Question 1: Date of Death:

Report the date the recipient died. Confirm that the date matches the last date of actual contact reported on the Form 2100 or Form 4100.

If the death occurred at an outside location and records of death are not available, the dictated date of death within a physician note may be reported. If the progress notes detailing the circumstances of death are available, request these records. These records are useful for completing required follow-up data fields on the Form 2100 or Form 4100 and the cause of death data fields on this form.

If the exact date of death is not known, use the process described for reporting partial or unknown dates in General Instructions, Guidelines for Completing Forms.

Question 2: Was cause of death confirmed by autopsy?

Indicate if the cause of death was confirmed by autopsy.

  • If “yes,” continue with question 3.
  • If “autopsy pending,” continue with question 4. Report the cause of death as determined by a physician. A second Form 2900 will become due six months from the date of death to report any additional cause of death information found during autopsy. All pertinent causes of death should be reported on the second Form 2900.
  • If “no,” continue with question 4.
  • If “unknown,” continue with question 4.

Question 3: Is an autopsy report attached?

Indicate if a copy of the autopsy report is attached. Use the “Add Attachment” feature to attach a copy of the autopsy report in FormsNet. Attaching a copy of the report may prevent additional queries.

Questions 4-5: Primary cause of death:

Report the underlying cause of death. According to the Centers for Disease Control and Prevention, National Center for Health Statistics, the underlying cause of death is “the disease or injury that initiated the chain of events that led directly or inevitably to death.”

Report only one primary cause of death. Options which require additional specification include “Other infection”, “Other pulmonary syndrome”, “Multiple organ failure”, “Other organ failure”, “Other hemorrhage”, “Other vascular”, and “Other cause”. Information reported in the specify field (Question 5) must pertain to the option selected (e.g., an infectious cause of death should be specified for “Other infection”).

If the recipient has recurrent/persistent/progressive disease at the time of death, consider if the disease was the primary cause of death or a contributing cause of death. It should not be assumed that the presence of disease indicates that the disease was the primary cause of death.

If a cause of death has related questions on the follow up form, report the appropriate data in both locations. For example, if a primary cause of death was infection, complete the infection data fields on the follow up form.

If the primary cause of death is unclear, consult with a physician for their best medical opinion.

Questions 6-7: Contributing cause of death:

Report any additional causes of death. All contributing causes of death are important for analysis of transplant outcomes.

Options which require additional specification include “Other infection”, “Other pulmonary syndrome”, “Multiple organ failure”, “Other organ failure”, “Other hemorrhage”, “Other vascular”, and “Other cause”. Information reported in the specify field (Question 5) must pertain to the option selected (e.g., an infectious cause of death should be specified for “Other infection”).

If a cause of death has related questions on the follow up form, report the appropriate data in both locations. For example, if a contributing cause of death was acute graft-versus-host disease (GVHD), complete the acute GVHD data fields on the follow up form.

If there were multiple contributing causes of death, check all that apply.

Last modified: Feb 04, 2019

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