End-stage organ disease
Recipient-side scoring tools for disease severity assessment and waitlist prioritisation. Standalone manual calculators — values are not stored or linked to any case record.
Liver - Recipient - Waitlist Priority
MELD-Na Score
Primary liver allocation tool incorporating serum sodium for improved mortality prediction.
Kim et al., NEJM 2008Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Bilirubin (mg/dL)1.0
INR1.0
Creatinine
1.0 mg/dLDialysis 2+ times in past week
Sets creatinine to 4.0 mg/dL per UNOS policy
Serum sodium (mEq/L)137
Capped 125-137 in formula
MELD
6
MELD-Na
6
-
-
Clinical note: Sodium correction is most impactful in patients with refractory ascites. Update at minimum every 30 days for MELD 25+. In the Eurotransplant region, reMELD-Na (adopted March 2025) uses recalibrated European coefficients.
MELD = 3.78*ln(bili) + 11.2*ln(INR) + 9.57*ln(Cr) + 6.43. MELD-Na = MELD + 1.32*(140-Na) - 0.168*MELD*(140-Na). Min input 1.0, Cr capped 4.0 mg/dL.
Kidney - Renal Function
eGFR - CKD-EPI 2021 (race-free)
Race-free GFR estimation endorsed by KDIGO and NKF. Used for CKD staging, listing eligibility, and living donor screening.
Inker et al., NEJM 2021 - NKF-ASN Task Force 2021Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Male
Female
Age55 yr
Serum creatinine
1.0 mg/dLeGFR
-
mL/min/1.73m2
G1
90+
G2
60-89
G3a
45-59
G3b
30-44
G4
15-29
-
-
eGFR = 142*(Scr/k)^a*(0.9938)^age*1.012[female]. k=0.7(F)/0.9(M), a=-0.241 if Scr less than or equal k, -1.200 if Scr greater than k. Kidney Int 2021;99:149. Listing threshold most centres: eGFR <20.
KDPI pairing: EPTS and KDPI are designed to be used together — EPTS captures expected recipient survival benefit, KDPI captures donor organ quality. KDPI is available in the Donor section of this tool.
Kidney - Recipient - Longevity Matching
EPTS - Estimated Post-Transplant Survival
Four-variable recipient score predicting post-transplant longevity. EPTS 20% or less gives priority access to KDPI 20% or less kidneys.
OPTN policy formula - EPTS Guide 2020Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
EPTS percentile uses an approximated mapping table. Raw EPTS is exact. Confirm percentile with the official OPTN EPTS calculator for allocation decisions.
Age45 yr
Time on dialysis2.0 yr
Set to 0 for pre-emptive transplant
Diabetes mellitus
As cause of renal failure or comorbidity
Prior solid organ transplant
EPTS Score
-
% - lower = longer expected survival benefit
Raw EPTS
-
Cox model output
Access pathway
-
-
-
KDPI + EPTS together: EPTS 20% or less + KDPI 20% or less = longevity-matched pair. This recipient receives priority for this kidney per OPTN policy. For KDPI above 20%, standard allocation applies regardless of EPTS.
Raw EPTS = 0.047*max(age-25,0) - 0.015*DM*max(age-25,0) + 0.398*PriorTx - 0.237*DM*PriorTx + 0.315*ln(dial+1) - 0.099*DM*ln(dial+1) + 0.130*(dial=0) - 0.348*DM*(dial=0) + 1.262*DM. Raw range 0-3.84. OPTN policy formula.
Liver — Recipient — Surgical Risk
Child-Pugh Score
Assesses severity of chronic liver disease and surgical risk. Complements MELD-Na — particularly useful for hepatocellular carcinoma assessment and surgical risk stratification.
Child & Turcotte 1964 · Pugh et al. 1973Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Bilirubin
2.0 mg/dLReference thresholds: <2 mg/dL (34 µmol/L) · 2–3 (34–51) · >3 (51+)
Albumin (g/dL)3.5
Thresholds: >3.5 · 2.8–3.5 · <2.8
INR1.2
Thresholds: <1.7 · 1.7–2.3 · >2.3
Ascites
None
Mild / controlled
Moderate–severe / refractory
Hepatic encephalopathy
None
Grade I–II
Grade III–IV
Child-Pugh Score
—
points (5–15)
Class
—
—
—
5 parameters, 1–3 points each. Class A: 5–6 pts (1-yr survival ~100%, 2-yr ~85%). Class B: 7–9 pts (81%, 57%). Class C: 10–15 pts (45%, 35%). Child CG, Turcotte JG 1964; Pugh RN et al. Br J Surg 1973;60:646.
