Transplant Informed Consent Discussion Note (Recipient)

Transplant Informed Consent Discussion Note

(Concise documentation of informed consent discussion for organ transplantation; complements but does not replace signed consent forms.)

Date/Time: [Date and time]

Location: [Location]

Discussion Type: [Initial listing consent / Annual re-education / Organ offer–specific / Special donor consent]

Organ(s): [Organ(s) under discussion]

Attending Surgeon: [Name, credentials]

Note Author/Role: [Name, role]

Participants and Capacity

Patient present: [Yes / No] (If no, identify legally authorized representative and relationship.)

Others present: [Family/support persons, if applicable]

Interpreter: [Yes / No] (If yes, specify language and modality.)

Capacity: [Patient demonstrated decision-making capacity / Consent obtained from legally authorized representative due to (reason)]

Clinical Context

[Underlying diagnosis, current clinical status relevant to timing/urgency, and key comorbidities materially affecting the risk discussion] (Limit to 2–3 sentences; do not include full H&P.)

Informed Consent Discussion

(Tailor content to the organ(s) and discussion type. Document only items actually discussed.)

Nature and Benefits: [Proposed transplant procedure, purpose, and realistic expected benefits, noting that outcomes depend on donor quality, recipient condition, and adherence]

Material Risks: [Perioperative risks, infection risks, immunosuppression-related complications, graft-specific complications, and long-term care burdens actually discussed; include patient-specific risk modifiers as applicable] (Document tailored to organ type and patient factors; do not list risks not discussed.)

Alternatives: [Alternatives discussed, including continued medical management, remaining on waitlist for a different offer, and palliative/supportive care when appropriate; include key tradeoffs]

Program Outcomes (SRTR): [SRTR report version/date used; confirm that national and program-specific 1-year patient and graft survival (observed vs. expected) were reviewed; note whether patient received copy or declined review]

Donor Risk Factors: [At listing: general framework for how donor factors affect outcomes. At organ offer: specific donor factors known at decision time. For donors meeting infectious disease risk criteria or with known HBV/HCV/HIV status: specific transmission risk counseling, planned monitoring, and treatment pathways]

Rights and Disclosures: [Patient understands right to refuse transplant or specific offers without jeopardizing future care; Medicare immunosuppression coverage disclosure if applicable]

Understanding and Decision

Understanding Assessment: [Method used (teach-back preferred) and what the patient demonstrated: e.g., ability to describe main risks, alternatives, and that donor infection risk is low but not zero] (Do not state only "verbalized understanding.")

Decision: [Consents to proceed / Declines / Defers] (If conditional, document specific conditions. Include patient-stated goals or preferences informing the decision.)

Plan

[Next steps (e.g., listing activation, pre-op testing, additional education); consent forms signed and storage location; follow-up actions and responsible parties] (If forms are pending, document plan to complete.)

(If any element was not addressed, document as [not discussed]. If information is pending, document as [not yet available]. Do not infer understanding from signature alone or SRTR review from packet distribution—document the actual discussion.)