Formulier voor transplantatie buitenland

Survey on patients who received an organ transplant abroad and returned to their home country after the transplant procedure.

1. Centre where case was identified
2. Date of transplantation
3. Organ transplanted

Choose as many as apply

4. Country where transplantation took place
5. City and hospital where transplantation took place
6. Referral of the recipient by your centre or a centre in your country for transplantation abroad

Specify if the patient was referred by your centre or a centre in your country for transplantation in another country.


Referral should be understood as the establishment of a direct contact between the centre of origin and the centre where the transplantation procedure would take place in order to ensure transfer of medical records and continuity of care.


Referral should not be understood as a simple recommendation to travel for transplantation abroad without any further engagement or contact between the centre of origin and the centre where the transplantation procedure would take place.

6 a. Reason for referring the recipient for transplantation abroad

Choose as many as apply

7. Donor type

According to the World Health Organization classification, a living donor has one of the following relationships with the recipient:


A. Related


A1. Genetically related

  • 1st degree genetically related: e.g. parent, sibling offspring
  • 2nd degree genetically related, e.g. grandparent, grandchild, aunt, uncle, niece, nephew
  • Other than 1st or 2nd degree genetically related, e.g. cousin


A2. Emotionally related, e.g. spouse, (if not genetically related, in-law, adopted, friend).


B. Unrelated: not genetically or emotionally related

8. Any other comment