Eligible Death Definition

The Centers for Medicare and Medicaid Services (CMS) established the Eligible Death Definition to use as a way to measure organ procurement organization (OPO) and hospital performance with respect to organ donation. Patients that fall outside of the Eligible Death Definition can still become organ donors. It is up to the OPO and the nation's transplant centers to determine ultimate donor suitability. For that reason, it is imperative that all patients meeting the Clinical Trigger be referred to LOPA in a timely manner (see Making Referrals to LOPA).

Calculating the Donation Rate

To calculate the Donation Rate, divide the number of actual donors by the number of eligible deaths and other donors. Other donors are those patients that become organ donors but do not fit the definition of eligible. These may be brain dead patients over the age of 70 or donors after cardiac death (DCD) or may have one of the active infections listed in the Eligible Death Definition.

The formula for the Donation Rate looks like this:

(Actual Donors)/(Eligible Deaths + Other Donors) = Donation Rate

Eligible Deaths

Eligible Death for organ donation means 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:
    • Tuberculosis
    • Gangrenous bowel or perforated bowel and/or intra-abdominal sepsis
  • Viral:
    • HIV infection by serologic or molecular detection
    • Rabies
    • Reactive Hepatitis B Surface Antigen
    • Retroviral infections including HTLV I/II
    • Viral Encephalitis or Meningitis
    • Active Herpes simplex, varicella zoster, or cytomegalovirus viremia or pneumonia
    • Acute Epstein Barr Virus (mononucleosis)
    • West Nile Virus infection
    • Severe acute respiratory syndrome (SARS)
  • Fungal:
    • Active infection with Cryptoccocus, 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
• General:
  • Aplastic Anemia
  • Agranulocytosis
  • Extreme Immaturity (<500 grams or gestational age of <32 weeks)
  • Current malignent neoplasms except non-melanoma skin cancers such as basal cell and squamous cell cancer and primary CNS tumors without evident metastatic disease
  • Previous malignent neoplasms with current evident metastatic disease
  • A history of melanoma
  • Hematologic malignancies: Leukemia, Hodgkin's Disease, Lymphoma, Multiple Myeloma
  • Multi-system organ failure (MSOF) due to overwhelming sepsis or MSOF without sepsis defined as 3 or more systems in simultaneous failure for a period of 24 hours or more without response to treatment or resuscitation
  • Active Fungal, Parasitic, Viral, or Bacterial Meningitis or Encephalitis

For more information see the OPO Conditions of Participation Final Rule or contact us as info@lopa.org or 800-521-GIVE.

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