Las Palmas Medical Center - Transplant Recipient Application Las Palmas Medical Center - Transplant 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your personal information in the 'Patient Information' section. Fill in your last name, first name, social security number, and date of birth. Select your sex and provide contact numbers.
  3. Complete the 'Nephrologist / Kidney Specialist Doctor' section by providing your physician's name and contact details.
  4. Indicate whether you are currently on dialysis and provide the necessary details about your dialysis center.
  5. In the 'Previous Transplants' section, indicate if you have had any organ transplants and provide relevant details.
  6. Fill out the insurance information sections, including Medicare, Medicaid, and private insurance details as applicable.
  7. Complete personal information regarding marital status, employment status, and emergency contacts.
  8. Review all sections for accuracy before submitting. Use our platform’s features to save or print your completed application.

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Absolute contraindications for adults and children include, but may not be limited to: Major systemic disease. Age inappropriateness (70 years of age) Cancer in the last 5 years except localized skin (not melanoma) or stage I or prostate.
Local patients typically receive preference when an organ donation happens in their community. This is because the less time that elapses during the transplant process, the greater chance of success for the transplant operation.
By registering as an organ donor, individuals can play a direct role in addressing the pressing need for kidneys and contribute to saving lives within their communities and beyond. The demand for kidneys reveals a critical need for individuals to step forward as donors.
In general, health issues that may keep you from having surgery or taking long-term medication may be reasons not to list you. Examples can include current or recent cancer diagnosis or morbid obesity.
The first step is to talk with your doctor to find out whether youre a candidate for a transplant. If youre on dialysis, your dialysis team will also be part of the process. If you and your doctor think a kidney transplant is right for you, your doctor will refer you to a transplant center.
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Most health conditions do NOT prevent donation and age is not a factor. There are very few diseases that would make you ineligible to be an organ donor. Some severe infections, such as viral meningitis, active tuberculosis, Creutzfeldt-Jakob (Mad Cow) disease, and a few others would disqualify donation.

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