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
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City
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Afghanistan
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State
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District Of Columbia
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State/Province
Zip/Postal Code
Did you receive Navigator support in the Finding a Living Donor From Home Program?
Yes
No
Demographic Information
What is your gender?
Please select...
Female
Male
Other
I choose not to answer
How would you describe your race/ethnicity? (Please check all that apply)
American Indian or Native Alaskan
Asian American
Black or African American
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
White or Caucasian
Other
I choose not to answer
Do you have any fiends or family members who have received dialysis or a kidney transplant?
Please select...
Yes
No
Prefer not to answer
Have you talked to them about your kidney health?
Please select...
Yes
No
Prefer not to say
Connection to Kidney Disease
Connection to Kidney Disease
Please select...
I am a kidney patient
I am a living donor
Type of Connection to Kidney Disease
Please select...
I am at risk for kidney disease
I have CKD Stage 1 or 2
I have CKD Stage 3
I have CKD Stage 4 or 5 and not on dialysis
I am on dialysis
I am a transplant recipient
I have kidney cancer
I have kidney stones
Transplant Consideration?
Please select...
Waiting for transplant
On dialysis and have NOT been evaluated for a transplant
Neither on dialysis nor waiting for a transplant
Were you part of a kidney donor chain?
Yes
No
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
Please select...
I received a deceased donor kidney
I received a living donor kidney
Donor Type
Please select...
Directed Donor - Someone that I know
Non-Directed Donor - Someone that I did NOT know
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?
Please select...
I was a Directed Donor (I knew the recipient)
I was a Non-Directed Donor (I did NOT know 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 donation
Learning more about living with a transplant
Learning more about transplant and the evaluation process
Learning about dialysis
Learning about transplant
Learning about healthy meals
learning how to keep my kidneys healthy
learning 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
500 words remaining
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
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