Kidney Spotlight Form

Do you have a unique or inspiring story about your experience with a kidney transplant, living donation, or kidney disease? Share it with us. Your story may be the one that gives someone hope.

Contact Information

First Name

Last Name

Birthdate

Phone

Street Address

City

Country

State

Provinces

State/Province

Zip/Postal Code

Did you receive Navigator support in the Finding a Living Donor From Home Program?

YesNo

Demographic Information

What is your gender?

How would you describe your race/ethnicity? (Please check all that apply)

Do you have any fiends or family members who have received dialysis or a kidney transplant?

Have you talked to them about your kidney health?

Connection to Kidney Disease

Type of Connection to Kidney Disease

Transplant Consideration?

Were you part of a kidney donor chain?

YesNo

Transplant Information

Age at time of transplant

Date of Transplant

Which center did your transplant take place?

If you could share ONE important piece of information that you learned going through the transplant process, what would it be?

Transplant Recipient

Type of Transplant

Donor Type

What was the reason you needed a transplant?

Why did you choose transplant over starting or continuing dialysis?

How did your donor find out you needed a kidney? (Examples: Read about your need through social media or other messaging, heard about your need through someone they knew, etc.)

What did you do to share your story? (Examples: Shared on social media, shared in your community through place of worship, created business cards, etc.)

If someone asked you how to find a kidney donor, what would you say to them?

What would you say to someone who is unsure about letting people know about their need for a kidney?

Transplant Donor

What is your relationship with the recipient?

What motivated you to become a living donor?

How did you find out your recipient needed a kidney? (Examples: Read about their need through social media or other messaging, heard about their need through someone you knew, etc.)

What would you say to someone considering being a living donor?

Kidney Patient Info

Would you be interested in hearing more of the following? (Please select all that apply)

Learning more about living donationLearning more about living with a transplantLearning more about transplant and the evaluation processLearning about dialysisLearning about transplantLearning about healthy mealslearning how to keep my kidneys healthylearning about palliative care and quality of life (stopping or not starting dialysis)

Share Your Story

Tell us your story in a few words (500 words or less). If selected, we might contact you for more details

Photo Upload

Please submit a high definition photo with the subject(s) clearly visible (Optional)

Disclaimer and Permission

Do you have an external URL or location where your story is being shared? If so, please share:

By checking this box, you agree that all photos, videos and other information you have provided or will provide to National Kidney Foundation may be publicly displayed, copied and used in any form or media, whether now known or hereafter devised, for any and all editorial and related promotional purposes without making payment or other remuneration to you or any third party. You represent and warrant that all content provided is your original work, or is properly licensed to you, and does not violate the copyright or any other personal or property right of any third party. You also represent and warrant that you have obtained any and all releases and permissions necessary for us to publicly display, copy, reproduce and use all content provided. Your submission also allows National Kidney Foundation to edit, crop or otherwise alter any submission as it chooses. You also understand and agree that National Kidney Foundation may contact you through the information you have provided.

Yes, I agree to the above language.

Yes, I would like to receive emails of kidney news and updates!

Contact Information