Director Registration:

Please have the OPTN approved Program Director (surgeon or physician) complete this registration form for your live donor program. The program director is required to attest that your transplant program is in good standing with the OPTN. Check only those organs for which you are the OPTN approved Program Director.


Transplant Center Name:
Living Donor Program: (check all that apply)
Liver Kidney	Lung Intestine

Liver Program
Program Director Name
First Name: *	M.I	Last Name: *
Email Address: *

Kidney Program
Program Director Name
First Name: *	M.I	Last Name: *
Email Address: *

Lung Program
Program Director Name
First Name: *	M.I	Last Name: *
Email Address: *

Intestine Program
Program Director Name
First Name: *	M.I	Last Name: *
Email Address: *

ATTESTATION OF MEMBERSHIP AND PROFESSIONAL STANDARDS COMMITTEE (MPSC) STANDING
I hereby certify that the transplant program for which reimbursement of living donor expenses is being requested in this registration is in good standing with the Organ Procurement and Transplantation Network (i.e. is not currently considered a Member Not in Good Standing).
Agree Disagree

Potential Donors

If you are considering organ donation, NLDAC may be able to lessen the burden of travel expenses. View the NLDAC Eligibility Screening Tool for NLDAC household income requirements. To learn more about the application process, read the NLDAC brochure "How to Apply" in English or Spanish.

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Transplant
Centers

Join NLDAC in its mission to reduce financial disincentives to living organ donation.

Transplant Centers

Director Registration:

Potential Donors

Transplant Centers

Transplant
Centers