I Want To Be A Living Donor
Thank you for making the life-saving decision to donate a kidney to someone in need of a transplant. Being healthy and your willingness to donate are two of the most importat factors needed to accomplish your goal. Here, we will tell you how to begin the process, and give you instructions on how to complete the paperwork that we will need to begin your evaluation. Please read these instructions carefully and provide all the information requested. Incomplete paperwork may delay your evaluation.
Let's get started!
Living Donor Handbook
This handbook describes the living donation process. Please read this before you come for your evaluation. It may answer many of the questions you have.
Maine Medical Center Pre-Registration
For living donor evaluation to go forward, we will need the information on this form to register you as a patient at Maine Medical Center. Please fill this form out completely. We will not be able to arrange for your evaluation if this form is incomplete.
Medical Release Form
Sign this form, but leave it blank. We are going to be requesting the past three years of your medical records from your primary care physician, but we may also need to request records from others who have provided you with medical care. Let us know if you see a specialist, such as an OB/GYN or cardiologist. We’ll need records from them as well.
Living Donor History Form
Our philosophy is to provide living donors with the best care possible. You willonly be able to donate if you are in good general health and have normal kidney function. To determine this, we need to review your medical history. Please be complete when you fill this out. Feel free to call us with any questions.
Consent to be Evaluated to Become a Living Donor
Please call Roxanne Taylor at (207) 662-7180 (Option 4) to review this form. This must be done for us to meet informed consent regulations. After the form is reviewed with Roxanne, please sign it in the presence of one witness. The witness can be anyone 18 years old or older except the potential recipient. Return the signed form to Amie Neikirk at the Maine Transplant Program. You can print out a second copy for yourself, or make a copy of the original form.
Physical Examination by your Primary Care Physician:
For you to be a living donor, you must have had a physical examination by your PCP within the past year. We require all our living donors to have a PCP who oversees their care. Please do not have any testing done specifically for the possible donation. If you are able to donate, we’ll order these tests for you.
Returning the Forms to Us
After you finish the paperwork, please return it to us. Before you send it back, make sure that it contains:
- Maine Medical Center Pre-Registration Form
- Medical Release Form
- Living Donor History Form
- Consent to be Evaluated to Become a Living Donor
What’s the Next Step?
After we receive the paperwork and are able to get your medical records, these will be reviewed by a transplant physician and the living donor coordinator. If you are found to be healthy, we will mail you a kit to have genetic testing and kidney function testing done. If there are any issues with your medical history, Roxanne Taylor will call you.
Please feel free to contact Amie Neikirk if you have any questions about the enclosed forms or the living donor evaluation process. Roxanne Taylor, our Living Donor Coordinator, would be happy to answer any medical questions.
- Amie Neikirk
- Living Donor Assistant
- (207) 662-7180 or 800-870-5230 (Option 4)