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Updated list of organ refusal reasons will go into effect on Dec. 2

Updated list of organ refusal reasons will go into effect on Dec. 2
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


An updated list of organ refusal reasons will go into effect on December 2,, 2021.

To complete these updates, DonorNet® and DonorNet MobileSM will temporarily be unavailable on Thursday, Dec. 2 starting at 8 a.m. EST, for approximately 30 minutes.

The Organ Procurement and Transplantation Network (OPTN) Board of Directors (BOD) reviewed and approved the updated list at the June 2021 OPTN BOD meeting. It will provide more relevant and granular options when refusing organ offers for patients, and will allow for greater insights into refusal and acceptance practices.

The new codes will be available for use on matches run after the completion of the aforementioned implementation on Dec. 2. Members will be notified of the change on that day. Matches run prior to implementation will continue to use the previously approved refusal reasons.

What you need to do

Transplant hospitals

  • Review the list of revised refusal codes and train staff on when to use the new codes.
    • Note: Several refusal reasons will include an “other specify” text field that can be used when entering a response.

Organ procurement organizations

  • Become familiar with the updated list of refusal reasons and descriptions.
    • A new bypass code, “799 – Other, specify” is being introduced to replace “898 – Other, specify.”

Education and resources

  • An educational offering is now 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

CategoryCodeDescriptionFull Description Other Specify
Donor and Candidate Matching700Donor ageDonor age is not clinically suitable for potential recipientN/A
701Organ size, specifyDonor organ expected to be too large or small for potential recipientOptional
Organ Specific710Organ preservation: Unacceptable method or findingsMethod or findings of organ preservation does not meet acceptable criteria (pump pressures, pumping issue, not pumped, on pump, etc.).N/A
711Organ anatomical damage or defectSurgical damage, non-surgical trauma, diseased organ, organ vasculature, en bloc kidneys or any other anatomical reasonN/A
712Actual or projected cold ischemic time too longThe actual or projected cold ischemic time is too long for the organN/A
713Warm ischemic time too longThe warm ischemic time is too long for the organN/A
714Biopsy not availableOrgan biopsy results are not available or a biopsy was not performedN/A
715Biopsy results unacceptableOrgan biopsy results do not meet acceptable criteriaN/A
716Organ specific test results not available, specifyOrgan 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
717Unacceptable organ specific test results, specifyOrgan 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 Specific720Candidate temporarily medically unsuitablePotential recipient temporarily too sick, medically contraindicated, or not optimized to attempt transplantN/A
721Candidate transplanted or pending transplantPotential recipient has been transplanted, a transplant is in progress, or another offer is being consideredN/A
722Candidate’s condition improved, transplant not neededPotential recipient’s condition has improved and transplant is currently unnecessaryN/A
723Candidate requires different lateralityPotential recipient requires organ of a different laterality (e.g., right lung is specified)N/A
724Candidate requires multiple organ transplantPotential recipient requires a multiple organ transplant (e.g., heart offered without kidney)N/A
725Epidemic/Pandemic – CandidatePotential 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
726Candidate temporarily ineligible due to insurance or financial issuePotential recipient is temporarily ineligible for transplant due to insurance or financial related reasonsN/A
727Candidate unavailablePotential recipient is unavailable (e.g., traveling) or could not be contactedN/A
728Candidate refusedPotential recipient refused the offered organN/A
Histocompatibility Related730No candidate serum for crossmatchingNo candidate serum is available for crossmatchingN/A
731No donor cells/specimen for crossmatching, or no time for crossmatchNo donor cells (or specimen) for crossmatching or no time to complete a crossmatchN/A
732Positive physical crossmatchPhysical crossmatch result between donor and potential recipient is positiveN/A
733Positive virtual crossmatch/unacceptable antigensVirtual crossmatch result between donor and potential recipient is positive or potential recipient has donor-specific antibodies that are considered contraindications to transplantN/A
734Number of HLA mismatches unacceptableNumber of HLA mismatches between donor and potential recipient is unacceptableN/A
Disease Transmission Risk740PHS risk criteria or social historyPHS 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
741Positive infectious disease screening test: CMV, HBV, HCV, etc.CMV, HBV, HCV, HIV, HTLV, VDRL, etc. donor testing is positiveN/A
742Donor infection or positive cultureDonor has an active infection or positive culture results (e.g., meningitis)N/A
743Malignancy or suspected malignancyA malignancy or potential malignancy is suspected with the organN/A
744Epidemic/Pandemic – DonorDonor 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 Specific750Donor medical history, specifyDonor medical history is not clinically suitable for potential recipientRequired
751Donor instability/high vasopressor usageDonor has prolonged hemodynamic instability and/or requires high vasopressor useN/A
752Prolonged downtime/CPRDonor has experienced prolonged downtime and/or CPRN/A
753DCD donor neurological function/not expected to arrestDCD donor has high neurological function and is not expected to arrest in timeN/A
754VCA graft appearance or quality, specifyVCA graft is unsuitable due to appearance or quality reasons such as incompatible skin tone, tattoos, scars, bruising, ecchymosis, hematoma, etc.Optional
Logistics760Resource time constraint (OPO, TXC, donor hospital, etc.)Time constraint for transplant imposed by the OPO, TXC, donor hospital, etc.N/A
761Donor family time constraintTime constraint imposed by the donor familyN/A
762Recovery team availabilityRecovery team or local recovery team is unavailable to perform procedure (heavy workload, etc.)N/A
763Transplant team or transplant facility availabilityTransplant team is unavailable to perform transplant procedure (heavy workload, etc.)N/A
764Transportation availabilityTransportation for the organ cannot be obtained.N/A
765Exceeded policy defined response timeResponse was not received from center within the time period specified in policyN/A
Other790Disaster Emergency Management ConsiderationUse only in the event of a natural disaster, regional emergency, etc. that is affecting the operations or recovery of organs.N/A
798Other, specifyUse 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


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