Table of Contents:

1. Quick Donor FAQs
   
2. Donor Approval Process
   
3. Donating Restrictions
   
4. Collecting Your Milk
5. Storing Your Milk
   
6. Delivering Your Milk
   
7. Share Your Story
   
8. Appendix
   

Step 2: Medical History Questionnaire

Complete your donor interview form with:

1. Medical history questionnaire
   
2. Consent to contact your healthcare provider
   
3. Signed Donor Consent Form
   

Read all information carefully before submitting. By giving consent to contact your healthcare provider, we will request information on medical history listed on the donor interview form.

Next Steps?

After you return your paperwork and get your blood drawn:

• MMBNT donor coordinators will work to obtain the forms from your healthcare provider to complete your file.
• Blood test results take 5-7 business days. You will be notified of results.
• Once your file is complete with all required documents, it will be reviewed for approval.
• Once approved, your milk is ready to be processed in our onsite laboratory.
  

If you need to make room in your freezer, you can drop off milk before you are approved; however, it will not be processed until you are approved. Milk cannot be returned to you for any reason once it is dropped off.

You can never be too careful!

Do NOT donate if:

You, your baby or any household member is sick:

• MMBNT cannot accept milk collected between the 24 hours before the person became ill and 24 hours after they are well.
  
• There is an exception for an uncomplicated cold or seasonal allergies, during which the sick person’s temperature is no higher than 100°F orally.
  

You need to take any medication or drug that is not listed in "accepted medications" under Donating Restrictions below:

call us to dicuss.

You have breast tenderness consistent with a breast infection.

• If you have a breast infection or plugged ducts, unsafe bacteria could be present in the milk.
• You CAN keep feeding your own baby.
  
• You may continue donating once the infection has cleared and you are off medication.
  

Restrictions:

Drinking alcohol requires a 6-hour waiting period before pumping following consumption of one serving and a 12-hour waiting period following consumption of more than one serving before pumping.

A serving equals:

• 5 ounces of wine
• 12 ounces of beer
• 1.5 ounces of hard liquor
• 10 ounces of wine cooler/any other alcohol

Caffeine from tea, coffee, soda or chocolate is allowed as long as consumption is no more than 24 ounces per day.

Vitamins are allowed in regular dosages. No mega-dosing and no mega herb-containing vitamins.

Common accepted medications include acetaminophen, ibuprofen, cough drops, nasal sprays, and birth control methods.

Discuss any medication/drug use not listed with MMBNT.

As a reminder, donors will be deferred for use of any tobacco or nicotine products* including gum, patches, e-cigarettes, vaping or use of a hookah; cannabis and illicit drugs.

*If you begin consuming any of these substances during your time as a donor, contact MMBNT immediately.

Wash hands thoroughly with soap and warm water. Dry with a clean towel.

Gently wipe nipples, then breast from the nipple out, with a clean, damp washcloth before each pumping.

Express/pump your milk into a sterile container.

A sterile container is a breastmilk storage bag or any food-grade hard plastic or glass container (Tupperware, baby bottles, etc.) that can be boiled for 5 minutes and used to store milk.

MMBNT can provide a limited number of milk storage bags upon request.

Clean your pump - rinse after each session and sterilize fully once a day:

• You must wash, rinse and sterilize the pump parts that touch your breast or milk one time per day, every day that you use it.
• If you pump 2 or more times per day, simply rinse between sessions.
• Always follow manufacturer’s instructions.
  

SToring Your Milk

Labeling Your Milk

1. Write the pump date on each container/milk storage bag with a permanent marker.
   
1. Write date range for pooled milk from more than one day of pumping.
   
2. Make a note on any container/bag you are not sure whether to send*. For example, if you begin taking a new medication for an illness, make note of milk pumped and confirm with MMBNT these bags are okay to donate.
   

*Please do not send marked containers/ bags; contact MMBNT first to discuss if you can donate these marked containers/bags.

SToring Your Milk

• Refrigerate or freeze your milk within 30 minutes of pumping. You may refrigerate your milk up to 96 hours before freezing. DO NOT add anything to, heat, or alter milk in any way other than freezing.
  

• If there is still room for more milk in the container after 1 pumping session, you may add to it before freezing.
  
• You may also add fresh milk to frozen milk using the following method: chill fresh milk in the refrigerator for 30 minutes, then pour chilled fresh milk on top of frozen milk. Close container and replace in freezer.
  

