Thank you for your interest in living kidney donation. To state your interest in becoming a kidney donor, please complete and submit a questionnaire using the link below. After you submit the questionnaire, a representative from Intermountain Transplant Center will call you to discuss the living donation process.

Here's what you need to know when completing this form online:

  • Complete as much information on each of the pages to the best of your knowledge.
  • The information you complete on each page will be saved as you move to the next page.
  • After 1 hour of inactivity, your session will timeout and your form will be sent with as much information as was filled out at that time.
  • You may submit the form even if you do not have all the fields completed.
  • Click the submit button and the form will be sent to the facility where your service is scheduled. You will only be able to submit a form once.
  • A Kidney Transplant Patient Service Representative will contact you by telephone to review and confirm your information. You may provide any additional updates at that time.

To learn more, visit our Frequently Asked Questions About Living Donation web page.

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Kidney Donor Questionnaire

Click here to access the kidney donor questionnaire.