This donor has passed a rigorous medical examination to ensure absolute safety. Our screening process includes strict testing for infectious diseases (HIV, Hepatitis B/C, STIs), an evaluation of lifestyle habits, and a general physical assessment. We confirm the donor is currently in excellent health and free from transmissible conditions.
Assess your vision without corrective contact lenses
Do you wear contact lenses or have you had corrective surgery?
If yes, describe a problem:
What is the condition of your teeth?
Have you ever had braces?
Do you use nicotine products?
Do you drink alcoholic beverages?
If yes, how much alcohol do you drink?
Describe your diet
Estimate the level of nutrition:
Do you have allergies?
If yes, describe what exactly you are allergic to:
What is your sexual orientation?
How many children do you have?
Age at the time of the first menstruation:
The interval between menstruation is:
Have there been cases of multiple pregnancies in the family:
Please provide information about your biological relatives (indicate only natural hair and eye color):
Relative
Height, cm
Weight, kg
Eye color
Natural hair color
Primary medical history
Mother:
Father:
Complete the table
Family (which relative has the disease)
Age
Cause of death
Disease
The age at which was diagnosed
| Have you ever been diagnosed with or suspected of having any neurological disease (including dementia or degenerative /demyelinating disease of the CNS or other neurological disease of unknown etiology)? | No |
| Have you or any of your sexual partners ever been diagnosed with or suspected of having West Nile Virus (based on symptoms and/or laboratory results or confirmed WNV viremia), experienced symptoms of WNV infection? | No |
| Have you ever been exposed to known or suspected HIV, Hepatitis B, Hepatitis C infected blood or body fluids through skin inoculation, open wounds, non-intact skin or mucous membranes? | No |
| Have you or any of your sexual partners has had sex in the preceding 12 months with a person known to have HIV, clinically active HBV or clinically active HCV? | No |
| Have you or any of your sexual partner(s) ever received, blood, blood components, blood products, or other human tissues that are known to be possible sources of blood-borne pathogens? | No |
| Have you or your sexual partners been diagnosed with Zika virus in the past 6 months? | No |
| Have you travelled to an area with Zika virus transmission? | No |
| Alcoholism | No |
| Drug addiction | No |
| Alzheimer's disease / dementia before age 60 | No |
| Aneurysm | No |
| Fear / panic attacks | No |
| Attention deficit / hyperactivity disorder | No |
| Autism or Asperger's syndrome | No |
| Bipolar disorder | No |
| Blood coagulation disorders / hemophilia | No |
| Blindness before the age of 50 | No |
| Brain tumor / abnormality | No |
| Breast cancer | No |
| Cerebral palsy | No |
| Non-union of the lip or palate | No |
| Colorectal cancer | No |
| Flat feet | No |
| Depression | No |
| Epilepsy or seizures | No |
| Extra or fused fingers or toes | No |
| Genetic disorders | No |
| Hearing disorders / deafness under the age of 50 | No |
| Heart attack before age 50 | No |
| Heart defect | No |
| Huntington's disease | No |
| Immune disorders | No |
| Kidney defect / disorder / cancer | No |
| Intellectual disability / developmental delay | No |
| Melanoma | No |
| Mental retardation | No |
| Obsessive-compulsive disorder | No |
| Ovarian cancer | No |
| Pancreatic cancer | No |
| Parkinson's disease before the age of 60 | No |
| Pituitary disorder | No |
| Prostate cancer before the age of 50 | No |
| Schizophrenia | No |
| Speech disorders / lisping / stuttering | No |
| Split spine | No |
| Stroke under the age of 50 | No |
| Uterine cancer | No |
| Tourette syndrome | No |
| Vision disorders | No |
| Vitiligo / pigmentation disorders | No |
| Death before the age of 50, including childhood | No |
| Other cancer diagnoses before the age of 50 | No |
| Other congenital defects | No |
| Other health disorders | No |
| Diabetes | No |
| Hypertension | No |
| Rheumatoid arthritis | No |
| Pathology of the thyroid gland | No |
| Endometriosis | No |
“Big Five” personality traits of the Donor
1
Extraversion
2
Emotionality
3
Openness to New Experiences
4
Conscientiousness
5
Agreeableness
A
Psychological assessment of the donor:
The donor's participation in the donation program was prompted by the desire to help those who cannot become parents for some reason. Because she has seen, communicated with, and knows people who need such help - she understands their experiences, feelings, and emotions.
The donor is married and has a 13-year-old son. Her son is smart, inquisitive, and diligent in his studies. He is an athletic, active, and energetic boy.
She and her husband have been together for more than 15 years. The donor says that they have an "ordinary loving family." That sometimes she herself does not believe in her "quiet" happiness.
Her mother lives nearby, often visits, helps, and supports. For the donor, her mother is the closest and kindest person in her life. She does not remember her father - he left them when she was 2-3 months old. From the age of three, she grew up with her stepfather. The mother and him are no longer together, but they still communicate, he periodically helps with her grandson - her son. They have developed warm, friendly relations, so the donor would not want to lose such relations.
She has an older and younger brother, they communicate with each other, always ready to come to each other's aid. There was a period in the donor's life when she lived with her grandparents. In her memory, her grandmother remained a warm, caring and gentle person who always shared love with her.
The donor says about her childhood that she did well at school. She was an obedient, responsible, active and sociable child. It so happened that her first teacher now teaches her son at school. She remembers with special warmth the support and love of her mother and grandmother, time together and conversations, and grandmother's fragrant pies. She loved summer vacations, when all the relatives came to her grandmother in the village for the summer and had a fun time, and at the end of the summer they went home, said goodbye and missed the next summer.
After the 11th grade, she went to work in a grocery store. Then she got married and gave birth to a child. The donor does not have a professional education, but plans to go to school - she wants to become a hairdresser.
The donor shows herself as an active, sociable, open and sincere person in communication. She is characterized by such basic personality qualities as purposefulness, responsibility, and perseverance. The donor is hardworking, conscientious, and punctual in fulfilling her commitments. She is also an emotional, courageous, and friendly person.
