# Database Requirement Notes from IQ

Typed up notes from a document used by IQ as the basis for looking for a system to procure.

## General

To be used by:

1. Surgical Team
2. Recipient Coordinators
3. Living Donor Team
4. Small bowel Team
5. Pancreas Specialist Nurses
6. Vascular Access nurses
7. Transplant Clinic
8. Anaesthetists
9. Pharmacists
10. Dieticians
11. Researchers
12. Tissue Typing
13. Psychologists

Should produce reports for:

1. NHSBT
2. Collaborative Transplant Study
3. Renal Registry

### Recipient Assessment

1. Correspondence
 1. Referral Letter
 2. Surgical Assessment
 3. Further correspondence
 4. Nurse notes/emails
2. Clinical Assessment
 1. Name of surgeon assessing patient
 2. Present history
 3. Past medical history
 4. Drugs and allergies
 5. Social history
 6. Examination
 7. Compliance
3. Virology
 1. CMV
 2. EBV
4. Cardiac Assessment
 1. MPS
 2. ECHO
 3. Angio
 4. Cardiac MDT
5. Diabetes
 1. DM type
 2. Date of diagnosis
 3. 24 hour insulin dose
 4. Pump or sensor
 5. Complications - (Peripheral Neuropathy, Autonomic Neuropathy, Hypoglycaemic unawareness, Retinopathy, gastroparesis)
6. Renal
 1. Type of dialysis
 2. Native output
 3. Ureteric reflux
 4. Outflow obstruction
 5. UTI
7. Vascular access
 1. Type of fistula
 2. Intervential radiology
8. Anaesthetic assessment
9. Tissue Typing
 1. HLA Type
 2. Blood group
 3. Date of activation on waiting list
 4. Screening information (calculated reaction frequency %)
 5. Previous transplant offers
10. Other investigations
 1. CXR
 2. CT
 3. Lung function tests
 4. Duplex
11. Listing meeting
 1. Names of doctors present
 2. Issues discussed
 3. Concerns
 4. Further investigations required
 5. Decision

### Cadaveric Donor Assessment

1. All information from EOS
2. Follow up information from EOS regarding other organs from the same donor

### Retrieval Data

1. HBD/NHBD
2. Retrieval Team
3. Surgeon's Name
4. Organs retrieved
5. Perfusion solution
6. Retrieval times
7. Damage
8. Quality of perfusion
9. Machine perfusion
10. NORS database

### Living Donor Assessment

1. Referral letters and all correspondence
2. Surgical Assessment
3. Investigations

### Transplant

1. Back table
2. Operation details
3. Anasomosis times
 1. Calculated CIT
 2. Calculated WIT 
4. Automatic operation note with extra free text
5. Post operative instructions
6. Stent
7. Perfusion culture

### Post-operative Curse

1. Duplex scan
2. DGF Y/N
3. Rejection - Y/N, Date
4. Biopsy - Date, Histology report/result
5. Blood transfusion - Date, number of units
6. TEGS
7. Anticoagulation
8. Drains
 1. Y/N
 2. Culture
 3. Chemistry
 4. Date removed
9. Antibiotics
10. Length of hospital stay
11. Length of ITU stay
12. Re-admissions to ITU
13. Complications
 1. Infections
 2. Re-operations
 3. Collections
 4. Interventional radiology
14. Medication during admission and on discharge
15. Discharge summary automatically generated

### Transplant Clinic

1. Date
2. Doctor/nurse
3. Weight
4. Blood pressure
5. BMs
6. OGTT
7. Complications
8. Graft dysfunction
9. Medication

### Re-admission

1. Complications
2. Operations

### Labs results

1. Biochemistry
2. Drug levels
3. Haematology
4. Coagulation

### Graft Function

1. Graft Failure
2. Date of failure

### Alerts

1. Stent
2. Missed follow-up
3. Tacrolimus levels outside set range
4. CMV
5. BKV PCR

## Page 7: Diagram 1
![Page 7: Diagram 1](../../_static/transplant_epr/iq_requirements/IQ_Diagram1.svg)

## Page 8: Diagram 2
![Page 8: Diagram 2](../../_static/transplant_epr/iq_requirements/IQ_Diagram2.svg)

* AR = Acute Rejection
* TEGS = Thromboelastograms
* OGTT = Oral Glucose Tolerance Test
* DGF = Delayed Graft Function
* OPA = Out Patients Assessment
* TT = Tissue Typing

## Page 9: Diagram 3
![Page 9: Diagram 3](../../_static/transplant_epr/iq_requirements/IQ_Diagram3.svg)

* CxR = Chest X-Ray
* HNI = Histocompatibility and Immunogenetics

## 2: Surgeon Assessment

### Diabetes
* Year/age diagnosis
* Type I / II / Mody (Mature Onset of Diabetes of the Young)
* Insulin dose - total units
* Hypos Y/N
* Awareness / Unawareness
* Frequency of hypos
* Complications

### Neuropathy
* Peripheral Y/N
* Extent - Hands / Feet / Lower legs / Thighs
* Wheelchair Y/N
* Autonomic Y/N
* Vomiting Y/N
 * Frequency
* Nausea
* Diarrohea / Constipation
* Gastric pacemaker Y/N

### Vasculopathy
* Y/N
* Amputations Y/N
 * Extent
* Ulcers Y/N
* MI Y/N  (Myocardial Infarction)
* Stroke Y/N
* Clauidication Y/N
 * Distance

