When should a patient be referred for a potential heart transplant? 

Refer if patients meet these criteria:

• Inoperable coronary artery disease/refractory angina
• At NYHA class II or III
• Refractory VT
• EF 30% or less

For every patient for whom heart transplant is a possibility, there is a window of opportunity when transplant surgery is a realistic option. This critical window must not be allowed to close. To ensure it remains open, our specialists should see patients as early as possible in the heart disease process.

Even if a patient is not ready for transplant, our specialists can help determine bridge-to-transplant opportunities when transplant might be a possibility, as well as the likely timeline and the steps necessary to ensure the patient’s health for transplant.

We consider the physicians who refer their patients to us for specialized transplant care our valued partners. We want to work with you to ensure the continued health and well-being of your patients.

To refer a patient or for more information, call 614-293-4100.

Heart Transplant Referral Form

Please include this patient information with your referral for a heart transplant:

• Demographics
• Insurance
• Cardiology notes
• Surgical notes
• Social notes
• RHC/LHC
• Cardiac interventions
• VO2
• EKG
• CXR
• RUQ US
• Colonoscopy
• CBC/Coags
• Chemistry/LFTs
• Drug/Nicotine screens
• Lipid panel
• Urine studies

When should a patient be referred for a potential lung transplant? 

Refer if patients meet these criteria:

• Idiopathic Pulmonary Fibrosis (IPF)
• COPD/Emphysema – Gold Stage IV
• Other end-stage lung diseases with life expectancy of two years or less

For every patient for whom lung transplant is a possibility, there is a window of opportunity when transplant surgery is a realistic option. This critical window must not be allowed to close. To ensure it remains open, our specialists should see patients as early as possible in the lung disease process.

Even if a patient is not ready for transplant, our specialists can help determine bridge-to-transplant opportunities when transplant might be a possibility, as well as the likely timeline and the steps necessary to ensure the patient’s health for transplant.

We consider the physicians who refer their patients to us for specialized transplant care our valued partners. We want to work with you to ensure the continued health and well-being of your patients.

To refer a patient or for more information, call 614-293-4100.

Lung Transplant Referral Form

Please include this patient information with your referral for a lung transplant:

• Demographics
• Insurance
• Height/Weight
• Pulmonary progress notes
• Surgical notes (if done)
• Social notes (if available)
• Recent pulmonary function tests
• Chest CT scans (mail CD if possible)
• Any cardiac testing (echocardiogram, catheterizations)
• Nicotine/Cotinine screens
• Drug screens
• Smoking history – including product type, pack years (ppd x years smoked), e-cigarette, smokeless tobacco use, nicotine product use (gum, patches) and duration of absence
• Routine health screens (if available):
  • Colonoscopy
  • Dental clearance
  • Pap smear and mammogram (women)
  • Prostate exam (men)

When should a patient be referred for a potential kidney transplant? 

Refer if patients meet these criteria:

• CKD stage 4 or 5
• GFR < 20
• Type I DM with renal failure
• BMI < 45
• No active malignancies

For every patient for whom kidney transplant is a possibility, there is a window of opportunity when transplant surgery is a realistic option. This critical window must not be allowed to close. To ensure it remains open, our specialists should see patients as early as possible in the kidney disease process.

Even if a patient is not ready for transplant, our specialists can help determine bridge-to-transplant opportunities when transplant might be a possibility, as well as the likely timeline and the steps necessary to ensure the patient’s health for transplant.

We consider the physicians who refer their patients to us for specialized transplant care our valued partners. We want to work with you to ensure the continued health and well-being of your patients.

To refer a patient or for more information, call 614-293-4100.

Kidney Transplant Referral Form

Please include this patient information with your referral for a kidney transplant:

• Demographics
• Insurance
• Chest X-ray
• EKG within past 12 months
• Kidney biopsy (if done)
• Vaccinations (Hepatitis B, pneumonia, influenza)
• Most recent TB test
• Cardiac testing (if diabetic or over the age of 55)
• Cardiology notes (if applicable)
• Colonoscopy report with pathology
• Any lower extremity vascular studies
• Dental clearance
• HCFA 2728
• Pap smear and mammogram (women)
• Prostate exam (men)

When should a patient be referred for a potential kidney/pancreas transplant? 

Refer if patients meet these criteria:

• Kidney failure
• Insulin-dependent diabetes
• BMI < 30
• Demonstration of intensive efforts to manage diabetes in close cooperation with a diabetes care team (meeting at least one of the following):
  • ≥ 3 self-monitored blood glucose (SMBG) a day
  • ≥ 2 injections of insulin a day
  • Use of an insulin pump
  • ≥ 3 contacts with a member of the diabetes care team (physician, diabetes nurse educator and nutritionist) in the last 12 months

For every patient for whom kidney/pancreas transplant is a possibility, there is a window of opportunity when transplant surgery is a realistic option. This critical window must not be allowed to close. To ensure it remains open, our specialists should see patients as early as possible in the kidney/pancreas disease process.

