American Family Children's Hospital

Pancreas Transplant 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 and patients who have questions about setting up an appointment for a potential pancreas transplant should call (608) 263-9531 and ask to speak with a pancreas transplant coordinator. The coordinator will review the patient's medical history and then assist with setting up an appointment.
Referring providers or the patient themselves, 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, primary doctor, name of dialysis unit (if the patient is on dialysis), insurance and if the patient has received a transplant previously.
After the initial referral call, the provider or the patient will be asked to forward the following patient records as they are available: 
  • Current history and physical
  • Current labs, including a fasting c-peptide and a creatinine clearance if the patient is not on dialysis
  • Cardiac tests including, ECG, Echo, stress test, cath report/film, cardiac surgical report
  • Medication list
  • An overview of the patients diabetes history and management
  • Overview of radiology reports
  • Overview of discharge summaries and clinic visits
  • Operative notes from major surgeries
  • Mammogram, pap and pelvic exam results for females
  • Documentation of any cancer diagnosis and the treatment
  • Colonoscopy report (If done within past three years)
  • Advance directived or living will
  • Chest X-ray report
  • Records from a previous transplant evaluation or transplant