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Transplantation
Transplantation:
Kidney
Liver
Bone Marrow
Heart
Lung
Swap Transplantation:
What is Swap?
Register for Swap Recipient
Register for Swap Donor
Cadavar Liver Transplant:
What is Cadaver?
Cadaver Registration
Comparison:
Cost Comparison
Hospital
Kidney
Karnataka
Kerala
Uttar Pradesh
Maharashtra
Tamil Nadu
Haryana
Telangana
Delhi
Abu Dhabi ( UAE )
Liver
Karnataka
Kerala
Uttar Pradesh
Maharashtra
Tamil Nadu
Haryana
Telangana
Delhi
Abu Dhabi ( UAE )
Bone marrow
Uttar Pradesh
Tamil Nadu
Haryana
Telangana
Delhi
Abu Dhabi ( UAE )
Heart
Karnataka
Kerala
Uttar Pradesh
Maharashtra
Tamil Nadu
Haryana
Telangana
Delhi
Abu Dhabi ( UAE )
Lung
Karnataka
Kerala
Uttar Pradesh
Maharashtra
Tamil Nadu
Haryana
Telangana
Delhi
Abu Dhabi ( UAE )
Pancreas
Uttar Pradesh
Maharashtra
Tamil Nadu
Haryana
Telangana
Delhi
Doctor
Kidney
Liver
Bone marrow
Heart
Lung
Pancreas
Care At Home
Gallery
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Cadaver Registration
Home
Cadaver Registration
Cadaver / Deceased Donor Transplantation Waiting List Pre-Operative Recipient Workup Form
Name
*
:
Date:
*
Age
*
:
Gender:
Male
FeMale
Blood Group
*
:
Select
O+
O-
A+
A-
B-
B+
AB+
AB-
Weight(kgs)
*
:
Height(cms)
*
:
BMI:
*
Tel No. (S)
*
:
Mobile No. (S)
*
:
Marital Status:
Married
Un-Married
Seperate
Occupation
*
:
No. of Children
*
:
Brother's
*
:
Sister's
*
:
Previous Surgery (add if any):
Contact Person
*
:
Email Address
*
:
Address
*
:
City
*
:
State
*
:
Country
*
:
Relevant PMH & Medication
Tuberculosis:
Yes
No
Diabetes Mellitus:
Yes
No
Hypertension:
Yes
No
Jaundice/Hepatitis:
Yes
No
Asthma:
Yes
No
Thyroid:
Yes
No
Others:
Yes
No
Other Medication
*
:
Clinical Data
Primary Diagnosis:
Organ
*
:
--Select--
Kidney Transplant
Liver Transplant
Heart Transplant
Lung Transplant
Pancreas Transplant
Small Intestine Transplant
Kidney-pancreas T(Dual Transplant)
Liver-Kidney (Dual Transplant)
Problem List
1:
2:
Child-Pugh Score ( A=5-6; B=7-9; C=10-15 )
Albumin:
Bilirubin:
INR:
Encephalopathy:
Ascites:
MELD Score:
Personal History
Alcohol:
Yes
No
Smoking:
Yes
No
Tobacco:
Yes
No
HBV Vaccination:
Code: