This donor is a healthy carrier for a genetic disease.
Please see his Genetic Testing Summary and Acknowledgment of Genetic Risk for details

Personal Behavior History

Question Response
Current alcohol use:
If yes, oz./week and type of alcohol:		Never
Tobacco use: Do you smoke?
If yes, #/day and for how long:		No
If you did smoke but quit, when did you last smoke?N/A
For how many years?N/A
Do you sleep well?Yes
Do you exercise on regular basis?Yes
Is your diet well balanced?
If no, explain:		Yes
Are you a vegetarian?No
Any dietary restrictions?
If yes, explain:		No

Sexual History

Have you ever had sex with:
Question Response
A partner whose sexual background you are unsure of in the past 12 months?No

Donor Genetic History

Question Response
Were you or any family members born with any birth defects?
If yes, explain:		No
Have you been tested for Cystic Fibrosis?
If yes, the result:		Yes - Non-carrier by gene sequencing
Karyotype?
If yes, the result:		Yes - Normal karyotype
Spinal Muscular Atrophy (SMA)?
If yes, the result:		Non Carrier - by gene sequencing
Tay Sachs?
If yes, the result:		Non Carrier - by gene sequencing
Ancestry
Question Response
Are you of Jewish ancestry?
If yes, please note: Ashkenazi, Sephardi, or Other		No
If you are of Jewish ancestry, have you been tested as a carrier of any of the following diseases?
Question Response
Tay Sachs:
If yes, result(s):		Yes - Non-carrier by gene sequencing
Gaucher:
If yes, result(s):		Yes - Non-carrier for mutations tested
Canavan:
If yes, result(s):		Yes - Non-carrier by gene sequencing
Fanconi Anemia Type C:
If yes, result(s):		Yes - Non-carrier by gene sequencing
Niemann-Pick Type A:
If yes, result(s):		Yes - Non-carrier by gene sequencing
Bloom Syndrome:
If yes, result(s):		Yes - Non-carrier by gene sequencing
Familial Dysautonomia:
If yes, result(s):		Yes - Non-carrier by gene sequencing
Mucolipidosis IV:
If yes, result(s):		Yes - Non-carrier by gene sequencing
Maple Syrup Urine Disease 1B:
If yes, result(s):		Yes - Non-carrier by gene sequencing
Usher Syndrome III & 1F:
If yes, result(s):		Yes - Non-carrier by gene sequencing
Glycogen Storage Disease 1A:
If yes, result(s):		Yes - Non-carrier by gene sequencing
ABCC8-Related Hyperinsulinism:
If yes, result(s):		Yes - Non-carrier by gene sequencing
Lipoamide Dehydrogenase Deficiency:
If yes, result(s):		Yes - Non-carrier by gene sequencing
Ancestry
Question Response
Are you of African ancestry?No
If yes, have you been tested as a carrier of sickle cell anemia?Yes
If yes, result:Non Carrier - by gene sequencing
Are you of Mediterranean, Greek or Italian ancestry?No
If yes, have you been tested as a carrier of beta thalassemia?Yes
If yes, result:Non Carrier - by gene sequencing

Donor Medical History

Question Response
List any operations:
Age & reason:		None
Hospitalization other than surgery:
Age & type of illness:		N/A
Have you ever had any broken bones?
If yes, please give age and description:		No
Have you ever had any serious illnesses?
If yes, please give age and description:		No
How many days in the past 12 months could you not work because of all illness (colds, flu, accidents, surgery, etc)?
Please describe:		0
Are you presently under a physician's care for any reason?
If yes, please describe:		No
List all drugs you have taken in past 12 months (prescription, nonprescription, herbal, and sports supplements, and recreational). Include drug, frequency and duration taken, and reason:Whey protein powder, taken 1-2 times per week
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:Whey protein powder, taken 1-2 times per week
Do you wear glasses or contact lenses?
Are you near or far-sighted?		No
Usual weight?198
Recent weight loss or gain?
# of lbs and reason:		No
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:		No
Have you been tested for HIV (AIDS)?
If yes, when:		Yes - Negative, ongoing donor screening
How many sexual partners do you currently have?1
Have you ever had a tattoo?
If yes, what year did you get the tattoo?		No
Have you ever had your ear(s) or body pierced?
If yes, where and what year?		No

Family Medical History
See list of questions asked here

Your Mother
Question Response
Current age or age at death 50
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father
Question Response
Current age or age at death 65
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Sisters
Your Sister 1
Question Response
Current age or age at death 28
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Father
Question Response
Current age or age at death 85
Living / DeadDead
Cause of death and any treatment prior to deathNatural causes
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Died in his sleep
85
N/A
Your Mother's Mother
Question Response
Current age or age at death 82
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Osteoarthritis
82
None
Your Mother's Sisters 1
Question Response
Current age or age at death 55
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Brothers 1
Question Response
Current age or age at death 49
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Brothers 2
Question Response
Current age or age at death 48
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Father
Question Response
Current age or age at death 92
Living / DeadDead
Cause of death and any treatment prior to deathNatural causes
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Died in his sleep
92
N/A
Your Father's Mother
Question Response
Current age or age at death 88
Living / DeadDead
Cause of death and any treatment prior to deathComplications of pneumonia
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Pneumonia
82
Hospitalized
Your Father's Sisters 1
Question Response
Current age or age at death 70
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Sisters 2
Question Response
Current age or age at death 67
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Brothers 1
Question Response
Current age or age at death 25
Living / DeadDead
Cause of death and any treatment prior to deathDrowned
Health Problems
Healthy
Your Father's Brothers 2
Question Response
Current age or age at death 75
Living / DeadDead
Cause of death and any treatment prior to deathLung cancer
Health Problems
Disease
Age Diagnosed
Treatment For Condition
High cholesterol
57
Medication
Blocked blood vessel in leg
57
Stent
Lung cancer (smoker), age at diagnosis unknown
 
Unknown
Your Father's Brothers 3
Question Response
Current age or age at death 68
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Brothers 4
Question Response
Current age or age at death 63
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Brothers 5
Question Response
Current age or age at death 61
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Brothers 6
Question Response
Current age or age at death 59
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy