icon showing high importanceTo ensure a smooth and expedited intake process: 

Please encourage your patient to call Mass General registration at 866-211-6588, Monday-Friday, 8:00 am to 5:00 pm ET.

Please submit the secure form below to refer your patient to a provider in the Kidney Transplant Program at Massachusetts General Hospital. Be sure to submit the following required documents via fax: 617-726-0822.

  • 2728 CMS ESRD form (if on chronic dialysis)
  • Recent nephrologist visit note
  • Recent ED discharge summary
  • Pertinent test results (e.g., kidney biopsy)
  • Insurance information

Incomplete submissions may result in delays.

* indicates a required field.

Patient Information




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If on dialysis, 2728 form must be included in referral submission.






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As of July 2022, UNOS has removed the race variable in eGFR calculation. Providing the race-neutral eGFR and date obtained can identify affected patients potentially eligible for increased time on the transplant waitlist.
Referring Physician



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Preferred Method of Communication

Physician Gateway is our secure online portal allowing real-time access to your patients’ medical record. Physician Gateway enables you to submit referrals for patients, monitor patient status and order imaging tests. 

To learn more or to enroll, please visit the Physician Gateway.

If you would like to schedule Provider Education or Transplant Referral Process training for your team, please contact Stacy Jean-Claude at 617-726-0037 or by email at sjean-claude@mgh.harvard.edu.