Lung — Recipient — Mortality Prediction
BODE Index
Four-domain COPD severity and mortality predictor. Predicts all-cause and respiratory mortality better than FEV₁ alone. Used in listing assessment and timing of transplant referral.
Celli et al., NEJM 2004;350:1005Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
BODE index applies to COPD only — not validated for other lung diseases. Requires post-bronchodilator spirometry.
BMI (kg/m²)22.0
Threshold: >21 (0 pts) · ≤21 (1 pt)
FEV₁ (% predicted)65 %
Post-bronchodilator. ≥65% (0) · 50–64% (1) · 36–49% (2) · ≤35% (3)
6-minute walk distance (m)350 m
≥350 m (0) · 250–349 m (1) · 150–249 m (2) · ≤149 m (3)
mMRC Dyspnoea Scale
0–1
2
3
4
0=only strenuous · 1=hurrying/hills · 2=walking pace · 3=100m on flat · 4=too breathless to leave home
BODE Index
—
0–10 points
Quartile
—
—
—
BODE = BMI(0–1) + FEV₁%(0–3) + 6MWT(0–3) + mMRC(0–3). Quartile 1 (0–2): 52-month survival ~80%. Q2 (3–4): ~67%. Q3 (5–6): ~57%. Q4 (7–10): ~18%. Celli BR et al. NEJM 2004;350:1005.
Heart — Recipient — Advanced Heart Failure Classification
INTERMACS Profiles
Seven-level classification of advanced heart failure severity. Used for timing of VAD implantation and transplant listing. Higher profile numbers indicate more stable disease.
Stevenson et al., J Heart Lung Transplant 2009;28:535Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
INTERMACS = Interagency Registry for Mechanically Assisted Circulatory Support. Profiles 1–2 account for ~50% of VAD implants and have highest short-term mortality. Stevenson LW et al. J Heart Lung Transplant 2009;28:535.
Heart — Recipient — Transplant Listing
Heart Failure Survival Score (HFSS)
Seven-variable score predicting 1-year event-free survival in advanced heart failure. Originally developed to identify patients who benefit most from cardiac transplantation.
Aaronson et al., Circulation 1997;95:2479Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Aetiology
Non-ischaemic
Ischaemic
Resting heart rate (bpm)80
LVEF (%)25 %
Mean arterial pressure (mmHg)75
Serum sodium (mEq/L)138
Peak VO₂ (mL/kg/min)14.0
Intraventricular conduction delay (IVCD)
QRS duration > 120 ms
HFSS
—
Risk group
—
—
—
HFSS = 0.0216×(HR) − 0.0255×(MAP) − 0.0464×(LVEF) − 0.047×(Na) − 0.546×(peakVO₂) + 0.608×(ischaemic) + 0.6931×(IVCD). Low risk ≥8.10 (1-yr survival ~93%), medium risk 7.20–8.09 (~72%), high risk <7.20 (~43%). Aaronson KD et al. Circulation 1997;95:2479.
Kidney — Recipient — Kidney Failure Risk
Kidney Failure Risk Equation (KFRE)
Predicts 2-year and 5-year probability of kidney failure (requiring dialysis or transplant) in CKD patients. Validated in over 700,000 patients across 31 countries.
Tangri et al., JAMA 2016;315:164Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Male
Female
Age60 yr
eGFR (mL/min/1.73m²)30
Most relevant for eGFR 15–45. Below 15 = very high risk regardless.
Urine albumin:creatinine ratio (mg/mmol)30
To convert from mg/g: divide by 8.84
2-year risk
—
% probability
5-year risk
—
% probability
—
—
4-variable model: 1 − 0.9832^exp(−0.2201×(age−7.036) + 0.2467×(male−0.5642) − 0.5567×(eGFR−7.222) + 0.4510×(ln(uACR)−5.137)) for 2-yr. Validated in 31 countries, 730,577 patients. Tangri N et al. JAMA 2016;315:164.
