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Transplant Professional Survey
The Children's Organ Transplant Association needs your help. Please complete this survey to help us better understand and meet the needs of our families and our partners. Your responses will help us review our resources and create additional tools for families, transplant professsionals and volunteers. Thank you for your assistance!
 
1.
Which title best describes your position?
Social Worker
Financial Coordinator
Transplant Coordinator
Other  
2.
Describe the patients you serve:
Children (infant to age 21)
Adults (over age 21)
Both Children & Adults
3.
Please indicate your specialty: (Check all that apply)
Liver
Lung
Heart
Small Bowel
Kidney
Pancreas
Bone Marrow
Stem Cell
Multivisceral
Cystic Fibrosis Clinic
Cord Blood
Other  
4.
Which pediatric transplant service line does your hospital offer?
Liver
Small Bowel
Bone Marrow
Lung
Heart
Kidney
Stem Cell
Pancreas
Cord Blood
Multivisceral
Other  
5.
In your service line, how many children were transplanted last year?
 

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6.
In your service line, how many children were listed for transplant last year?
 

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7.
Of your patients, approximately what percent have transplant-related financial issues?
Less than 25%
Greater than 25% but less than 50%
Greater than 50% but less than 75%
Greater than 75%
8.
Does your facility perform adult lung transplants for patients with Cystic Fibrosis?
Yes
No
9.
At your facility, how many adults with Cystic Fibrosis were transplanted last year?
 

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10.
Are you aware of the Children's Organ Transplant Association?
Yes
No
If yes, please answer questions 11 and 12. If no, please skip to question 13.
 
11.
How did you first become aware of the Children's Organ Transplant Association?
Site visit by staff member of the organization
Conference attendance (exhibit and/or staff member presentation)
Internet search
E-newsletter
Mail to my office
Peers
Transplant Family
Other  
12.
Of COTA's services and features, which do you know about?
Financial support to families with children needing a transplant
Financial support to adults with Cystic Fibrosis needing a transplant
Financial support to adults who, due to a genetic condition, need a transplant
No fees charged for services
Challenge grant of up to $10,000 per patient
100% of funds raised directly benefit patients
Fundraising training and support provided to families and volunteers
Funds raised not classified as income to the family
13.
How do you prefer to receive information about the services of an organization, like the Children's Organ Transplant Association?
Meeting at my facility with a staff member from the organization
Conference - Organization exhibits at the conference trade show
Conference - Organization makes presentation at the conference
Organization website
Direct mail via postal service
Email
Other  
14.
Which of the following features are important to your transplant patients and their families? Rank each item using a scale of 1 to 5 with 1 being extremely important and 5 being not important.

(1 = Extremely Important)
 
The percentage of funds raised that directly benefit the patient
Fundraising and support materials available
Training available in the hometown of the patient
The fees charged for services
The geographic location of the organization
The ongoing support provided to the family
Funds raised not classified as income
Challenge Grant program
Tax deductibility of gifts to the campaign
No cost website available to the family
15.
When you make a patient referral to an organization providing fundraising assistance, which process best describes your methodology?
Provide resource listing to patient
Provide patient with organization materials
Provide recommendation for one organization
Provide recommendation and organization materials
Other  
16.
What organization(s) information do you provide to your patients?
Children's Organ Transplant Association
National Transplant Assistance Fund
National Foundation for Transplants
Other  
If you currently refer patients to the Children's Organ Transplant Association, please answer question 17.
 
17.
What is your overall impression of the Children's Organ Transplant Association?
 Excellent Very Good Good Fair Poor 
Services/support provided to you
Awareness of COTA services
Communication with COTA staff
Printed materials provided to you
Services/support provided to your patients
Satisfaction of families who have worked with COTA
18.
If you have any comments or suggestions that you would like share, please do so.
 

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19.
If you would like to be added to our mailing list, please complete the following:

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

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