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American Family Children's Hospital
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Pancreas 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 pancreas transplant candidate can call (608) 263-9531 and ask to speak to one of the pancreas transplant coordinators, or learn more about the UW Health Pancreas Transplant app for iOS and Android users.

 
The coordinator will review the patient's medical history and help schedule an appointment.
 
You, or the referring physician, 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
  • 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