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Liver Transplantation Program Referral

This form is intended for clinicians or patients who wish to initiate a liver transplant evaluation with end-stage liver disease.

The Tufts Medical Center liver transplant team takes a personalized, multidisciplinary approach and works closely with referring clinicians to ensure each patient’s needs goals and circumstances are thoughtfully considered throughout the evaluation process. After submission, a member of the transplant team will contact the patient within two business days to begin next steps.

This form is not for medical emergencies. If the patient requires urgent medical attention, please contact their current care team, dial 911, or refer them to the nearest emergency department.

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