Henry Ford — Living Donor Program
Welcome to the BREEZE TRANSPLANT™ online health history questionnaire.
Please answer all questions truthfully, accurately, and completely, as the information provided here will be used by our Living Donor Team to detect any medical conditions that may affect your ability to be a living donor.
This questionnaire is confidential. Only health professionals on the Living Donor Team will use this information. This information will not be shared with the transplant candidate or others.
Please choose below whether you wish to be evaluated for living kidney or liver donation.