General — Recipient — Frailty Assessment
Clinical Frailty Scale (CFS)
Nine-level global assessment of frailty based on activity, energy, and function. Widely used in transplant work-up to assess baseline vulnerability and predict post-transplant outcomes.
Rockwood et al., CMAJ 2005;173:489Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
CFS was originally developed at Dalhousie University, Halifax. Scores 1–4 indicate varying degrees of fitness without frailty. Score 5 = mildly frail. Score ≥7 associated with significantly increased post-transplant mortality in most published series. Rockwood K et al. CMAJ 2005;173:489.
General — Recipient — Comorbidity Burden
Charlson Comorbidity Index (CCI)
Weighted comorbidity scoring system predicting 10-year mortality risk. Widely used in surgical risk assessment and post-transplant outcome prediction.
Charlson et al., J Chron Dis 1987;40:373Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Age60 yr
Age 50–59: +1 · 60–69: +2 · 70–79: +3 · 80+: +4
Comorbidities (tap to toggle)
CCI Score
—
10-yr survival
—
estimated
—
—
Original Charlson ME et al. J Chron Dis 1987;40:373. Age-adjusted version: add 1 point per decade above 40. Score 0: 10-yr survival ~98%. Score 1–2: ~89%. Score 3–4: ~77%. Score ≥5: <21%. Quan H et al. Med Care 2011;49:1079 (updated coding).
General — Recipient — Anaesthetic Risk
ASA Physical Status Classification
Six-level anaesthetic risk classification system. Used universally in pre-operative assessment. Provides a common language between surgical, anaesthetic, and transplant teams.
ASA House of Delegates 1963 · Updated 2020Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
American Society of Anesthesiologists Physical Status Classification. ASA PS Classification System, 2020 update. Perioperative mortality correlates strongly with ASA class: ASA I ~0.06%, II ~0.47%, III ~2.4%, IV ~12.5%, V ~58%. Doyle DJ, Hendrix JM. StatPearls 2023.
Haemodynamic Panel — Assessment
Haemodynamic Calculations
Pulmonary vascular resistance, cardiac index, and body surface area. Essential in heart and lung transplant candidate assessment, particularly for quantifying pulmonary hypertension.
Standard formulae · Wood units · Mosteller BSA 1987Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Pulmonary vascular resistance (PVR)
Mean PA pressure (mPAP) mmHg25
Pulmonary capillary wedge pressure (PCWP) mmHg12
Cardiac output (CO) L/min5.0
PVR
—
Wood units
PVR
—
dynes·s·cm⁻⁵
Cardiac index (CI)
Height (cm)170 cm
Weight (kg)75 kg
BSA
—
m² (Mosteller)
Cardiac index
—
L/min/m²
PVR in transplant: PVR >3 Wood units (240 dynes·s·cm⁻⁵) is associated with increased post-heart-transplant right heart failure risk. Reversibility testing with vasodilators is used to distinguish fixed from reactive pulmonary hypertension. PVR >5 Wood units that is irreversible is generally a contraindication to heart transplantation.
PVR (Wood units) = (mPAP − PCWP) / CO. PVR (dynes) = PVR(Wu) × 80. BSA = √(Ht(cm) × Wt(kg) / 3600) [Mosteller]. CI = CO / BSA.
Donor-related calculators
Donor quality, matching, and risk tools used at the time of organ offer evaluation. Standalone manual calculators — values are not stored or linked to any case record.
Liver - Donor - Eurotransplant
ET-DRI - Eurotransplant Donor Risk Index
Adds GGT, rescue status, sharing type, and CIT to the Feng DRI - all known at time of organ offer in Eurotransplant.
Braat et al., Am J Transplant 2012Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Donor age39 yr
GGT (IU/L)50
Reference 50 IU/L. Elevated GGT especially in DCD donors meaningfully increases ET-DRI.
Cold ischaemia time (h)8.0
Cause of death
Trauma
Anoxia
CVA
Other
DCD
DBD
DCD
Graft
Whole
Split
Sharing
Local
Regional
National
Rescue transplant
No
Yes
ET-DRI
1.00
reference = 1.00
Relative graft risk
+0%
-
-
GGT insight: GGT is uniquely included in ET-DRI (not in US DRI). For each 100 IU/L increase in GGT, ET-DRI rises by ~0.06. Particularly informative for DCD donors where hepatic stress is common. Review GGT alongside haemodynamic support requirements.
