Submit this form if you are in need of a kidney donor. Please give as much information as you are comfortable with.

Read stories from other people in need of a donor

Name *
The city and state where you live.
Month day and year for hospital contact by any potential living donor.
Is a Kidney Paired Exchange or Swap an option with the hospital you are registered with? *
Where people go to get more information about being a living donor.
Facebook, Instagram, Twitter, YouTube, etc.
Do we have permission to tag you in social media posts about you in order to reach more people?
Describe as much health history as you'd like to help others understand your story.
Do we have permission to share your story on our website and social media? *
Would you be able to email us a picture of yourself for the blog? *
This is required for the post. Please email photos to OR I can choose from your social media with your permission.
Would you like to be signed up for the Get Loud for Kidneys Newsletter? *
Get notifications about new kidney blog posts, kidney stories and upcoming events and advocacy. Minimal emails - I promise. You can unsubscribe at any time.