CORE DRC: nPOD Case Referral

Case being offered - New or Accepted case?*

New
Accepted

Which organization is the caller from?*

IIAM
NDRI
Novabiosis/OmniLife
Direct/Other

If "direct/other" please specify referring agency:*

OPO name or Code

Name:

First Last

Call-back number:

UNOS ID:*

Donor Age:*

Months, Weeks, Days old:*

please indicate how old since less than 1 year

Years old (round the the nearest whole number):*

please indicate the number of years

Please enter a number from 1 to 70.

Organs being offered:*

Case offered as (donor condition):*

does the donor have a history of diabetes?

Disease Duration (in years):*

Round to the nearest whole number. Enter "0" if unknown

Please enter a number greater than or equal to 0.

DKA/Aab/Transplant offer - call TEAM 1

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DKA/Aab/Transplant offer - call TEAM 1

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Type 1 Diabetes offer - call TEAM 1

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OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

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Type 1 Diabetes offer - call TEAM 1

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OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

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OUT OF CRITERIA: Alpha Cell Please decline the offer and submit the form for record keeping.

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OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

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Type 2 Diabetes offer - call TEAM 1

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Lung/Intestine offer - call TEAM 2

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OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

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OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

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OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

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This is an ACCEPTED Case - call nPOD ADMIN

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Case condition undetermined - call nPOD ADMIN

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Case condition undetermined - call nPOD ADMIN

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OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

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OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

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Lung/Intestine Case Offer - call TEAM 2

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OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

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OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

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Slice offer - call TEAM 1

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OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

View Outlook Online On-Call Calendar

OUT OF CRITERIA: Please decline the offer and submit the form for record keeping.

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CORE Personnel answering call:*

please provide name and call-back #

Who did you call? Check all that apply.*

Team 1

Alberto
Carmella
Clive
Martha
Robert
Brittany

Who did you call? Check all that apply.*

Team 1

Alberto
Carmella
Clive
Martha
Robert
Brittany

Who did you call? Check all that apply.*

Team 1

Alberto
Carmella
Clive
Martha
Robert
Brittany

Who did you call? Check all that apply.*

Team 1

Alberto
Carmella
Clive
Martha
Robert
Brittany

Did you call admin? Check all that apply.*

Out of Criteria - Slices Control

Did not call admin
Robert
Brittany

Who did you call? Check all that apply.*

Team 1

Alberto
Carmella
Clive
Martha
Robert
Brittany

Who did you call? Check all that apply.*

Team 1

Alberto
Carmella
Clive
Martha
Robert
Brittany

Who did you call? Check all that apply.*

Team 2

Maigan
Todd
Clive
Robert
Brittany

Who did you call? Check all that apply.*

Team 2

Maigan
Todd
Clive
Robert
Brittany

Did you call admin? Check all that apply.*

Did you call admin? Check all that apply.

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.*

Did you call admin? Check all that apply.

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.*

Did you call admin? Check all that apply.

Did not call admin.
Robert
Brittany

Who did you call? Check all that apply.*

Admin

Robert
Brittany

Who did you call? Check all that apply.*

Admin

Robert
Brittany

Who did you call? Check all that apply.*

Admin

Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria: Pancreas - Age Restriction

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria: Pancreas - Age Restriction

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria: Pancreas - Age Restriction

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

HPAP Control On Hold

Did not call admin
Robert
Brittany

Did you call admin? Check all that apply.

HPAP Control On Hold

Did not call admin
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria: Type 2 Diabetes (lower age limit)

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria: Type 2 Diabetes (upper age limit)

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria: Lung/Intestine Case (Age Restriction)

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria: Lung/Intestine Case (Age Restriction)

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria: Lung/Intestine Case (Disease Condition)

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria: Lung/Intestine Case (Disease Condition)

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria: Lung/Intestine Case (Disease Condition)

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria: Lung/Intestine Case (Disease Condition)

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria: Lung/Intestine Case (Disease Condition)

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria: Lung/Intestine Case (Disease Condition)

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria - age limit for case offered

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria - age limit for case offered

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria - age limit for case offered

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria - age limit for case offered

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria - age limit for case offered

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria - age limit for case offered

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria - T2D Direct/Other offer

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria - T2D offer

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria - HPAP Control offer

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria - HPAP Control offer

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria - DKA Age

Did not call admin.
Robert
Brittany

Did you call admin? Check all that apply.

Out of Criteria - T1D Age Limit

Did not call admin.
Robert
Brittany

(Optional) Please list any comments you may have.

Show Acceptance Criteria

•

1. (nPOD T1D) Pancreas from donors with type 1 diabetes age 40 years or younger with disease duration of 10 years or less.

•

2. (nPOD Aab+) Pancreas from Aab+ donor Age ≤ 30 years positive with at least 1 or more autoantibodies.

•

3. (nPOD DKA) Pancreas from non-diabetic donors 30 years in age or less, BMI less than 30 and cause of death related to Diabetic ketoacidosis (DKA), and/or has an HbA1C of 6.5% or higher. This criterion is to capture undiagnosed T1D donors.

4. (nPOD Slices) (Sun 0800- Fri 0800) Pancreas from donor 2-30 yo, non-diabetic, BMI 30 or less, normal amylase/lipase level, downtime less than 30 min, DCD okay.

•	Controls needed- Females 11-13 years and 19-30 years
•	Controls needed- Males 25- 30 years
•	Controls needed- Male and Female early age groups (0-10 years)

•

5. (nPOD adolescent T2D) Pancreas from donors 10-18 yo with type 2 diabetes or BMI greater than 35.

6. (CaRe-T1D Heart) Heart, kidneys, and peripheral vessels. (Calls Admin On-Call)

•	a. 18 years and older w/ T1D any duration, no illegal drug use, BMI <40
•	b. (Daily 0800 - 2000) 18-65 yo w/ T2D any duration with documented cardiovascular disease (including dx during terminal admission), no illegal drug use, BMI <40
•	c. (Daily 0800 - 2000) 18-65 years; Control donors, no illegal drug use, BMI <35

•

7. (HANDEL-P) Pancreas from donors 2 to 4 years in age, non-diabetic donors. (islet isolation)

•

8. (HANDEL-I) Lung (right, left or bilateral), intestine, blood, spleen, and nodes from donors 26 weeks gestation to 12 years in age, non-diabetic donors.

•

9. (Tier 3 Pancreas) (Sun-Thurs from 0800-2000) Pancreas from donors 11-40 yo, BMI less than 30 (Calls Admin 2 On-Call)

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CORE DRC - Case Referral (LIVE)

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