ET-DRI = exp(0.960*(age+COD+0.01*(CIT-8)+share) + 0.411*DCD + 0.422*split + 0.06*(GGT-50)/100 + 0.180*rescue). Reference: trauma, DBD, whole, local, CIT 8h, GGT 50, age under 40.
Liver - Donor/Recipient Match
D-MELD Score
Donor age x recipient MELD. Use alongside ET-DRI - ET-DRI captures donor characteristics only; D-MELD adds recipient disease severity.
Halldorson et al., Liver Transpl 2009Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Donor age45 yr
Recipient MELD18
Use MELD-Na where available
Donor age
45
x
MELD
18
=
D-MELD
810
-
-
Complementary use: A young donor (ET-DRI 1.1) offered to a MELD-40 recipient carries very different risk than the same donor offered to a MELD-15 recipient. D-MELD captures this. Threshold: D-MELD 1600+ is associated with significantly worse 1-year graft survival.
D-MELD = donor age x recipient MELD. Below 1200: low risk. 1200-1599: intermediate. 1600+: high risk. Halldorson JB et al., Liver Transpl 2009;15:1279.
EPTS pairing: KDPI and EPTS are designed to be used together — KDPI captures donor organ quality, EPTS captures expected recipient survival benefit. EPTS is available in the End-stage disease section of this tool.
Kidney - Donor Quality
KDPI - Kidney Donor Profile Index
Cumulative percentile ranking of kidney graft failure risk. Updated October 2024 - race and HCV removed. 8 variables remain.
OPTN update October 2024Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
KDPI mapping table updates annually. This uses a 2023-calibrated approximation - may differ +/-2-3% from official DonorNet value. Confirm at hrsa.gov/optn before allocation decisions.
Donor age45 yr
Height170 cm
Weight75 kg
Serum creatinine
1.0 mg/dLHistory of hypertension
History of diabetes
DCD - donation after circulatory death
Cause of death
Non-CVA
CVA / stroke
KDPI
-
%
KDRI scaled
-
vs median donor
0%20%35%70%85%100%
-
-
Longevity matching: KDPI 20% or less kidneys are preferentially allocated to recipients with EPTS 20% or less. Use KDPI alongside EPTS (Recipient tab) to assess compatibility for high-quality kidneys.
KDRI coefficients 2024: age 0.0092/0.0113/0.0067; height -0.0557; weight -0.0333; HTN 0.1106; DM 0.2577; CVA 0.0743; creatinine 0.2128/-0.2199; DCD 0.1966. Scale factor 2023: 1.3090. Race and HCV removed October 2024.
Heart - PGD Risk - Pre-offer
Wright PGD Risk Score
Four-variable pre-transplant score combining donor biochemistry, recipient pharmacology, and immunology. Each point carries OR 2.0 for PGD.
Wright et al., JHLT 2020Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Donor
Donor pH < 7.05 on last ABG
Reflects resuscitation quality - 3 points
Recipient pharmacology
Amiodarone use pre-transplant
Dose-dependent - OR 8.68 - 2 points
Milrinone use pre-transplant
Inotropic support at time of transplant - 1 point
Recipient immunology
Class II PRA > 50%
Panel reactive antibody - OR 13.85 - 3 points
Score
0
out of 9
Relative risk vs 0
1x
Low risk
No significant risk factors.
Amiodarone dose-dependency: Each 100 mg increase in amiodarone dose on the day of transplant raises odds of severe PGD by ~55%. Ask whether the dose can be reduced pre-operatively - one of the few modifiable PGD risk factors. Use alongside RADIAL for a complete risk picture.
Score: 3x[pH<7.05] + 2x[amiodarone] + 1x[milrinone] + 3x[PRA II>50%]. Derivation n=122, PGD incidence 29.5%. Not externally validated. Wright M et al., JHLT 2020;39:1070.
Heart - PGD Risk - Validated Score
RADIAL Score
The original validated PGD risk tool. Six binary variables, one point each. Performance has declined in the DCD/LVAD era (c-stat ~0.53 in 2024 registry data).
Segovia et al., JHLT 2011Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Contemporary caveat: International Consortium on PGD (n=2,746, 2024) found RADIAL poorly discriminates in the modern era. Use as a structured checklist alongside the Wright score.