### Retinopathy
* Y/N
* Laser Y/N
 * Number
* Surgery
* Stable / Unstable
* Regular Follow Up
* Research Link

### Nephropathy
* Y/N
* Cause of renal failure
 * Polycystic Kidneys - UTIs Y/N; Bleeds Y/N; Large kidneys Y/N; Previous nephrectomies
 * Lupus - Antibodies Y/N; Previous thrombotic events: DVT's / Pulmonary Embolism / Miscarriage / Recurrant thrombosis of AVF; Previous treatment 
 * FSGS (focal segmental glomerulo sclerosis) - Fulminant; Recurrance; Type of treatment
* Biopsy proven Y/N
* Predialysis / dialysis
 * (Estimated) start day 
* HD (hemodialysis)
 * Access type
 * Problems Y/N
 * HD days
* PD (Peritoneal Dialysis)
 * Catheter inserted where?
 * Previous peritonitus
 * Exit site R/L
* Urine output volume
* Previous UTI Y/N
* Frequency UTIs
* Date of last UTI
* Renal stones
* Reflux
* Outflow obstruction symptoms
 * Nocturia Y/N + Number
 * Frequency Y/N + Number
 * Hesitancy
 * Dribbling

### Previous Transplant
* Tx Type
* Date of Tx
* Reason for failure
* Previous donor TT
* Previous immunosuppresion

### Past Medical History
* Cardiac
* Respiratory
* GI (Gastro Intestinal)
* GU (Genitourinary)
* Surgical
* Gynaecological

### Current Drugs

### Allergies

### Sensitising events
- Tx
- Pregnancies
- Blood transfusions

### Social History
* Employment Y/N
* Job
* Disable Y/N
* Wheelchair bound
* Registered Blind
* Lives with family / alone
* Family numbers
* Relatives / friends close by
* Smoker Y/N
 * CPD (number per day)
* Alcohol
 * Number units
* Other recreational drugs

### Examination
* CVS (Cardio Vascular System)
* RS (Respiritory System)
* Abdomen
* Pulses
* Fistula
* Hands
* Teeth

### Decision to list

### Generate Template Letter

## 3: Listing Meeting
* List of people present
* Further investigations
* Concerns and name of those with reservations
* Decision to list Y/N

## 4: Annual Review
...and Report / Letter Tissue Typing (about sensitisation status and calls)

### Diabetes
* Insulin dose
* Hypos
* Awareness / Unawareness
* Frequency of hypos

New changes in complications...

### Neuropathy
* Peripheral Y/N
* Extent - Hands / Feet / Lower legs / Thighs
* Wheelchair Y/N
* Autonomic Y/N
* Vomiting Y/N
 * Frequency
* Nausea
* Diarrohea / Constipation
* Gastric pacemaker Y/N

### Retinopathy
* Y/N
* Laser Y/N
 * Number
* Surgery
* Stable / Unstable

### Vasculopathy
* Y/N
* Amputations Y/N
 * Extent - Toes; Forefoot; BKA (Below Knee); AKA (Above Knee); 
* Ulcers Y/N
* MI Y/N
* CVA (stroke) Y/N  <-- system alert need or carotid duplex
* Stroke Y/N
* Clauidication Y/N  <-- system alert - lower limb & iliac duplex
 * Distance

* Admissions during last year
* Transfusion or possible sensitisation events
* New problems

### Social History
* Any changes?

### Examination

### Investigations

#### Decision
* Remain on waiting list
* Suspend
* Remove from waiting list

## 5: Call / Selected for Transplant
* Not attended
 * Unwell
 * No transport
 * Unable to find patient
 * Patient refused
 * Other
* Attended
 * Back-up
 * Donor did not die
 * Organ not suitable
 * Proceeded with transplant...

##  6: Donor
* Cadaveric - EOS Information 
* Living donor - LRD (Living related donor) team
* Letters - Direct; Paired exchange; altruistic

### Retrieval
* Team and surgeon
* DBD - cross clamp date and time
* DCD
 * Withdrawal time
 * BP < 50
 * As?stole
 * Certification
 * KTS (Knife to skin)
 * Perfusion
 * HTA A Number
* Type of solution
* Reported damage
* Abnormal anatomy

## 7: Organ and Backtable
* Name of surgeon and assistant
* Start time

### Kidney R / L + Biopsy + Perfusion fluid culture

* Number of arteries
* Number of veins
* Number of ureters
* Number of patches
* Quality of patch
* Quality of arterial ostium

### Backtable reconstruction
* Aortic patch shortened
* Ao patch sacrificed
* Arteries troussered
* Arteries anastomosed end-to-side to renal arteries

#### Damage

* Y/N
* Capsular
* Arterial
* Vein
* Ureter
* Substance of kidney

Perfusion solution on back table + batch number

Machine perfusion Y/N

* at retrieval / base
* time perfusion started / finished
* reason for perfusion
* kps (kidney perfusion solution) batch number

### Pancreas + Perfusion fluid culture
* Fatty - No; Mild; Moderate; Severe
* Damage Type - Report to NHSBT + HTA B form
* Vascular reconstruction
* Preservation solution on back table
 * UW (University of Wisconsin) Solution
 * Batch number 

## 8: Transplant
* Surgeon's name
* Assistant's name
* Consultant in charge

### Templates for operations and back table

* Kidney
* SPK (Simultaneous Pancreas Kidney)
* PTA (Pancreas Transplant Alone)
* PAK (Pancreas After Kidney)

HTA B Form - Number keep for tracability