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 never received care at Mass General or you are not sure, 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 617-643-6321.

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.

Prospective Donor Information


About Your Appointment