R - RAP
A - Age
D - Diabetes
I - Inotropes
A - Donor age
L - Length ischaemia
Right atrial pressure >10 mmHg
Pre-transplant RHC - marker of RV loading
Recipient age >60 years
Diabetes mellitus
Inotrope dependence at transplant
Donor age >30 years
Low threshold reflects 2011 derivation cohort
Total ischaemic time >4 hours
4h threshold now poorly discriminating in most programmes
RADIAL score
0
out of 6
Est. PGD incidence
~5%
Segovia 2011 cohort
Low risk
No significant risk factors. Standard monitoring appropriate.
RADIAL: Right atrial pressure>10 + recipient Age>60 + Diabetes + Inotrope dependence + donor Age>30 + Length of ischaemia>4h. 1 pt per variable. Segovia J et al., JHLT 2011;30:644.
Heart - Donor/Recipient Size Match
Predicted Heart Mass (PHM) Size Match
MESA-derived LV+RV mass equations. PHM outperforms body weight - especially in sex-mismatched pairs where weight ratio systematically misclassifies size. ISHLT 2024: Class IIa, Level C.
Bluemke 2008 - Kawut 2011 - Kransdorf, JHLT 2019Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Donor
Male
Female
Age35 yr
Height175 cm
Weight80 kg
Donor PHM
-
-
Recipient
Male
Female
Age55 yr
Height175 cm
Weight80 kg
Recipient PHM
-
-
Recipient has pulmonary hypertension
PVR >3 Wood units - increases demand on donor RV
PHM ratio
-
donor / recipient
Weight ratio
-
donor / recipient
-
-
Sex mismatch insight: A female donor offered to a male recipient with matched body weights will almost always have a PHM ratio below 0.86 - the critical mortality threshold - because female hearts are 15-20% smaller at equivalent height/weight. Weight ratio alone misses this entirely. Always calculate PHM for sex-mismatched offers.
LV = a*H^0.54*W^0.61 (a=8.25M/6.82F). RV = a*Age^-0.32*H^1.125*W^0.315 (a=11.25M/10.59F). PHM ratio <0.86: HR 1.34 for 1-year mortality. ISHLT 2024: Class IIa, Level C. Kransdorf EP et al., JHLT 2019;38:156.
Lung - Donor/Recipient Size Match
pTLC Size Match
Predicted total lung capacity ratio. Captures sex-based volume differences that height alone misses - a male and female donor of identical height have ~20% difference in lung volume.
Stocks and Quanjer, Eur Respir J 1995Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Recipient diagnosis
Donor
Male
Female
Height172 cm
Donor pTLC
-
Recipient
Male
Female
Height168 cm
Recipient pTLC
-
pTLC ratio (donor / recipient)
-
0.50.750.91.11.251.5
-
-
IPF caution: In restrictive disease the actual thoracic cavity can be 30-40% smaller than pTLC predicts. A matched ratio may represent functional oversizing. Most centres prefer donor pTLC at or below recipient pTLC for IPF. Consider CT chest volume assessment in borderline cases.
pTLC (men) = 7.99*H(m)-7.08. pTLC (women) = 6.60*H(m)-5.79. ISHLT bilateral target 0.75-1.25. Higher ratio (up to ~1.3) associated with improved survival and lower BOS risk. Eberlein M et al., AJRCCM 2013.
Lung — Donor — Standard vs Extended Criteria
Lung Donor Assessment
Classifies donors as ideal or extended criteria (ECD) against Cooper / ISHLT standard criteria. Extended criteria flags include evidence context — none is an absolute contraindication. EVLP consideration is triggered by physiological findings only.
Cooper / ISHLT · Chaney, J Thorac Dis 2014 · AATS 2025 · Bacchetta/McCurry, JTD 2025
Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Donor demographics
Age
yr
Diabetes mellitus
Lung function
PaO₂/FiO₂ ratio
At FiO₂ 1.0 and PEEP 5 cmH₂O
mmHg
Chest X-ray / CT
Bronchoscopy
Sputum / BAL cultures
History
Smoking history
pack-yr
Inhalational drug use
Prior cardiothoracic surgery
Significant chest trauma
Logistics
Estimated cold ischaemia time
h
Coordination and logistics
Operational timing tools for organ procurement and donation coordination. These tools record and display timestamps and intervals only — no clinical scores are generated or stored.
