Health Screening Worksheet
These conditions typically disqualify a volunteer
from participating in the University of Iowa Marrow Donor Program. Please review this
page.
If you answer YES to any question, this may
disqualify you.
Please consult with us at 800-944-8220 before requesting the
donor application.
Do you have - or have you had - any of the
conditions listed below?
- Previous
cancer (exceptions: some skin cancers; some cervical cancers)
- Inherited disorders such as sickle cell
anemia, muscular dystrophy, etc.
- Neurological disorders, such as seizures,
multiple sclerosis, etc.
- Major organ dysfunction of the heart, lung,
bowel, liver or kidney
- Mitral valve prolapse with medication,
shortness of breath, irregular heartbeat, dizzy spells
- Insulin-dependent or medication-controlled
diabetes
- Rheumatoid arthritis that is being treated
with methotrexate or gold therapy
- Medication-dependent asthma (exception: no
asthmatic attack for 5 years)
Are you healthy enough to be a donor?
When you join the University of Iowa Marrow Donor Program, a donor center for the Be The Match Registry®, you will complete a health questionnaire to confirm you meet the medical guidelines. The medical guidelines protect your health as a potential donor, as well as the health of transplant patients.
The guidelines from the Be The Match Registry® describe many factors that may make a person medically ineligible to join the Be The Match Registry. These guidelines do not include every situation that could prevent a person from donating. If you are identified as a potential match for a patient, you will receive a physical exam to be sure it is safe for both you and the patient to donate.