Saint Luke’s Hospital Living Kidney Donor Screener

We appreciate your interest in becoming a living kidney donor. Each year, more than 4,700 people die waiting for a kidney transplant, so your decision literally means everything for your intended recipient or someone in need of a kidney. If you’re found to be a compatible match, your recipient’s life expectancy doubles compared to remaining on dialysis, and your gift shortens the waiting time for others on the kidney transplant wait list.

We ask that you answer the following questions to begin the process. The information you provide below is secure and will only be used to determine your compatibility as a kidney donor.

Enter your information below:

Indicates required field

Contact

First Name

Last Name

Phone

Alternate Phone

Address

City/Town

State/Province

ZIP/Postal Code

Date of Birth

Weight (in pounds):

Height (in feet and inches):

Do you have a primary care physician?

Do you have health insurance?

Do you have a history of diabetes?

Do you have a history of high blood pressure?

Do you have a history of kidney stones?

Do you have someone you want to donate to?

Intended Recipient’s First Name:

Intended Recipient’s Last Name:

Intended Recipient’s Date of Birth:

Relationship to recipient (example: sister, brother, aunt):

Math question 2 + 1 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.