Living Donor Screening Form

To be considered as a living donor there are a number of criteria that one must meet. These criteria are necessary to insure that a living donor is a truly compatible donor for the recipient and that the transplantation process does not medically pose a risk to the donor or to the recipient. By completing/submitting the following secure form, you will provide us with valuable information that we may use as a preliminary screening tool to see if you meet the initial criteria necessary to become a living donor and can therefore move on to the next more involved phase of the process.

*=required, *= If your answer to a related question is yes, then required
Diatetes Test


If your answer is "Yes", please note you are not a candidate for living organ donation. Please feel free to call Upstate Transplant Center for more details: 315-464-5413. End of questionnaire.

Living Donor Screening




















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