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 learned about the donation program from social advertising, became interested and wondered why she shouldn't become a donor and help people who dream of becoming parents. Her husband supported her in this, she decided to take part in the program.
She lives in a civil marriage, her husband is now a military man. They raise a 3-year-old son, who is an active, energetic, cheerful boy. He is developing quickly, loves to tell stories, play. He is sociable, emotional and kind.
Her parents divorced. She maintains communication with both of them. Her mother is closer to her in spirit, warm, caring, loving. She has a strong, strong and strong-willed character. She is hardworking, responsible. Now she is the biggest support, always helps with her grandson.
Her father is calmer, softer, kinder. In childhood she was her father's daughter, followed him everywhere.
Family for her is support, trust, and mutual assistance. These are people she can rely on and trust in everything.
The donor has a sibling. They often spent time together as children. She believes that he is calmer, he is better at home, in silence. But the donor loved the company of friends, communication, walks, active games more. She was an active, mobile, inquisitive child. She studied well, was fond of playing chess, checkers. She played sports - volleyball, basketball. She was also a creative child, and to this day she has hobbies - she draws well, embroiders with a cross, beads.
After the 11th grade, she entered the university to become a primary school teacher, a speech therapist. But Covid, then the war destroyed her plans. There was no opportunity to study, so she suspended her studies. But now she is a student again - she is studying at a vocational lyceum to become a hairdresser. She has long liked this specialty, she decided to master it. She manages to study easily, with interest and enthusiasm.
She considers her inner strength to be her achievement. When her husband went to war, she was 6 months pregnant, but she didn’t give up, pulled herself together, and took on the main responsibility for the family.
Her special feature is perseverance. If she decides to learn or do something, she won’t stop until she does it.
She dreams of becoming a hairdresser, developing professionally, and realizing her own plans. She also dreams of the end of the war and a joint vacation with her husband.
Her loved ones consider her responsible, persistent, and hardworking. They believe that she does a lot, knows a lot, and is able to do it.
Donor is an independent, purposeful person who goes to her goal, ambitious. She is kind, positive, and always ready to help people and understand their feelings. She is modest, well-mannered, pleasant to talk to, and friendly.
