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Community-Directed Donation
Donor Protection
Contact Us
About
Our Mission
Our Team
FAQ
Donation FAQ
Transplantation FAQs
Facts about Kidney Donation
Covid-19 Info
Donor Pre-Screen Form
Fill out this brief form and one of our Donor Advocates will reach out to you within 2 business days.
Name
*
First
Last
Phone
*
Email
*
Medical Pre-Screening
The following questions will allow our medical staff to determine if you a medically qualified to become a living kidney donor.
Check an of the following conditions that you have had or are currently experiencing:
*
Kidney Stones
Kidney Infections
Cancer
Family History of Kidney Disease
Chronic Depression
Suicidal thoughts
Other
Personal Information
What motivated you to come forward as a donor?
*
I want to donate a kidney but I do not know anyone who needs a transplant.
*
Yes
No
Is it important to meet the recipient?
*
Yes
No
I want to donate to a specific individual?
*
Yes
No
If yes, name of recipient:
How did you learn about Kidneys in Common?
How would your familiy and friends react to your desire to be a living kidney donor?
*
Does your faith or belief in a higher power play a role in your decision to be a donor?
*
