Please use this form only if:
  • You have never been a patient in the Living Liver Donor Program, OR
  • You have been a patient in the Living Liver Donor Program but are seeking an appointment with a new clinical area or doctor
The living donor evaluation starts with a phone call to a member of the living donor transplant team, who will describe the donation evaluation process and ask you questions about your medical history. A member of our team will call you within two business days once you complete the following:
  • Submit the secure form below
  • Obtain a Mass General Medical Record Number (MRN). If you have not received care at Mass General in the last six months, or if you have never received care at Mass General, please call 1-866-211-6588 (toll free) to verify your information and/or obtain an MRN.

You may also speak with a representative directly Monday–Friday, 8:30 am to 5:00 pm EST by calling 877-644-2860.

Important note: Some questions on this form may appear or disappear based on your responses.

* indicates a required field.

Please call 911 if you are experiencing a medical emergency.

Requestor Information

If you are an international patient, please complete the International Patient Appointment Form.

Patient Information


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