All Organs - Coordinator - Logistics
Donation Timeline Calculator
Cascade all phases from a known start time. Toggle any phase between estimated duration or confirmed fixed time. CIT runs from cross clamp to OR arrival. Total ischaemia extends to reperfusion.
TransplantMD original tool - 2026Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Air transport
Ground only
Heart
Lung
Liver
Kidney
Organ arrives OR (primary)
-
- h - m CIT
Cross clamp to OR arrival
Total ischaemia
-
Cross clamp to reperfusion
Heart transplantation: Total ischaemia above 4h is an independent risk factor for primary graft dysfunction and 30-day mortality. CIT is the coordinator concern - can I get this organ there in time? Total ischaemia is the surgeon concern - how long until reperfusion? Both should be estimated before accepting a heart offer.
DCD — Coordinator — Controlled donation (Maastricht III)
DCD Ischaemia Time Tracker
Tap Stamp as each event occurs. Organ warm ischaemia clocks run from WLST and stop when NRP is started. Edit limits to match your programme protocol.
TransplantMD original tool — 2026
Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Event timestamps
Key intervals
Organ warm ischaemia — WLST to NRP start · tap limit to edit
Warm ischaemia clock: Organ clocks run from WLST to NRP start. Functional warm ischaemia (haemodynamic instability to cold perfusion) is typically shorter — heart 30 min, liver 30 min. Edit limits to match your site protocol. No-touch period duration after arrest varies by centre and is not pre-set.
Early graft dysfunction
Retrospective classification tools for post-transplant graft function. These tools apply published consensus definitions to classify an event that has already occurred — they are not predictive and do not guide management.
Retrospective classification only — not a predictive or decision-support tool
Heart — Post-transplant — Retrospective classification
Heart PGD — 2014 ISHLT Waterfall Classification
Step-by-step classification of early cardiac graft dysfunction severity. Classifies the maximum haemodynamic support required in the first 24 hours post-transplant for registry reporting and audit. Not a management guide — the clinical team already knows what happened.
TransplantMD adaptation · Kobashigawa et al., JHLT 2014;33:327
Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Left Ventricular (L-PGD)
Right Ventricular (R-PGD)
Classification note: PGD is a standardised retrospective severity label. Before assigning PGD, discernible causes must be excluded — the tool asks this as its final step. This tool is additive to, not a replacement for, clinical judgment.
Heart — Post-transplant — Retrospective classification
Heart EGD — 2024 ISHLT Classification (10-year update)
Revised terminology and simplified severity grading replacing PGD. Inotrope score eliminated. Both LVEF ≤40% and haemodynamic compromise now required for LV classification. Severe EGD-LV sub-typed by presentation timing.
Kobashigawa et al., JHLT 2026 · 2024 Prague Consensus Conference
Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Key changes from 2014: PGD → EGD (Early Graft Dysfunction, <24h). New sEGD category (24–72h). Mild/Moderate/Severe → Non-Severe / Severe only. Inotrope score removed. LVEF ≤40% now required alongside haemodynamic compromise. Severe EGD-LV sub-classified: immediate (failed wean from CPB) vs delayed (after weaning). New RV echo criteria: RVEF ≤35% and/or TAPSE <1.6 cm.
Important change regarding ECMO: Under the 2024 classification, VA-ECMO alone does not qualify as Severe EGD-LV if LVEF is above 40%. LVEF ≤40% and haemodynamic compromise are both required before MCS is considered. The rationale given was that increasingly aggressive and prophylactic ECMO use — including continuation of pre-transplant ECMO without clinical indication — was inflating severe PGD rates. Patients on ECMO with preserved ventricular function should be evaluated for vasoplegia or institutional ECMO policy as the primary driver. This differs substantially from the 2014 criteria where ECMO immediately classified as Severe PGD regardless of echo findings.
Timing:
Left Ventricular (EGD-LV)
Right Ventricular (EGD-RV)
Classification note: EGD is a retrospective severity label for registry reporting and audit. If a known cause is identified (surgical, pulmonary hypertension, immunological, etc.) the classification is Secondary Graft Dysfunction (SGD), not EGD. The tool asks this as its final step.
