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 a friend who also participated in it. At first, the donor did not dare to try to become a donor, but with more details and information, she came to the program. She understands that her participation in the program is a chance to become parents for some couple who dream of it.
The donor is married, she has known her husband since she was 16, she got married at 19, and at 23 they already had a son, who is now 2 years old. About the child, the donor says that he is an active, mobile, inquisitive baby. He likes to draw, easily learns new words and develops rapidly.
The donor's mother is a calm, friendly, selfless person. She worked as a nurse in a children's ward for several years, where she showed herself as a sensitive, attentive, caring person.
The donor's father is a more emotional and strong-willed person. He is strong, courageous, and at the same time caring and loving for his family.
The donor's older sister has her own family and two children.
For the donor, family is the most valuable thing she has in life. She cannot imagine herself without her loved ones.
As a child, the donor was a calm, polite and well-mannered child. She studied well, was fond of biology and chemistry. For several years, she did gymnastics, attended needlework and embroidery clubs. She was active in school life, participated in competitions, various events. She loved to spend her free time with her family and friends in nature, by the river, by the sea.
After the 11th grade, she entered a medical school for state-funded studies. She was diligent, persistent, and purposeful. It was a profession that she found interesting and desirable.
The donor has a secondary medical education - a midwife. After studying, she received interesting professional experience - she worked in a maternity ward. Now she works in a private gynecological clinic.
Her main feature is her reliability, empathy and understanding of other people's situations. She is always ready to help a person in need.
She considers her own happy, strong family and relationships with her husband to be her achievement, and her work is interesting and promising.
She dreams of continuing her studies - entering a medical university, she would like to become a pediatrician. She likes working with children.
At work, Donor is sensitive and caring, she is afraid of doing something unpleasant or painful to the patient. She is a balanced person, first she thinks in detail, then she makes a decision. Donor seeks communication, but with acquaintances and close people. When meeting a new person, she is more reserved and concise.
Donor is purposeful, ambitious, hardworking. She keeps her promises, is decent and punctual.
