Download organ transplant operative abo verification form tips

ORGAN TRANSPLANT OPERATIVE ABO VERIFICATION FORM TIPS
THIS FORM SHOULD BE USED FOR ALL TRANSPLANT RECIPIENTS
SECTION 1:
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Donor and recipient information will be initially obtained by the OR charge nurse when the case is boarded by the
organ procurement coordinator or the transplant coordinator. Information provided: Donor ID, Match ID, MRN, organ,
laterality
The OR charge nurse will access DonorNet:
o https://portal.unos.org and enter user ID and password
o Click on DonorNet
o Click on Donors
o Click on Search
o Enter Donor ID and Match ID
o To get ABO lab tests:
 Click donor summary
 Attachments- Need two ABOs
SECTION 2:
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This section is to be completed when the organ arrives to the transplant hospital prior to opening the external transport
container
To verify contents: compare the expected (organ, laterality, and donor ID) with the external label of the transport
container
IF THE DONOR IS A VUMC DONOR (LIVING OR DECEASED) THIS STEP IS NOT REQUIRED. PLEASE
CHECK THE BOX
Organs that go back and forth from VUMC to VCH require organ check in
For organs that are taken directly back to the OR, the organ check in will be performed in the OR
If a discrepancy is noted during the organ check in process, the organ procurement organization (i.e. Tennessee Donor
Services) needs to be contacted within one hour.
SECTION 3:
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This section is required for heart. lung and liver transplants prior to the organ arriving in the OR.
Verification of correct ABO must be completed while the recipient is in the operating room prior to the patient
receiving anesthesia NOTE: If patient is receiving continuous sedation this verification occurs prior to incision.
Proceduralist in this section refers to the transplant surgeon or someone they have designated to confirm ABO
verification (i.e. a resident or fellow)
SECTION 4:
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This section must be completed for every transplant
This section is completed when the organ is in the operating room
MAKE SURE THAT THE TIME IN THIS SECTION IS AFTER THE ARRIVAL TIME IN SECTION 2
SECTION 5:
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This section is only required if the transplant surgeon is scrubbed in when the organ arrives and is unable to sign at the
time of ABO verification
If there are two transplant surgeons on a case and one is not scrubbed in they can complete section 4
The time in this section should reflect a time after the organ arrival time in section 2
The transplant surgeon must complete section 4 upon the completion of the case
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ORGAN TRANSPLANT OPERATIVE ABO VERIFICAITON FORM
Section 1: Blood Type and UNOS ID
UNOS DONOR # ____________________
MATCH ID # _____________________
Donor Blood Type: A
Recipient Blood Type: A
B
AB
O
B
AB
(Circle One)
(Circle One)
Source documents to be used to verify donor blood type:
Source documents to be used to verify recipient blood type:
_____ DonorNet: Donor hospital laboratory ABO documentation
______ Past ABO notations (Star panel)
_____ DCI report or a second laboratory ABO report
______ Current ABO notations (Star panel)
O
Section 2: Organ Check In
(TO BE COMPLETED WHEN THE ORGAN ARRIVES TO VUMC, IF DISCREPANCY MUST REPORT TO ORGAN PROCUREMENT ORGANIZATION WITHIN AN HOUR)
TIME OF ARRIVAL________________
Organ:
Heart
Single Lung
Double Lung
Liver
Left Kidney
Right Kidney
Pancreas
Vessels
I verify that the intended UNOS DONOR ID and ORGAN match the UNOS DONOR ID and ORGAN that is printed on the protective
packaging containing the organ.
1st Verifier X_______________________________
2nd Verifier X________________________________
VERIFICATION NOT REQUIRED FOR VUMC DONORS INCLUDING LIVING DONORS
(CHECKArrival
BOX IF VERIFICATION
DOES NOT APPLY
) begins prior to organ arrival)
Section 3: ABO Verification Prior to Organ
(Only to be completed
if surgery
VERIFICATION OCCURS PRIOR TO INDUCTION OF ANESTHESIA AND WHILE THE RECIPIENT IS IN THE OPERATING ROOM
I verify that I have reviewed the following:
Expected Donor ID
Recipient MRN
Expected Organ (laterality if applicable)
Recipient Blood Type
Expected Donor blood type
Compatibility or intended incompatible
Transplant Surgeon (or proceduralist) X_______________________________
Date _____________
Time________________
OR Circulator, RN X______________________________
Date _____________
Time________________
Section 4: Prior to Implantation ABO Verification
VERIFICATION OCCURS AFTER THE ORGAN IS IN THE OPERATING ROOM AND BEFORE ANASTOMOSIS OF RECIPIENT ORGAN
I verify that I have reviewed the following using the donor source documents that came with the organ:
Donor ID
Recipient MRN
Organ (laterality if applicable)
Recipient Blood type
Donor Blood Type
Compatibility or intended incompatibility
Transplant Surgeon X_______________________________
OR Circulator, RN X______________________________
Date _____________
Date _____________
Time________________
Time________________
Section 5: Visual Verification Documentation
ONLY REQUIRED IF TRANSPLANT SURGEON IS SCRUBBED IN WHEN ORGAN ARRIVES
I attest that a visual ABO verification occurred with the transplant surgeon prior to implantation of donor organ.
Name of Transplant Surgeon who visual verified ______________
OR Circulator, RN X______________________________
Date _____________
Time________________
TRANSPLANT SURGEON MUST SIGN SECTION 4 AFTER COMPLETION OF CASE