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:		Regularly - 48oz./week beer
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 - Standard donor screening
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 by gene sequencing
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:		N/A
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:Infrequent marijuana use
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:None
Do you wear glasses or contact lenses?
Are you near or far-sighted?		Yes - Near-sighted
Usual weight?182
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?		Yes - 2011, 2012
Have you ever had your ear(s) or body pierced?
If yes, where and what year?		Yes - Left ear, 2009

Family Medical History
See list of questions asked here

Your Mother
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
Question Response
Current age or age at death 64
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Brothers
Your Brother 1
Question Response
Current age or age at death 29
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Brother 2
Question Response
Current age or age at death 24
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 89
Living / DeadDead
Cause of death and any treatment prior to deathHeart failure
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart failure
89
No treatment
Your Mother's Mother
Question Response
Current age or age at death 90
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Sisters 1
Question Response
Current age or age at death 64
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Sisters 2
Question Response
Current age or age at death 62
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Sisters 3
Question Response
Current age or age at death 54
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Sisters 4
Question Response
Current age or age at death 34
Living / DeadDead
Cause of death and any treatment prior to deathBrain aneurysm
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Brain aneurysm
34
No treatment, healthy prior to death
Your Mother's Brothers 1
Question Response
Current age or age at death 60
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 57
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 59
Living / DeadDead
Cause of death and any treatment prior to deathHeart attack
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart attack
59
Suspected heart attack while on boat, fell into water and drowned as a result
Your Father's Mother
Question Response
Current age or age at death 74
Living / DeadDead
Cause of death and any treatment prior to deathHeart failure
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart failure
74
No treatment, passed in sleep
Your Father's Sisters 1
Question Response
Current age or age at death 66
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 64
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Sisters 3
Question Response
Current age or age at death 62
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 54
Living / DeadDead
Cause of death and any treatment prior to deathAlcohol poisoning
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Alcohol poisoning
54
No treatment