Request an Appointment: Living Donor Transplant

Please fill out the form below to initiate the process to be considered a living kidney or liver donor. A member of our living donor transplant team will contact you within two business days.

  • You may also schedule an appointment by phone: 877-644-2860

If you are experiencing a medical emergency, call 911 or go to your local emergency room.

Thank you for your interest in the Kidney and Liver Transplant Programs at the Massachusetts General Hospital Transplant Center. 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:

  1. Submit form below
  2. 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

Required fields are marked with an*

Potential Donor Information

Name*   

Date of birth (MM/DD/YEAR)*   

Home phone*   

Cell phone

Street address*   

City*   

State*   

Zip code*   

E-mail address

Primary insurance*   

Secondary insurance

Mass General Medical Record Number (MRN)

Weight (lbs)

Height (ft, in)

Blood type

Intended recipient's name

Recipient's relationship to you