Audience: (Please share this notice with anyone in your organization who would benefit from it.)
- Transplant program administrators, primary physicians, primary surgeons, primary data coordinators
- TX program administrators/managers, TX program directors, TX program medical directors, clinical training coordinator/managers, TX program – clinical coordinators, support staff-clinical, regulatory Affairs Coordinators/Managers, Compliance Officers, Quality Directors/Managers, Quality coordinators, TX program surgical directors, TX physicians, TX surgeons, data coordinators
- OPO CEOs, medical directors, procurement directors and coordinators, compliance and quality officers
- OPTN Data Advisory Committee members
Implementation date
December 2, 2021
At-a-glance
An updated list of organ refusal reasons are available in DonorNet® and DonorNet MobileSM for use on matches.
The Organ Procurement and Transplantation Network (OPTN) Board of Directors (BOD) reviewed and approved the updated list at the June 2021 OPTN BOD meeting. These new codes provide more relevant and granular options when refusing organ offers for patients, and allow for greater insights into refusal and acceptance practices.
Education and resources
- An educational offering is available in UNOS Connect to assist transplant programs and OPOs in reviewing the revised list of refusal reasons. The resource number and title is “SYS169 – DonorNet Refusal Codes.”
- A crosswalk that contains a high-level overview of the changes to refusal codes that were approved by the OPTN BOD in June 2021 is available in UNOS Connect, within the existing SYS169 course. This crosswalk serves as a reference and not a strict recommendation. Please examine your hospital’s acceptance and refusal practices on a per code basis as you review.
- OPTN policy notice: Update to Refusal Codes.
Refusal codes
| Category | Code | Description | Full Description | Other Specify |
| Donor and Candidate Matching | 700 | Donor age | Donor age is not clinically suitable for potential recipient | N/A |
| 701 | Organ size, specify | Donor organ expected to be too large or small for potential recipient | Optional | |
| Organ Specific | 710 | Organ preservation: Unacceptable method or findings | Method or findings of organ preservation does not meet acceptable criteria (pump pressures, pumping issue, not pumped, on pump, etc.). | N/A |
| 711 | Organ anatomical damage or defect | Surgical damage, non-surgical trauma, diseased organ, organ vasculature, en bloc kidneys or any other anatomical reason | N/A | |
| 712 | Actual or projected cold ischemic time too long | The actual or projected cold ischemic time is too long for the organ | N/A | |
| 713 | Warm ischemic time too long | The warm ischemic time is too long for the organ | N/A | |
| 714 | Biopsy not available | Organ biopsy results are not available or a biopsy was not performed | N/A | |
| 715 | Biopsy results unacceptable | Organ biopsy results do not meet acceptable criteria | N/A | |
| 716 | Organ specific test results not available, specify | Organ specific test not done or results not available at the time of the organ offer (e.g., HIV NAT testing, cardiac catheter results, etc.) Do not use for unavailable biopsies. | Optional | |
| 717 | Unacceptable organ specific test results, specify | Organ specific test results do not meet acceptable criteria (e.g., low PaO2, high creatinine, low ejection fraction, or imaging findings). Do not use for biopsy results that are unacceptable. | Required | |
| Candidate Specific | 720 | Candidate temporarily medically unsuitable | Potential recipient temporarily too sick, medically contraindicated, or not optimized to attempt transplant | N/A |
| 721 | Candidate transplanted or pending transplant | Potential recipient has been transplanted, a transplant is in progress, or another offer is being considered | N/A | |
| 722 | Candidate’s condition improved, transplant not needed | Potential recipient’s condition has improved and transplant is currently unnecessary | N/A | |
| 723 | Candidate requires different laterality | Potential recipient requires organ of a different laterality (e.g., right lung is specified) | N/A | |
| 724 | Candidate requires multiple organ transplant | Potential recipient requires a multiple organ transplant (e.g., heart offered without kidney) | N/A | |
