Formulier voor transplantatie non-resident

Form on transplant procedures having taken place in your country and involving:

  1. A non-resident recipient and a non-resident living donor
  2. A non-resident recipient and a resident living donor
  3. A resident recipient and a non-resident living donor
1. Centre where case was identified
2. Year of transplantation
3. Organ transplanted

Choose as many as apply

4. Country(ies) of legal citizenship/residency of the recipient
5. Country(ies) of legal citizenship/residency of the donor
6. In case of non-resident recipient:

Was the recipient referred for transplantation abroad by a team/centre or relevant government body in their country of residency?


Referral should be understood as the establishment of a direct contact between the treating team/centre or relevant government body in the country of origin and the team/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 treating team/centre or relevant government body in the country of origin and the team/centre where the transplantation procedure would take place.


Complete only if recipient is non-resident

6 a. Reason for referring the recipient for transplantation abroad

Choose as many as apply

7. Donor-recipient relationship

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 1 st or 2 nd 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