Transplant History and Outcomes

This form captures information about the patient’s transplant and history outcomes.

Enter relevant information, such as the date the patient was referred for transplant evaluation, the date the patient was listed for transplantation, and the transplant date. The form also captures donor characteristics, transplant characteristics, and transplant outcomes.

Please add a new row for each transplant outcome. Include information about the outcome/complication and date of onset.

• If the date of the transplant is unavailable, use July 1 with the approximate year of diagnosis. If an exact year is not available, an approximation is acceptable. If any approximations are used, please make a note in the comments section.

• Once the date is entered, please click on the calculator to calculate the age at the time of the INDEX diagnosis date.