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American Family Children's Hospital
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Liver Transplant Referrals

Referrals

If you are interested in having an evaluation to determine if you are a potential transplant recipient, you, your physician, or any other caregiver may contact the program.

Referring providers who have questions about referring a patient who may be a potential liver transplant candidate can call (608) 263-9531 and ask to speak to one of the liver transplant coordinators. 
 
Referring providers will be asked to provide the following information about the patient when calling to make a referral:  name, address, phone number, date of birth, social security number, disease, primary doctor, insurance, and if the patient has received a transplant previously.
 
After the initial referral call, providers will be asked to forward the following patient records, if available: 
  • Current history and physical
  • Summary letter of patient's medical condition
  • Current Labs
  • Abdominal CT scan report
  • Liver biopsy report
  • Cardiac tests including, ECG, Echo (tape), stress test
  • Medication list
  • Most recent discharge summaries
  • Mammogram, pap and pelvic exam results for females
  • Documentation of cancer diagnosis
  • Colonoscopy report (if done within past three years)
  • Advance directives or living will
  • Chest X-ray report