Even if a patient is not ready for transplant, our specialists can help determine bridge-to-transplant opportunities when transplant might be a possibility, as well as the likely timeline and the steps necessary to ensure the patient’s health for transplant.

We consider the physicians who refer their patients to us for specialized transplant care our valued partners. We want to work with you to ensure the continued health and well-being of your patients.

To refer a patient or for more information, call 614-293-4100.

Kidney-Pancreas Referral Form

Please include this patient information with your referral for a kidney/pancreas transplant:

• Demographics
• Insurance
• Chest X-ray
• EKG within past 12 months
• Kidney biopsy (if done)
• Vaccinations (Hepatitis B, pneumonia, influenza)
• Most recent TB test
• Cardiac testing (if diabetic or over the age of 55)
• Cardiology notes (if applicable)
• Colonoscopy report with pathology
• Any lower extremity vascular studies
• Dental clearance
• HCFA 2728
• Pap smear and mammogram (women)
• Prostate exam (men)

All patients with acute and chronic liver disease may be referred to us for a comprehensive evaluation, including the need for a possible liver transplant.

For every patient for whom liver transplant is a possibility, there is a window of opportunity when transplant surgery is a realistic option. This critical window must not be allowed to close. To ensure it remains open, our specialists should see patients as early as possible in the liver disease process.

Even if a patient is not ready for transplant, our specialists can help determine bridge-to-transplant opportunities when transplant might be a possibility, as well as the likely timeline and the steps necessary to ensure the patient’s health for transplant.

We consider the physicians who refer their patients to us for specialized transplant care our valued partners. We want to work with you to ensure the continued health and well-being of your patients.

To refer a patient or for more information, call 614-293-4100.

Liver Transplant Referral Form

Please include this patient information with your referral for a liver transplant:

• History and physical
• Most recent lab results including CBC, CMP, LFTs, PT/INR
• Imaging studies of the liver and/or abdomen
• EGD and colonoscopy results with pathology reports

When should a patient be referred for a potential pancreas transplant? Refer if patients meet these criteria:

• Insulin-dependent diabetes
• BMI < 30
• Stable renal function for at least six months
• Metabolic complications (meeting at least one of the following):
  • Reduced hypoglycemia awareness defined as the inability to sense hypoglycemia until blood glucose falls < 54 mg/dl
  • > 1 hypoglycemic episode in last 12 months requiring outside help and not explained by a clear precipitant

For every patient for whom pancreas transplant is a possibility, there is a window of opportunity when transplant surgery is a realistic option. This critical window must not be allowed to close. To ensure it remains open, our specialists should see patients as early as possible in the pancreas disease process.

Even if a patient is not ready for transplant, our specialists can help determine bridge-to-transplant opportunities when transplant might be a possibility, as well as the likely timeline and the steps necessary to ensure the patient’s health for transplant.

We consider the physicians who refer their patients to us for specialized transplant care our valued partners. We want to work with you to ensure the continued health and well-being of your patients.

To refer a patient or for more information, call 614-293-4100.

Pancreas Transplant Referral Form

Please include this patient information with your referral for a pancreas transplant:

• Demographics
• Insurance
• Chest X-ray
• EKG within past 12 months
• Kidney biopsy (if done)
• Vaccinations (Hepatitis B, pneumonia, influenza)
• Most recent TB test
• Cardiac testing (if diabetic or over the age of 55)
• Cardiology notes (if applicable)
• Colonoscopy report with pathology
• Any lower extremity vascular studies
• Dental clearance
• HCFA 2728
• Pap smear and mammogram (women)
• Prostate exam (men)

Patients should be considered for pancreas auto islet transplantation if they have:

• Chronic pancreatitis
• Chronic abdominal pain associated with chronic pancreatitis
• Failed interventions for chronic pancreatitis
• Idiopathic recurrent acute pancreatitis, especially if associated with organ failure

For every patient for whom pancreatic auto islet transplant is a possibility, there is a window of opportunity when transplant surgery is a realistic option. This critical window must not be allowed to close. To ensure it remains open, our specialists should see patients as early as possible in the pancreas disease process.

Even if a patient is not ready for transplant, our specialists can help determine bridge-to-transplant opportunities when transplant might be a possibility, as well as the likely timeline and the steps necessary to ensure the patient’s health for transplant.

We consider the physicians who refer their patients to us for specialized transplant care our valued partners. We want to work with you to ensure the continued health and well-being of your patients.

To refer a patient or for more information, call 614-293-4100.

Please include this patient information with your referral for a pancreatic auto islet transplant:

• Demographics
• Insurance
• Chest X-ray
• EKG within past 12 months
• Kidney biopsy (if done)
• Vaccinations (Hepatitis B, pneumonia, influenza)
• Most recent TB test
• Cardiac testing (if diabetic or over the age of 55)
• Cardiology notes (if applicable)
• Colonoscopy report with pathology
• Any lower extremity vascular studies
• Dental clearance
• HCFA 2728
• Pap smear and mammogram (women)
• Prostate exam (men)