November 17, 2018

DONOR PROFILE #420

DEMOGRAPHIC AND PHYSICAL DATA

Place of Birth:Tbilisi, GeorgiaBlood Type: A+ Complexion:Medium

Birth Date: March 1979 Height: 6’1” Hair Color: Brown

Race: CaucasianWeight: 185 lbs Hair Type: Straight

Religion: OrthodoxChristianBody Frame:Medium Eye Color: Green

Ethnic Origin: (Maternal): Georgian

(Paternal): Georgian

PERSONAL/EDUCATIONAL HISTORY

Marital Status: Single Education:MD

No. of Children: None Occupation: Physician

No. of Siblings: None CareerGoals: Academic position

Hobbies/Interests: Music composition, tennis, soccer, literature, singing, pianist, camping, poetry, and kayaking.

Describes himself as:Easygoing, fun loving, goal oriented, and dynamic.

PERSONAL FAMILY BACKGROUND

Age / HT
Height / WT
Weight / Cplx
Complexion / Hair/Eye Color / Educ/Occup / Decd / Cause of
Death
Mother / 65 / 5’6” / 132lbs / Fair / Brn/Brn / PhD/
Professor / -
Father / 64 / 6’0” / 165Ibs / Fair / Brn/Hazel / PhD/
Professor
SIB(F) / 41 / 5’6” / 135 lbs / Olive / Blk/Brn / MA/
Photographer
MGM / 140 lbs / Fair / Bld/Grey / PhD/
Professor / 58 / HA
MGF / 83 / 5’9” / 170 lbs / Fair / Brn/Brn / MS/Engineer / 83 / NC
PGM / 87 / 5’5” / 180 lbs / Fair / Brn/Blue / PhD/
Microbiologist
PGF / 64 / 6”0” / 180 lbs / Fair / LtBrn/Hazel / Composer / 64 / Prostate CA

KEY: AVG: Average BA: Bachelor of Arts BLK: Black BLU:Blue BRN: Brown HA: Heart Attack HS:High SchoolMA: Master of Arts

MD: Doctor of Medicine MED: Medium MGF: Maternal Grandfather MGM: Maternal Grandmother NC: Natural Causes PGF: Paternal Grandfather PGM: Paternal Grandmother PhD: Doctor of Philosophy RE: Real Estate Sib:Sibling

DONOR/FAMILY MEDICAL HISTORYDONOR PROFILE#: 420

Medical Problems / Donor / Relative
Circulatory (Blood/Heart) / None / Grandparents: Hypertensive
Gastrointestinal / None / GM: Crohn’s disease
Genital/Reproductive / None / PGF: Prostate Ca
Integumentary (Skin) / None / None
Mental Health / None / None
Metabolic/Endocrine / None / None
Musculo/Skeletal
(Muscles/Bones/Joints) / None / Mo: Arthritis
Grandparents: Arthritis
Neurological / None / None
Respiratory (Lungs) / None / FA: Asthma
Sight/Sound/Smell / None / None
Urinary / None / None
Allergies / None / None
Birth Defects / None / None
Genetic Diseases / None / None
Other / None / None

DONOR GENETIC SCREENING RESULTS

Chromosome Analysis:Male Karyotype, 46 XY.

Cystic Fibrosis: Tested for 99 Mutations, negative for all.

SMA: Non-carrier

Thalassemia: CBC/DIFF within normal limits, MCV normal.

PSYCHOLOGICAL SCREENING:The donor meets all of our criteria for participation in our anonymous

donor program including psychosocial history and current state of functioning.

OTHER: Multi-instrumentalist. Donor has multiple pianists and composers in his family.