December 20, 2018

DONOR PROFILE #349

DEMOGRAPHIC AND PHYSICAL DATA

Place of Birth:Cleveland, OhioBlood Type: O- Complexion: Fair- Medium

Birth Date: November 1983Height:5’9”Hair Color: Brown

Race:CaucasianWeight: 160lbs Hair Type:Straight

Religion: CatholicBody Frame:MediumEye Color: Blue

Ethnic Origin: (Maternal):Irish/French

(Paternal): Slovenian

PERSONAL/EDUCATIONAL HISTORY

Marital Status:Single Education:Undergrad./Sociology

No. of Children:None Occupation: Tutor

No. of Siblings: Two CareerGoals: PhD in Sociology

Hobbies/Interests: Drawing, screen printing, basketball, cycling, musical theater, and reading.

Describes himself as:Friendly, amiable, non-confrontational and laid-back.

PERSONAL FAMILY BACKGROUND

Age / HT
Height / WT
Weight / Cplx
Complexion / Hair/Eye Color / Educ/Occup / Decd / Cause of
Death
Mother / 5’9” / 150 lbs / Fair / Bld/Blu / MA/Research Nurse / 46 / Breast
Ca
Father / 57 / 5’ 8” / 165lbs / Medium / Brn/Blu / MA/Systems Analyst
Sib#1F / 23 / 5'5" / 150lbs / Medium / Brn/Blu / MBA/Acct.
Sib#2M / 18 / 6’1” / 165 lbs / Fair / Brn/Blu / College
Student
MGM / 78 / 5’9” / 160 lbs / Fair / Brn/Blu / MA/Nurse
MGF / 76 / 6’3” / 175 lbs / Medium / Brn/Blu / MA/Engr
PGM / 94 / 5'2” / Thin / Medium / Brn/Blu / HS
PGF / 5'’9” / 170 lbs / Dark / Brn/Blu / HS/Farmer / 85 / NC

KEY: Acct: accountant BLD:Blond BLK: Black Blu: Blue Brn: Brown Bus: Business CA: Cancer Coll: College Engr: Engineer

Grn: GreenHS:High School MA: Master in Arts MGF: Maternal Grandfather MGM: Maternal Grandmother NC: Natural Causes

PGF: Paternal Grandfather PGM: Paternal Grandmother Sib: Sibling Undergrad: Undergraduate

DONOR/FAMILY MEDICAL HISTORYDONOR PROFILE#: 349

Medical Problems / Donor / Relative
Circulatory (Blood/Heart) / None / None
Gastrointestinal / None / None
Genital/Reproductive / None / M0: Breast Ca, deceased
Integumentary (Skin) / None / None
Mental Health / None / None
Metabolic/Endocrine / None / None
Musculo/Skeletal
(Muscles/Bones/Joints) / None / None
Neurological / None / None
Respiratory (Lungs) / None / Brother: Asthma, Rx as needed
Sight/Sound/Smell / Nearsighted, wears glasses / Fa, and siblings wear glasses
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 97Mutations, negative for all.

Hemoglonopathies: Hemoglobin electrophoresis, normal.

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.

OTHER: His brother is a talented musician. The donor speaks Spanish and French.

KEY: Fa: Father Mo: Mother Rx: Treatment