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 has always wanted to help others. She has good genetics, good health, good physical data, and can be useful to someone else with this. She believes that being a donor is like charity, it is a good deed. Also, her participation in the program gives her and her children additional financial support, which also motivates her.
The donor lives with her second husband and three daughters. She has two older daughters - 11 and 14 years old from her first marriage. She divorced her first husband more than 7 years ago, but he hardly helps in raising her daughters. The donor initiates the children's communication with their father. Despite the fact that this situation is painful and difficult for her, she believes that she can cope with raising her daughters herself, the main thing is that her children are happy and healthy.
She has a 5-year-old daughter from her current husband. They have warm and friendly relations in the family, of course there are misunderstandings, but they try to resolve them through agreements, conversations, understanding and support for each other. The man also treats the older girls well, helps with their upbringing, and has warm and friendly relations with them.
The donor says with a smile about her children that the older daughters are calmer and more balanced, while the younger one is fragile and “with a strong character.” Her children are healthy, active, inquisitive, sociable, playful, and eager to learn new things.
Her parents live in a neighboring village. The donor often visits them and communicates. She has two older brothers from her mother’s first marriage, aged 12 and 13.
Family for her is warmth, home comfort, a circle of trust, love, mutual respect, and mutual support.
She says about her childhood that she was the youngest in the family, so everyone loved and pampered her. She was forgiven a lot, allowed, supported in everything, and went to meet her. She grew up in love – parents, grandparents, aunt, brothers, etc. She jokingly recalls that she often received the most gifts. Her parents worked hard to provide her and her brothers with everything they needed.
She had average grades at school. She loved the Ukrainian language, drawing, and physical education. She often worried before tests and independent ones, and took them to heart. At school she was calm, compliant, and non-conflict. She was not very active. But when she went to college, it was more interesting. There was more motivation and, accordingly, activity - in studies and outside the educational process. Because she dreamed of becoming a teacher since childhood, she loves children and working with them, teaching them what she knows how to do herself.
The donor has a secondary specialized education, specializing in a primary school teacher.
The donor can be described as a friendly, calm, and benevolent person. She is pleasant to talk to, concise, direct, and open. She has such personal qualities as purposefulness, responsibility, perseverance, and conscientiousness.
