To Become a Living Donor Buddy

  1. Complete the questionnaire below.
  2. Click on the “Submit” button.

You will receive a confirmation of receipt of your entry by email.

Note:  if you donated more than once (such as a kidney and a liver segment), choose “Other” in response to the “What did you donate?” question, include all dates of your donations, and include all the names of the facilities at which you donated.


First Name (required)

Last Name (required)

Address

City

State/Province

Zip Code

Email (required)

Remember to include your full email address including the domain name, for example, my_email@gmail.com. Use an email address that doesn’t change. Don’t use your work email. If your email changes, be sure to notify us so we can keep your contact information current. Your email address will not be disclosed in the Living Donor Buddy entry to protect your privacy. It will be shared only with potential donors interested in contacting you.

Your Gender

Your Marital Status

Are you a donor?

What did you donate? (required)

What was the date of donation?

If you selected “Other,” please specify what you donated:

To whom did you donate (for example, son, sister, parent, cousin, or unrelated)?

Was the recipient an adult or child?

At what transplant facility or hospital did you donate?

Answer this question only if you donated a kidney:
What surgical procedure was used to remove your kidney?

If “Other,” please describe the procedure:

Have you received any formal training to be a counselor or mentor to living donors?

How would you rate your donation experience? (required)

Describe the reasons why someone would want you as their Living Donor Buddy: (required)