| 725 | Epidemic/Pandemic – Candidate | Potential recipient related epidemic/pandemic reason (e.g., the candidate has a potential exposure, is symptomatic, is being tested, or has a positive test result). If the potential recipient is making the decision to refuse offers due to the pandemic, please select ‘Candidate refused’ as the refusal reason for the offer. | N/A | |
| 726 | Candidate temporarily ineligible due to insurance or financial issue | Potential recipient is temporarily ineligible for transplant due to insurance or financial related reasons | N/A | |
| 727 | Candidate unavailable | Potential recipient is unavailable (e.g., traveling) or could not be contacted | N/A | |
| 728 | Candidate refused | Potential recipient refused the offered organ | N/A | |
| Histocompatibility Related | 730 | No candidate serum for crossmatching | No candidate serum is available for crossmatching | N/A |
| 731 | No donor cells/specimen for crossmatching, or no time for crossmatch | No donor cells (or specimen) for crossmatching or no time to complete a crossmatch | N/A | |
| 732 | Positive physical crossmatch | Physical crossmatch result between donor and potential recipient is positive | N/A | |
| 733 | Positive virtual crossmatch/unacceptable antigens | Virtual crossmatch result between donor and potential recipient is positive or potential recipient has donor-specific antibodies that are considered contraindications to transplant | N/A | |
| 734 | Number of HLA mismatches unacceptable | Number of HLA mismatches between donor and potential recipient is unacceptable | N/A | |
| Disease Transmission Risk | 740 | PHS risk criteria or social history | PHS risk criteria for donor or other reasons related to social history. If a candidate refuses the offer for PHS risk criteria, please select ‘Candidate refused’ as the refusal reason for the offer. | N/A |
| 741 | Positive infectious disease screening test: CMV, HBV, HCV, etc. | CMV, HBV, HCV, HIV, HTLV, VDRL, etc. donor testing is positive | N/A | |
| 742 | Donor infection or positive culture | Donor has an active infection or positive culture results (e.g., meningitis) | N/A | |
| 743 | Malignancy or suspected malignancy | A malignancy or potential malignancy is suspected with the organ | N/A | |
| 744 | Epidemic/Pandemic – Donor | Donor related epidemic/pandemic reason. This may include reasons such as donors with high exposure risk, no testing available, positive or indeterminate test results, or if a different specimen type is preferred. | N/A | |
| Donor Specific | 750 | Donor medical history, specify | Donor medical history is not clinically suitable for potential recipient | Required |
| 751 | Donor instability/high vasopressor usage | Donor has prolonged hemodynamic instability and/or requires high vasopressor use | N/A | |
| 752 | Prolonged downtime/CPR | Donor has experienced prolonged downtime and/or CPR | N/A | |
| 753 | DCD donor neurological function/not expected to arrest | DCD donor has high neurological function and is not expected to arrest in time | N/A | |
| 754 | VCA graft appearance or quality, specify | VCA graft is unsuitable due to appearance or quality reasons such as incompatible skin tone, tattoos, scars, bruising, ecchymosis, hematoma, etc. | Optional | |
| Logistics | 760 | Resource time constraint (OPO, TXC, donor hospital, etc.) | Time constraint for transplant imposed by the OPO, TXC, donor hospital, etc. | N/A |
| 761 | Donor family time constraint | Time constraint imposed by the donor family | N/A | |
| 762 | Recovery team availability | Recovery team or local recovery team is unavailable to perform procedure (heavy workload, etc.) | N/A | |
| 763 | Transplant team or transplant facility availability | Transplant team is unavailable to perform transplant procedure (heavy workload, etc.) | N/A | |
| 764 | Transportation availability | Transportation for the organ cannot be obtained. | N/A | |
| 765 | Exceeded policy defined response time | Response was not received from center within the time period specified in policy | N/A | |
| Other | 790 | Disaster Emergency Management Consideration | Use only in the event of a natural disaster, regional emergency, etc. that is affecting the operations or recovery of organs. | N/A |
| 798 | Other, specify | Use only when the reason does not fit the other refusal reasons available. Provide a detailed description of the reason the organ is being refused. | Required |
