Waitlist Status Notification Letter (Placement, Removal, or Not Listed)

(This is a reusable patient-facing notification letter template for transplant waitlist status decisions. Before generating a final letter: 1) Select exactly one decision scenario and remove non-applicable options; 2) Replace all placeholders with specific information; 3) Omit any section or bullet that does not apply; 4) If any required field is unavailable, stop and request manual completion rather than outputting an incomplete letter.)

[Transplant Program Name]
[Program address line 1]
[Program address line 2] (Only include if applicable)
[City, State ZIP]
[Program main phone] | [Program website] (Only include if applicable)

[Date letter is sent]

[Patient full legal name]
[Patient mailing address line 1]
[Patient mailing address line 2] (Only include if applicable)
[City, State ZIP]

Medical Record Number: [MRN]

Re: [Placement on the Transplant Waiting List / Removal from the Transplant Waiting List / Transplant Evaluation Outcome – Not Listed at This Time] – [Organ type]

Dear [Patient preferred or legal name],

Decision

[Your transplant evaluation has resulted in placement on the [organ type] transplant waiting list, effective [listing date]. You are now eligible to receive organ offers based on national allocation policies. / Your name has been removed from the [organ type] transplant waiting list, effective [removal date]. You will not receive organ offers unless you are re-evaluated and re-listed. / Your [organ type] transplant evaluation is complete. You will not be placed on the waiting list at this time, effective [determination date].] Please contact your transplant coordinator to review this decision and discuss next steps at [coordinator direct phone].

Reason for This Decision

(Use clear, plain language. Include only applicable factors. Use neutral, non-stigmatizing phrasing. Briefly explain why each factor matters for transplant safety or outcomes.)

• Medical factors (Only include if applicable): [Description of specific medical factor(s) affecting transplant candidacy and why this matters for surgical safety or recovery]
• Testing or records needed (Only include if applicable): [Specific tests, imaging, labs, or outside records required to complete the assessment]
• Psychosocial or practical supports (Only include if applicable): [Support needs such as caregiver plan, transportation, housing, or financial factors affecting post-transplant recovery]
• Medication-taking and follow-up (Only include if applicable): [Concerns regarding adherence to medications, appointments, or lab monitoring and why consistency is essential for transplant success]
• Decision deferred pending additional information (Only include if applicable): [Clear statement of what is pending and exactly what is needed to finalize the determination]

Next Steps

(Include only items that apply to this patient. Provide concrete actions with timeframes and instructions for completion.)

• Testing or appointments: [Test/appointment name] by [deadline]. Schedule by calling [phone] or at [location].
• Outside records: Please ask [clinic/facility] to fax records to [fax number] by [deadline].
• Health goals: [Specific goal] by [target date]. Support available through [contact or resource].
• Caregiver or support plan: Provide names and contact information for your post-transplant support person(s) to [coordinator name] at [coordinator phone] by [deadline].
• Medication and follow-up: [Action required] by [timeframe]. Contact [clinic/educator phone] for assistance.
• Requesting reconsideration (Only include if removed or not listed): You may request reconsideration after completing the steps above or if your situation changes. Contact [coordinator name] at [coordinator phone] to discuss re-evaluation.

How to Reach Us

Transplant Coordinator: [Coordinator name], [Coordinator direct phone]
Clinic Phone: [Main clinic number]
Fax for Records: [Fax number]
Office Hours: [Days and hours]

Interpreter services are available at no cost. To request an interpreter for calls or visits, contact [clinic phone] or tell your coordinator when scheduling.

If you are experiencing urgent or worsening medical symptoms, call 911 or go to the nearest emergency department.

Important Information Enclosed

Please review the enclosed OPTN Patient Information Letter, which explains your rights, the transplant process, and available resources.

Enclosures: OPTN Patient Information Letter[; testing orders] (Only include if applicable)[; educational materials] (Only include if applicable)[; re-referral checklist] (Only include if applicable)

We are here to support you. Please contact us with any questions.

Sincerely,

[Signer name], [Credentials]
[Title]
[Transplant Program Name]

cc: [Referring physician / Primary care provider / Dialysis facility] (Only include if applicable)