To refer a patient to the Johns Hopkins Comprehensive Transplant Center, please complete the appropriate form below and return to us.

• Heart Transplant
• Incompatible Kidney Transplant
• Lung Transplant

For kidney or pancreas transplant, please call 410-955-5045 and press 1.

In general, we require the following information:

Physician Information

• Name
• Address
• Phone
• Fax
• Email

Patient Information

General Information

• Name
• Date of Birth
• Address
• Phone
• Social Security Number
• Insurance Information

Patient’s Medical History and Records

• Medical History
• Surgeries / Procedures
• Devices, including type and settings

Patient Medications

• Type(s)
• Dosages
• Allergies

Diagnostic Test Results

• Current chest X-ray report
• PPD (tuberculosis skin test)
• Mammogram
• Colonoscopy
• Stress test and other cardiac information
• Other information as available

Additional Test for Lung Transplantation

• Current chest X-ray report and films
• Current chest CT scan
• Complete Pulmonary Function Testing