PRAANA | Sri Lanka Stem Cell Donor Registry

Stem Cell Donor Registry

Donor Registration Form

If you are interested in becoming a Stem cell donor, please fill this form to register.

01. PERSONAL INFORMATION

Date of Birth*

Select Gender*

History of Pregnancy (If you are female)

Father's Race

Father's Religion

Fathers Country of Origin

Mother's Race

Mother's Religion

Mother Country of Origin

02. BLOOD DONATION HISTORY

Have you donated blood before*

Last Donated Date

Bar Code No

03. CONTACT INFORMATION

Mobile*

Home Phone Number

WhatsApp/Viber/IMO Number

Current Address*

Province

Permanent Address*

Province

04. CONTACT PERSONS

05. DONOR AGREEMENT

Participation in the SLSCDR is voluntary and you may withdraw at any time after notifying us. There is, however, a point of no return for the patient. This would be about a week before the actual donation, as the patient's own bone marrow is destroyed in preparation for receiving the donated stem cells. At this point, the patient will die unless healthy bone marrow is transplanted. It is therefore very important that you let us know well before this point of no return if you have any concerns regarding donation.

I sincerely pledge that,

I wish to be enlisted as a stem cell donor in the SLSCDR and have no objection towards being contacted for further details and sampling.
In the event of a change of contact address/phone number, I will inform the SLCSDR as soon as possible (Contact Email: slscdregistry@gmail.com).
Above-mentioned information is true and correct to my knowledge.

I have read and understood everything mentioned above.

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