Lung — Post-transplant — Retrospective classification
Lung PGD Grading
Grade 0–3 based on bilateral alveolar infiltrates and PaO₂/FiO₂ ratio. Select the assessment time point, then enter the clinical findings.
ISHLT 2005 · Updated 2016 · Christie/Snell et al., JHLT 2017;36:1219
Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Assessment time point
T0 <6h
T24 ±6h
T48 ±6h
T72 ±6h
1 Bilateral alveolar infiltrates on chest X-ray?
Consistent with pulmonary oedema
Yes
No
2 PaO₂/FiO₂ ratio
> 300Normal / mild hypoxaemia
200 – 300Moderate hypoxaemia
< 200Severe hypoxaemia
Not availableUse SpO₂/FiO₂ if available
3 Patient on extracorporeal lung support (ECLS/ECMO)?
VV-ECMO or other extracorporeal lung support
Yes
No
BOS risk: All grades at all time points independently increase bronchiolitis obliterans syndrome (CLAD/BOS) risk. T48–T72 grades are most prognostically significant for mortality. 30-day mortality for Grade 3: ~36–50%.
P/F ideally on PEEP 5 cmH₂O at FiO₂ 1.0 on mechanical ventilation. SpO₂/FiO₂ cutoffs: 235 and 315. Vasodilators (NO, epoprostenol) do not change grade. ECLS without bilateral infiltrates = ungradable. Exclude cardiogenic oedema, anastomotic complications, infection, aspiration.
Liver — Post-transplant — Retrospective classification
Liver Early Allograft Dysfunction (EAD)
Any single criterion met = EAD positive. Three criteria reflect hepatocellular injury (transaminases), synthetic function (INR), and excretory function (bilirubin).
Olthoff et al., Liver Transpl 2010;16:943
Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Criterion 1 — Peak transaminase, days 1–7
Peak AST or ALT > 2000 IU/L within first 7 days
Not met
Criterion 2 — INR on day 7
INR on postoperative day 71.2
Threshold: ≥1.6 · Reflects synthetic graft function
Criterion 3 — Bilirubin on day 7
Units:
Total bilirubin on day 72.0 mg/dL
Threshold: ≥10 mg/dL (171 µmol/L) · Strongest single predictor of mortality
EAD criteria met
-
-
Bilirubin and INR dominate: Transaminase-only EAD (AST/ALT criterion, normal bilirubin and INR) does not independently predict mortality in most analyses. Bilirubin ≥10 mg/dL and INR ≥1.6 on day 7 are the clinically meaningful thresholds. When both are met, early retransplant evaluation is warranted.
Olthoff KM et al. Liver Transpl 2010;16:943. EAD incidence 23.2%. Mortality 18.8% EAD vs 1.8% non-EAD (RR 10.7). Graft loss 26.1% vs 3.5%.
Kidney — Post-transplant — Retrospective classification
Kidney Early Graft Function — IGF / DGF / PNF
Three distinct post-transplant functional states reflecting the severity of ischaemia-reperfusion injury and early allograft performance.
UNOS/OPTN definition · Halloran et al. · Irish et al.
Informational use only. Standalone manual reference tool. Values are not stored. Not intended to guide clinical decision-making.
Immediate Graft Function (IGF)
Creatinine falls ≥10% per day on each of the first 3 postoperative days. No dialysis required. Minimal ischaemia-reperfusion injury.
Delayed Graft Function (DGF)
Need for dialysis within the first 7 days post-transplant (UNOS definition). Most widely used clinical and registry definition. Incidence 20–50% depending on donor type.
Primary Non-Function (PNF)
Permanent graft failure — the kidney never functions following transplantation, without immunological, surgical, or urological cause. Requires retransplant listing.
DGF vs slow graft function (SGF): Some centres use a third category — SGF — defined as failure of creatinine to fall below 3 mg/dL by day 5 without requiring dialysis. Not a universally adopted registry definition but captures an intermediate group. The UNOS dialysis-based DGF definition remains the standard for registry reporting. DGF incidence is significantly higher after DCD donation (~40–50%) than DBD (~20–25%).
UNOS dialysis-based DGF definition. Irish WD et al. Transplantation 2010. Halloran PF et al. Am J Kidney Dis 1988. DGF incidence: ~20–25% DBD, ~40–50% DCD. PNF incidence: ~1–5%.