Transplant ABO Verification Checklist Form
Complete this checklist to document ABO compatibility verification for transplant procedures.
Patient/Recipient Identifier
*
Donor Identifier
*
Transplant Type
*
Please Select
Kidney
Liver
Heart
Lung
Pancreas
Intestine
Other
Recipient Blood Group
*
Please Select
A
B
AB
O
Donor Blood Group
*
Please Select
A
B
AB
O
ABO Verification Status
*
Compatible
Incompatible
Discrepancy Notes (if any)
Reviewer Name
*
Date of Review
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reviewer Signature
*
Submit Verification
Submit Verification
Should be Empty: