October 20, 2018

DONOR PROFILE # 312

DEMOGRAPHIC AND PHYSICAL DATA

Place of Birth: Albany, NYBlood Type: A +Complexion: Fair

Birth Date: 11/73 Height: 5'7"Hair Color: Brown

Race: Caucasian Weight: 140 lbsHair Type: Straight

Religion: CatholicBody Frame: SmallEye Color: Brown

Ethnic Origin: (Maternal) Irish

(Paternal) Irish

PERSONAL/EDUCATIONAL HISTORY

Marital Status:Single Education: Coll, 3 years

No. of Children: None Occupation: Sales Assistant

No. of Siblings: Three CareerGoals: Writerand/or Performer

Hobbies/Interests: Running, films, reading, frisbee, theatre, writing, performing and comedy.

Describes himself as: Generous, bright, funny, sensitive and introspective.

PERSONAL FAMILY BACKGROUND

Age / HT
Height / WT
Weight / Cplx
Complexion / Hair/Eye Color / Educ/Occup / Decd / Cause of
Death
Mother / 59 / 5'1" / 145 / Fair / Brn/Brn / MA/Teacher
Father / 61 / 5'11" / 180 / Fair / Blk/Grn / PhD/
Biochemist
Sib #1F / 30 / 5'4" / 110 / Fair / Red/Grn / AA/
Accountant
Sib #2F / 23 / 5'3" / 125 / Fair / Brn/Brn / Coll student
Sib #3F / 23 / 5'4" / 110 / Med / Brn/Brn / Coll student
MGM / 5'1" / 100 / Fair / Brn/Brn / HS/Tele. Operator / 78 / NC
MGF / 5'8" / 160 / Fair / Brn/Brn / HS/Beer Coil Operator / 56 / Lung CA
PGM / 5'2" / 125 / Fair / Brn/Grn / HS/Secretary / 80 / NC
PGF / 6'0" / 170 / Fair / Brn/Brn / HS/Railroad worker / 56 / HA

KEY:AA: Associate of Art Blk: BlackBrn: Brown CA: CancerColl: College Grn: Green HA: Heart Attack

lbs: Pounds MA: Master of Arts MGF: Maternal Grandfather MGM: Maternal Grandmother NC: Natural Causes

PhD: Doctor of Philosophy PGF: Paternal Grandfather PGM: Paternal Grandmother Sib: Sibling

DONOR/FAMILY MEDICAL HISTORYDONOR PROFILE#:312

Medical Problems / Donor / Relative
Circulatory (Blood/Heart) / None / PGF: Heart Attack, Dx:56
Gastrointestinal / None / None
Genital/Reproductive / None / None
Integumentary (Skin) / None / None
Mental Health / None / None
Metabolic/Endocrine / None / None
Musculo/Skeletal
(Muscles/Bones/Joints) / None / None
Neurological / None / MGM & PGF: Alzheimers Disease, Dx: old age
Respiratory (Lungs) / None / PGF: Lung CA
Sight/Sound/Smell / Farsighted ,Dx: age 15
Mild Hayfever / None
Urinary / None / None
Allergies / Hayfever / 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 87 Mutations, negative for all.

Tay-Sachs Disease: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.

Key:Dx: Diagnosed