharing (UNOS) The private, nonprofit membership organization that coordinates the nation’s transplant system through HRSA’s OPTN contract. As OPTN contractor, UNOS is responsible for meeting all contract requirements. As contractor since the first OPTN contract award in 1986, UNOS has established and continually strives to improve tools, systems and quality processes that support OPTN contract objectives and requirements. These include: Managing the national organ transplant waiting list Collecting, managing and reporting of sensitive clinical data in a secure, fail-safe environment Facilitating an open, inclusive forum for development and continuous refinement of evidence-based policies and standards Member and policy performance assessment to ensure equitable, safe treatment of candidates and recipients Increasing donation and making the most of every organ that is donated through professional education, outcomes research, patient services and resources and public and professional education Continuously improving the care, quality of life and outcomes of organ transplant candidates and recipients UNOS Conversion Rate Eligible Death Organ Donors divided by Eligible Deaths UNOS Eligible Death Although it is recognized that this definition does not include all potential donors, for reporting purposes for DSA performance assessment, an eligible 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 with no UNOS medical rule outs. Wait List (WL) The list of candidates registered to receive organ transplants. When a donor organ becomes available, the matching system generates a new, more specific list of potential recipients based on the criteria defined in that organ’s allocation policy (e.g., organ type, geographic local and regional area, genetic compatibility measures, details about the condition of the organ, the candidate’s disease severity, time spent waiting, etc.). Warm Ischemic Time (WIT) Length of time during which the heart and lungs are functioning but not adequate to oxygenate blood and deliver it to the organs and tissues. Warm ischemia continues after heart function ceases until organs are removed.
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