Document

Complete hospital Record of Death Form to fulfill JCAHO and CMS requirements. The Donation Coordinator will provide a copy of the donation form for the medical record.

All patient deaths must be referred to the procurement organizations. There are no exclusions. Final donor suitability will be determined by the Donation Coordinator. When you call, please have the patient's chart available.
What you will be asked by the
1-800-24-SHARE Operator:
  1. Your name, title, unit, phone number, hospital, city, state.
  2. Patient name, age, sex, race.
  3. Is the patient on a ventilator?
  4. Time of death, cause of death.
  5. History/presence of cancer?
  6. History/presence HIV/Hepatitis?
  7. History/presence Alzheimer's or Parkinson's?
  8. Positive blood cultures in last 3 days & documented sepsis?
  9. Recent IV drug use?
Note: These are not absolute contraindications. If the operator determines that your patient meets initial donor criteria, a Donation Coordinator will be notified to assist you further. Your patient's age and medical history will determine which agency (Life Source,Spirit of the North Tissue Services or Lions Eye Bank) will return your call.
What you will be asked by the Donation Coordinator:
  1. Circumstances surrounding the death.
  2. If trauma death, what type of injuries?
  3. Is this an ME/Coroner case? Is there an autopsy?
  4. Any known past medical history?
  5. If trauma/surgical death, what bloods/colloids in last 48 hours? What crystalloid's in last 1 hour?
  6. Patient's height and weight.
  7. Is infectious process present? (Donor Coordinator may ask labs, CXRs, culture results, etc.)

Note: These are not absolute contraindications.

Lions Eye Bank International