#### § 486.302 Definitions.

As used in this subpart, the following definitions apply:

*Adverse event* means an untoward, undesirable, and usually unanticipated event that causes death or serious injury or the risk thereof. As applied to OPOs, adverse events include but are not limited to transmission of disease from a donor to a beneficiary, avoidable loss of a medically suitable potential donor for whom consent for donation has been obtained, or delivery to a transplant center of the wrong organ or an organ whose blood type does not match the blood type of the intended beneficiary.

*Agreement cycle* refers to the time period of at least 4 years when an agreement is in effect between CMS and an OPO.

*Assessment period* is a 12-month period in which an OPO's outcome measures will be evaluated for performance. The final assessment period is the 12-month assessment period used to calculate outcome measures for re-certification.

*Certification* means a CMS determination that an OPO meets the requirements for certification at [§ 486.303](/on/2024-09-17/title-42/section-486.303).

*Death record review* means an assessment of the medical chart of a deceased patient to evaluate potential for organ donation.

*Death that is consistent with organ donation* means all deaths from the state death certificates with the primary cause of death listed as the ICD-10-CM codes I20-I25 (ischemic heart disease); I60-I69 (cerebrovascular disease); V-1-Y89 (external causes of death): Blunt trauma, gunshot wounds, drug overdose, suicide, drowning, and asphyxiation.

*Decertification* means a CMS determination that an OPO no longer meets the requirements for certification at [§ 486.303](/on/2024-09-17/title-42/section-486.303).

*Designated requestor or effective requestor* is an individual (generally employed by a hospital), who is trained to handle or participate in the donation consent process. The designated requestor may request consent for donation from the family of a potential donor or from the individual(s) responsible for making the donation decision in circumstances permitted under State law, provide information about donation to the family or decision-maker(s), or provide support to or collaborate with the OPO in the donation consent process.

*Designation* means CMS assignment of a geographic service area to an OPO. Once an OPO is certified and assigned a geographic service area, organ procurement costs of the OPO are eligible for Medicare and Medicaid payment under section 1138(b)(1)(F) of the Act.

*Donation rate* is the number of donors as a percentage of the donor potential.

*Donation service area (DSA)* means a geographical area of sufficient size to ensure maximum effectiveness in the procurement and equitable distribution of organs and that either includes an entire metropolitan statistical area or does not include any part of such an area and that meets the standards of this subpart.

*Donor* means a deceased individual from whom at least one vascularized organ (heart, liver, lung, kidney, pancreas, or intestine) is transplanted. An individual also would be considered a donor if only the pancreas is procured and is used for research or islet cell transplantation.

*Donor after cardiac death (DCD)* means an individual who donates after his or her heart has irreversibly stopped beating. A donor after cardiac death may be termed a non-heartbeating or asystolic donor.

*Donor document* means any documented indication of an individual's choice regarding his or her wishes concerning organ and/or tissue donation that was made by that individual or another authorized individual in accordance with any applicable State law.”

*Donor potential* is the number of inpatient deaths within the DSA among patients 75 and younger with a primary cause of death that is consistent with organ donation. For OPOs servicing a hospital with a waiver under [§ 486.308(e)](/on/2024-09-17/title-42/section-486.308#p-486.308(e)), the donor potential of the county for that hospital will be adjusted using the proportion of Medicare beneficiary inpatient deaths in the hospital compared with the total Medicare beneficiary inpatient deaths in the county.

*Entire metropolitan statistical area* means a metropolitan statistical area (MSA), a consolidated metropolitan statistical area (CMSA), or a primary metropolitan statistical area (PMSA) listed in the State and Metropolitan Area Data Book published by the U.S. Bureau of the Census. CMS does not recognize a CMSA as a metropolitan area for the purposes of establishing a geographical area for an OPO.

*Kidney transplantation rate* is the number of kidneys transplanted from kidney donors in the DSA as a percentage of the donor potential.

