Living Kidney Donor Screening

We appreciate your interest in living kidney donation and ask that you answer the following questions to begin the process. Our living donor team will contact you within 10 business days when our medical team has made a decision about the next steps. If you have any questions please call us toll-free at 800.401.4444 or 402.559.5000. Our business hours are 8 a.m. to 4 p.m. CST. All information below will be kept secure and only used to determine if you meet initial requirements to be a living kidney donor.

Please fill out the form below.

Intended Recipient Information

Enter your information below

Example: sister, brother, aunt.
(Must be at least 19 years old.)
Yes   No
Yes   No
Male   Female
  • American Indian
  • Eskimo
  • Aleutian
  • Alaska Indian
  • American Indian or Alaska Native: Other
  • American Indian or Alaska Native: Not Specified / Unknown
  • Asian Indian / Indian Sub-Continent
  • Chinese
  • Filipino
  • Japanese
  • Korean
  • Vietnamese
  • African American
  • African (Continental)
  • West Indian
  • Haitian
  • Black or African American: Other
  • Black or African American: Not Specified / Unknown
  • Mexican
  • Puerto Rican (Mainland)
  • Puerto Rican (Island)
  • Cuban
  • Hispanic/Latino: Other
  • Hispanic/Latino: Not Specified / Unknown
  • Native Hawaiian
  • Guamanian or Chamorro
  • Samoan
  • Native Hawaiian or Other Pacific Islander: Other
  • Native Hawaiian or Other Pacific Islander: Not Specified / Unknown
  • European Descent
  • Arab or Middle Eastern
  • North African (Non-Black)
  • White: Other
  • White: Not Specified / Unknown
Yes   No
in pounds
in feet and inches
Have you ever been diagnosed with any of the following?
Yes   No
Yes   No
Yes   No
Yes   No
Yes   No
Yes   No
Yes   No
Yes   No
Yes   No
Yes   No
Yes   No
Yes   No
Yes   No
Yes   No   Unkown
(Example: Mother, brother, paternal aunt, etc.)
(Example: Cancer, Mother; Diabetes, Brother, etc.)
Yes   No
Yes   No
Yes   No
Yes   No

Internal Exchange Donations

Yes   No