Transplant Surgeon Survey
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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.

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1. What was the UNOS ID of the donor?

What was the UNOS ID of the donor?

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2. What was the date of:

	MM		DD		YYYY
When the organ was received	What was the date of: When the organ was received Month	/	Day	/	Year

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3. What organ was received?

What organ was received? Left Kidney Right Kidney Liver Pancreas	Heart Left Lung Right Lung
Other (please specify)

Transplant Surgeon SurveyExit this survey

1.

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

*2. What was the date of:

*3. What organ was received?

Transplant Surgeon Survey
Exit this survey

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

*
2. What was the date of:

*
3. What organ was received?