OPO name or Code
please indicate how old since less than 1 year
please indicate the number of years
does the donor have a history of diabetes?
Round to the nearest whole number. Enter "0" if unknown
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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Type 2 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 3
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Type 2 Diabetes offer - call TEAM 3
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Lung/Intestine offer - call TEAM 2
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OUT OF CRITERIA: Panc only (neonate) Please decline the offer and submit the form for record keeping.
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OUT OF CRITERIA: Panc only (neonate) Please decline the offer and submit the form for record keeping.
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Pancreas Case 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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Pancreas Case 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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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.
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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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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.
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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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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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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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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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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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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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Slice 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: 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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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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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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please provide name and call-back #
Team 1
Team 1
Team 1
Team 1
Out of Criteria - Slices Control
Team 1
Team 1
Team 2
Team 2
Team 2
Team 2
Did you call admin? Check all that apply.
Did you call admin? Check all that apply.
Did you call admin? Check all that apply.
Did you call admin? Check all that apply.
T2D Offer - Team 3
T2D Offer - Team 3
Out of Criteria: Panc Only (neonate)
Out of Criteria: Panc Only (neonate)
Admin
Admin
Admin
Out of Criteria: Pancreas - Age Restriction
Out of Criteria: Pancreas - Age Restriction
Out of Criteria: Pancreas - Age Restriction
HPAP Control On Hold
HPAP Control On Hold
Out of Criteria: Type 2 Diabetes (lower age limit)
Out of Criteria: Lung/Intestine Case (Age Restriction)
Out of Criteria: Lung/Intestine Case (Age Restriction)
Out of Criteria: Lung/Intestine Case (Disease Condition)
Out of Criteria: Lung/Intestine Case (Disease Condition)
Out of Criteria: Lung/Intestine Case (Disease Condition)
Out of Criteria: Lung/Intestine Case (Disease Condition)
Out of Criteria: Lung/Intestine Case (Disease Condition)
Out of Criteria: Lung/Intestine Case (Disease Condition)
Out of Criteria - age limit for case offered
Out of Criteria - age limit for case offered
Out of Criteria - age limit for case offered
Out of Criteria - age limit for case offered
Out of Criteria - age limit for case offered
Out of Criteria - age limit for case offered
Out of Criteria - T2D Direct/Other offer
Out of Criteria - T2D offer
Out of Criteria - T2D offer
Out of Criteria - HPAP Control offer
Out of Criteria - HPAP Control offer
Out of Criteria - DKA Age
Out of Criteria - T1D Age Limit
• | 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 5-30 yo, non-diabetic, BMI 30 or less, normal amylase/lipase level, downtime less than 30 min, DCD okay. |
• | 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. 35 years and older w/ T1D greater than 5 years duration, no illegal drug use, BMI <40 | • | b. (Daily 0800 - 2000) 40-65 yo w/ T2D greater than 8 years duration with documented cardiovascular disease (including dx during terminal admission), no illegal drug use, BMI <40 | • | c. (Daily 0800 - 2000) Control Heart, no illegal drug use, BMI <35 | |
• | 7. (HuBMAP-P) (Sun 0800 - Thurs 2000) 25-50 yo, Caucasian or Hispanic Male only. Transection okay but no tissue loss. Transplant grade pancreas, BMI less than 28, Cold time less than 18 hours, Brain Dead only (No DCD), excludes medical conditions require dialysis, or pacemaker, no history of drug use or heavy alcohol (Contact Martha Campbell-Thompson directly) |
• | 8. (HANDEL-P) Pancreas from donors 0 to 2 years in age, non-diabetic donors, Thymus required, no DCD. |
• | 9. (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. |
| 10. HPAP T2D |
• | a. T2D donors any disease duration, age 35-65 years with a BMI of 25-40 and an A1C > 6.5 (could be less than 6.5 with treatment). | • | b. Non-diabetic donors, age 41-65 years with a BMI of 25-40 and an A1C < 5.7. Excludes Caucasian donors. | • | Specific exclusionary criteria:• Severe renal disease (chronic) •Positive serology (HCV, HIV, hepatitis B) | |
• | 11. (Tier 3 Pancreas) (Sun-Thurs from 0800-2000) Pancreas from donors 11-40 yo, BMI less than 30 |
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