• If you are collecting milk directly into the container/bag you will use for freezing, open it and place the cap on the table facing up.
  

• If you are pumping into another container, leave the storage container closed until you are done pumping and ready to pour the milk into it. Do not touch the top lip of the container or the inside of the cap and container.
  

• Check your freezer regularly (power outages, door ajar, etc.)
  

• Milk for donation needs to reach MMBNT as soon as possible in order to be processed and dispensed in a timely manner. See delivery options here.
  

1. Place your frozen milk bags or containers in a plastic bag (such as a grocery bag; please do not use scented trash bags).
   

You may begin dropping off milk at any time after you have completed your phone screening, but MMBNT will not use your milk until you are approved.

Once you drop off milk, it cannot be returned to you for any reason.

DownLoad Printable Donation cardS:

Donation Card - ENGLISH

SHIPPING Donation Card - English

Donation Card - SPANISH

SHIPPING Donation Card - Spanish

Donor and NICU stories and photos help spread the word to new and potential donors about the benefits of donating to the milk bank and why donor milk is so important for fragile babies.

Share Your Story!

We use your shared videos, photos and stories during the year for our newsletter, social media and blog posts.

We'd love to hear your story: to make it easy for you to share, click here for a downloadable interview form with questions you can use as a guide.

Email your story and photos/videos to maggie@texasmilkbank.org

Follow us on Instagram, Facebook, and TikTok

Use #imakemiracles and tag us on your social media posts

about donating!

MMBNT covers all fees for your non-fasting blood work. Because the test is free, please don’t provide your insurance information.

Blood Test Information:

• Donors are tested for HIV 1, HIV 2, HTLV 1 & 2, Hepatitis B, Hepatitis C and syphilis.
• You still need to complete a blood test to be approved, even if your OB tested for these early in your pregnancy.
  
• All test results are confidential.
  

Options to complete your blood test:

1. At a lab near you- a requisition form for LabCorp or Quest Diagnostics will be emailed to you: make sure you select a site that does routine testing, not a drug testing only site.
2. At-home blood draw- if you live in the DFW or surrounding area, you may be able to get your blood drawn at home through a mobile service. If you’re interested in this option, talk to a donor coordinator.
   

Contact us if you are not in the area covered by the mobile service and there is not a LabCorp or Quest near you. We can make other arrangements on a case by case basis.

Click links to find a lab convenient to you: LabCorp or Quest Diagnostics

What does HIV/AIDS have to do with donating milk?

Acquired Immune Deficiency Syndrome (AIDS) is a condition caused by HIV (the AIDS virus) in which the body’s normal defense mechanisms against certain infectious diseases are severely reduced, putting a person at risk for unusual infections and cancers. HIV can spread via body fluids, including breastmilk. If you are in any of the high-risk groups listed below, we ask that you voluntarily refrain from donating milk:

• Those with a positive result when tested for HIV.
• Those with symptoms and signs of AIDS (unexplained enlarged lymph nodes, unexplained weight loss, night sweats, chronic diarrhea, fungal and viral infections of the mouth, unexplained dark skin nodules).
  
• Sexual partners of HIV-positive individuals, or those who are at risk for HIV infection.
  
• Men who have ever had sex with another man since 1977.
  
• Present or past users of non-medical, injected drugs.
  
• Persons with hemophilia who have received clotting factor concentrates.
  
• Sexual partners of individuals in any of the above categories.
  
• Men or women who have engaged in sex for money or drugs within the last 12 months and persons who have been their sexual partners.
  

1. I have voluntarily chosen to donate my breastmilk to the Mothers’ Milk Bank of North Texas. I understand that I will not be paid for the milk I donate. I am also aware that my milk will not be sold, but a processing fee will be charged to the recipient of the milk. My milk or data about the milk may be used for research or educational purposes.
   
2. will make every effort to see that my milk is donated according to the instructions provided. I understand that it is my responsibility to notify Mothers’ Milk Bank of North Texas:
   
1. If I, my baby, or a member of my household becomes ill
   
2. When I need to take any new medication
   
3. If a situation arises when I can no longer donate
   
4. When I have any questions
   
5. When I have been exposed to a contagious illness or disease
   
3. I am also aware that once my milk has been donated, it becomes the property of Mothers’ Milk Bank of North Texas and may be shared with another nonprofit milk bank if there is a critical need.
   
