Transplant Surgeon Survey

1.

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Thank you for participating in our Transplant Surgeon Follow Up Program. Please answer the following questions regarding the organ you received recently from our Michigan Donor.

Question Title

* 1. What was the UNOS ID of the donor?

Question Title

* 2. What was the date of:

When the organ was received

Date

Question Title

* 3. What organ was received?

Left Kidney

Right Kidney

Liver

Pancreas

Heart

Left Lung

Right Lung

Other (please specify)