Living Kidney Donor Referrals

Thank you for your interest in Living Donor Kidney Donation at Rhode Island Hospital. We are committed to providing treatment options to our patients living with and managing end stage renal disease. A kidney from a live donor is the best treatment option, as these kidneys function better and last longer than kidneys from a deceased donor.

Who can be a donor?

  • Related or unrelated to Recipient
  • Minimum age 18.
  • Free from
    • Diabetes
    • Uncontrolled high blood pressure
    • Active cancer
    • Kidney disease or recent kidney stones
    • Chronic pain, or infection.
  • Healthy weight
  • Adequate social support, stable mental health and financial security.
  • Active health insurance.

If you meet the criteria above and would like to be considered as a living kidney donor, please fill out the form below and someone from the transplant team will contact you. Please provide as much information as possible. 

Patient Information

Address
Phone Number
Please ensure that you have room in your voicemail inbox.
Insurance Information
Do you currently have health insurance?
Physician Information
Additional Care Providers
If none put "NA"
Have you ever been told you have or may have had any of the following:
Surgical History
Current Medications
Do you take any medications, including over the counter medications? Please list name and dose all medications (including vitamins, minerals, supplements and/or pain medication). 
Have your parents, grandparents, siblings and/or children ever been told they may have or have had any of the following:
Children
Recipient Information
Who is the person you are interested in donating your kidney to?  Give as much information as you have.
Acknowledgement
I attest that the information provided to the Division of Organ Transplantation is true to the best of my knowledge. I have been informed about the program’s purpose for use of this information and have been given the opportunity to ask questions. I understand that Rhode Island Hospital Division of Organ Transplantation is required by law to maintain the privacy/confidentiality of my health information. By typing your name below, you attest to the statement above and that your typed name will constitute your signature on this form.
Type your full name
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If you have not been contacted by the transplant team within 2-3 business days, please call 401-444-3091.
Transplant Center