4. I have read and understand the Notice of Privacy Practices provided by MMBNT and I understand that all donor information is confidential.
   
5. I hereby certify to the best of my knowledge that I understand and have answered all of the questions during my donor interview, including the health screening and medical history questionnaire, truthfully.
   
6. I have reviewed and understand the information provided to me regarding the spread of HIV. I do not consider myself to be a person at risk for spreading HIV.
   
7. I have read all of the information about HIV and the blood tests done for donors.
   
8. I agree to have my blood tested as described in Blood Testing for Donors and I understand that I will be notified if the results are of medical significance and any medically significant results will be reported to the local health department, as required by law.
   
9. I agree that my lab requisition can be sent to a third party company if they are drawing my labs at home or work for my convenience.
   
10. I understand that I am encouraged to discontinue donating milk anytime my participation interferes with my own family’s needs.
    
11. I understand that my approval as a milk donor does not indicate that my milk is safe to share or sell.
    
12. MMBNT will not use my name or picture with prior notification and permission for the purpose of promoting the service of MMBNT or in a newsletter published by MMBNT.
    
13. I understand that if I send photographs or cards to MMBNT they may be shared on social media unless otherwise specified.
    
14. I understand that a small sample of my milk may be tested for common recreational drugs.
    
15. I understand that I must communicate any changes to health & lifestyle every two-months.
    

PRINT FOR YOUR RECORDS.

A federal law took effect on April 14, 2003, called the Health Insurance Portability and Accountability Act (HIPAA) of 1996. One of the goals of this legislation is to set standards for the security and privacy of health information. Mothers’ Milk Bank of North Texas (MMBNT) understands that medical information about clients is personal and we are committed to protecting this information. This notice describes how medical information about clients is our office may be used and disclosed, and how clients can get access to this information. We also describe client rights and certain obligations we have regarding the use and disclosure of medical information. Please review this carefully.

The HIPAA law of 1996 requires MMBNT to:

• Keep medical information that identifies clients private;

• Give clients notice of our legal duties and privacy practices with respect to medical information about them;

• Follow the terms of this notice.

Any protected health information (PHI; i.e. individual identifiable information such as names, date, phone/fax numbers, email addresses, demographic data) may be used in connection with our services to a client, payment of an account or healthcare operations. It is expected that any organization with which we share information is HIPAA compliant, therefore ensuring the security of client information.

These are ways in which we may use or disclose medical information about a client:

• Healthcare providers may request PHI in order to meet our needs. For instance, a prenatal care provider may request verification of a patient’s birthdate before releasing results of their prenatal bloodwork to us. Or, a baby’s pediatrician may request information on how milk has been supplied for the baby receiving donor milk.

• PHI may be discussed with health insurers to verify eligibility for benefits, obtain prior authorization, or to bill and receive payment for the treatment and services provided by MMBNT.

• Certifying, licensing and accrediting bodies may request information about our donors or recipients in order to verify our operation and compliance with standards.

• We may provide PHI to our business associates so that they can perform certain functions or services on our behalf. These associates could include hospitals, blood and tissue laboratories or fundraising organizations.

• We will disclose PHI if required to do so by federal, state or local law.

• We may disclose PHI when necessary to prevent a serious threat to a client’s health and safety or that of another person or the public.

• We may disclose PHI for public health activities. These activities may include the prevention or control of disease, reporting of donor milk recipients, or reporting laboratory test results.

Individual rights under this agreement:

• A client has the right to inspect or copy their record. To do this, please submit your request in writing to the MMBNT privacy officer.

• Amend the information contained in your record. Please send your request in writing to the privacy officer.

• Request an accounting of all disclosures of PHI. Please send requests to the privacy officer.

• Request restrictions of access to a client record. Please send your request in writing to the privacy officer.

• A client may also issue a complaint, without risk of retaliation, to the MMBNT privacy officer or to the U.S. Department of Health and Human Services.

Privacy Officer:

Shaina Starks, MPH, CPH

Mothers’ Milk Bank of North Texas

7617 Benbrook Parkway, Fort Worth, TX 76126

Please keep this notice for your records. When you sign the Donor Consent Form on the Donor Interview Form, you acknowledge that you have received and understand this notice. Please call MMBNT with any further questions.