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Health Screening Worksheet
These conditions typically disqualify a volunteer from participating in the 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?
| 1. Previous cancer (exceptions: some skin cancers; some cervical cancers). |
Yes |
No |
| 2. Inherited disorders such as sickle cell anemia, muscular dystrophy, etc. |
Yes |
No |
| 3. Neurological disorders, such as seizures, multiple sclerosis, etc. |
Yes |
No |
| 4. Major organ dysfunction of the heart, lung, bowel, liver or kidney |
Yes |
No |
| 5. Mitral valve prolapse with medication, shortness of breath, irregular heartbeat, dizzy spells |
Yes |
No |
| 6. Insulin-dependent or medication-controlled diabetes |
Yes |
No |
| 7. Rheumatoid arthritis which is being treated with methotrexate or gold therapy. |
Yes |
No |
| 8. Medication-dependent asthma (exception: no asthmatic attack for 5 years) |
Yes |
No |
Find your height on the chart below . If your weight exceeds the maximum listed for your height, you should disqualify yourself as a marrow donor.
| Height |
Maximum Weight |
Height |
Maximum Weight |
Height |
Maximum Weight |
| 4'10" |
191 pounds |
5'7" |
255 pounds |
6'4" |
328 pounds |
| 4'11" |
198 pounds |
5'8" |
263 pounds |
6'5" |
339 pounds |
| 5'0" |
204 pounds |
5'9" |
270 pounds |
6'6" |
345 pounds |
| 5'1" |
211 pounds |
5'10" |
278 pounds |
6'7" |
355 pounds |
| 5'2" |
218 pounds |
5'11" |
286 pounds |
6'8" |
363 pounds |
| 5'3" |
225 pounds |
6'0" |
295 pounds |
6'9" |
374 pounds |
| 5'4" |
233 pounds |
6'1" |
301 pounds |
6'10" |
381 pounds |
| 5'5" |
240 pounds |
6'2" |
310 pounds |
6'11" |
392 pounds |
| 5'6" |
247 pounds |
6'3" |
321 pounds |
7'0" |
400 pounds |
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