*Lowest rate among the top 25 percent* will be calculated by taking the number of total DSAs in the time period identified for establishing the threshold rate. The total number of DSAs will be multiplied by 0.25 and rounded to the closest integer (0.5 will round to the higher integer). The donation rates and organ transplantation rates in each DSA will be separately ranked and the threshold rate will be the rate that corresponds to that integer when counting down the ranking.

*Open* area means an OPO service area for which CMS has notified the public that it is accepting applications for designation.

*Organ* means a human kidney, liver, heart, lung, pancreas, or intestine (or multivisceral organs when transplanted at the same time as an intestine). The pancreas counts as an organ even if it is used for research or islet cell transplantation.

| Organ type | Number of organs transplanted |
| --- | --- |
| (1) Right or Left Kidney | 1 |
| (2) Right and Left Kidney | 2 |
| (3) Double/En-Bloc Kidney | 2 |
| (4) Heart | 1 |
| (5) Intestine | 1 |
| (6) Intestine Segment 1 or Segment 2 | 1 |
| (7) Intestine Segment 1 and Segment 2 | 2 |
| (8) Liver | 1 |
| (9) Liver Segment 1 or Segment 2 | 1 |
| (10) Liver Segments 1 and Segment 2 | 2 |
| (11) Right or Left Lung | 1 |
| (12) Right and Left Lung | 2 |
| (13) Double/En-bloc Lung | 2 |
| (14) Pancreas (transplanted whole, research, islet transplant) | 1 |
| (15) Pancreas Segment 1 or Segment 2 | 1 |
| (16) Pancreas Segment 1 and Segment 2 | 2 |

*Organ procurement organization (OPO)* means an organization that performs or coordinates the procurement, preservation, and transport of organs and maintains a system for locating prospective beneficiaries for available organs.

*Organ transplantation rate* is the number of organs transplanted from donors in the DSA as a percentage of the donor potential. Organs transplanted into patients on the OPTN waiting list as part of research are included in the organ transplantation rate. The organ transplantation rate will be risk-adjusted for the average age of the donor potential using the following methodology:

(1) The age groups used for the adjusted transplantation rates are: <1, 1-5, 6-11, 12-17, 18-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-75.

(2) Calculate a national age-specific transplantation rate for each age group.

An expected transplantation rate for each OPO is calculated as ∑(g=1)Gdg\*Rg/∑gdg, where dg is the number of potential donors in the OPO in age group g, Rg is the age-specific national transplantation rate in age group g, and ∑gdg is the OPO's total number of individuals in the donor potential. This can be interpreted as the overall expected transplantation rate for an OPO if each of its age-specific transplantation rates were equal to the national age-specific.

(3) Calculate the age-adjusted organ transplantation rate as (O/E)\*P, where O is the OPO's observed unadjusted transplantation rate, E is the expected transplantation rate calculated in Step 2, and P is the unadjusted national transplantation rate.

*Re-certification cycle* means the 4-year cycle during which an OPO is certified.

*Transplant hospital* means a hospital that provides organ transplants and other medical and surgical specialty services required for the care of transplant patients. There may be one or more types of organ transplant centers operating within the same transplant hospital.

*Urgent need* occurs when an OPO's noncompliance with one or more conditions for coverage has caused, or is likely to cause, serious injury, harm, impairment, or death to a potential or actual donor or an organ beneficiary.

[[71 FR 31046](https://www.federalregister.gov/citation/71-FR-31046), May 31, 2006, as amended at [77 FR 29031](https://www.federalregister.gov/citation/77-FR-29031), May 16, 2012; [81 FR 79880](https://www.federalregister.gov/citation/81-FR-79880), Nov. 14, 2016; [84 FR 61492](https://www.federalregister.gov/citation/84-FR-61492), Nov. 12, 2019; [85 FR 77947](https://www.federalregister.gov/citation/85-FR-77947), Dec. 2, 2020]