CAGT- DONOR EVALUATION (NMDP/SIBLING)		version 5/9/2024		

Provider Communication 	

	
	Interval	Defer Until	Duration	
	☐	Please place procedure, imaging, and referral orders using your preference list. These orders must be placed outside of the therapy plan to be scheduled.	Once	S	1 treatment	
		Place the Donor Center, Imaging and Cardiology orders so they can be scheduled. Use your SmartSet or Preference List.
	
	Cardiology:
	ECG 12 Lead
	CV Stress Test
	
	Imaging: 
	XR Chest 2 Vw- PA and Lateral		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	CBC with platelet and differential	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Comprehensive metabolic panel	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Ferritin level	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Free PSA	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	hCG quantitative, serum	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Iron level	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	LDH	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Prostate specific antigen	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE
	Release to patient (Note: If manual release option is selected, result will auto release 5 days from finalization.): Immediate		
	☐	Serum electrophoresis	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Urinalysis, automated with microscopy	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		

Labs- Sibling 	

	
	Interval	Defer Until	Duration	
	☐	Cytomegalovirus Ab, IgG	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Cytomegalovirus Ab, IgM	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Epstein-Barr virus antibody panel	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Gulf Coast serology test	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	HLA specimen	Once	S	1 treatment	
		STAT, Normal, Clinic Collect
	Draw 2- ACD yellow top tubes for HLA Typing (low or high resolution) OR STR's (chimerism).  NOTE the desired test here AND submit the HLA requisition with the sample.
	
	Test Type:   {:11558517}		
	☐	Immunoglobulin A	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Immunoglobulin G	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Immunoglobulin M	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Magnesium level	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Phosphorus level	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Sickle cell screen	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Toxoplasma gondii antibody, IgG	Once	S	1 treatment	
		Routine, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Toxoplasma IgM Ab	Once	S	1 treatment	
		Routine, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		
	☐	Type and screen	Once	S	1 treatment	
		STAT, Normal, Clinic Collect, HMH DEPARTMENT OF PATHOLOGY AND GENOMIC MEDICINE		

Imaging 	

	
	Interval	Defer Until	Duration	
	☐	ECG 12 lead	Once	S	1 treatment	
		Ancillary Performed, Status: Future, Expires: S+365		
	☐	XR Chest 2 Vw	Once	S	1 treatment	
		Status: Future, Expected: S, Expires: S+365, Ancillary Performed
	PA and Lateral		

Procedures 	

	
	Interval	Defer Until	Duration	
	☐	CAGT Venous Access Evaluation Order	Once	S	1 treatment	
		Clinic Performed, Normal
	Performing Department: Blood Donor Center