How to Satisfy the NCAA Sickle Cell Testing Requirement: Opt-Out Removed

The NCAA sickle cell trait waiver form no longer exists. As of August 1, 2022, student-athletes can no longer sign a liability release to opt out of screening. If you are entering a Division I, II, or III program, you must confirm your sickle cell trait status before you are cleared to practice, compete, or take part in conditioning.¹

Why the Opt-Out Was Removed

Before August 2022, a student-athlete could sign a form releasing the university and the NCAA from liability rather than be tested.² The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports recommended eliminating the waiver across all three divisions, and the change took effect August 1, 2022.³ The reasoning was practical: athletes who declined testing could not be given the exercise precautions that protect trait-positive individuals from exertional sickling collapse.

The risk is not hypothetical. Military research found recruits with sickle cell trait were roughly 30 times more likely to die during basic training than those without, and their risk of exertional rhabdomyolysis was about 200 times higher.⁴ At least 15 college football players died from exertional sickling over a four-decade span, nearly all at schools that did not screen or had let precautions lapse.

If You Already Signed a Waiver Before August 2022

Athletes who signed the old waiver before August 1, 2022, are grandfathered in. They are not required to produce sickle cell solubility test results to keep participating.⁵ Getting tested anyway is still the safer choice. Once your training staff knows your trait status, they can adjust workouts to reduce your risk of a sickling episode, and that protection disappears if you rely on the grandfathered waiver.

How to Satisfy the Testing Requirement Now

Every student-athlete new to sport participation at their school, including prospective athletes trying out, must complete a sickle cell solubility test or provide documented results of a previous test before being cleared for practice, competition, or off-season conditioning.⁶ Only sickle cell solubility test results satisfy the rule; other hemoglobin tests on their own may not qualify.

You have three ways to meet the requirement:

Submit prior test results. If you have been tested before, give documented results from a physician or authorized medical provider to your school’s athletic training staff.
Provide newborn screening records. Every state screens newborns for sickle cell disease and trait at birth. Ask your healthcare provider or your state’s newborn screening program for a copy. Many schools accept these records as proof of status.
Take a new solubility test. If you have no prior results and cannot retrieve your newborn screening records, you will undergo a sickle cell solubility test as part of your preparticipation medical exam. It is a simple blood draw. Out-of-pocket costs for uninsured individuals typically run from about $25 to $100, though many schools cover the test or fold it into the athletic physical.

Your school’s athletic training staff or sports medicine department will point you to where to submit documentation. Most programs use a secure athletic department portal or electronic health record system where you upload results directly. A written release is not an option for anyone entering a program after August 1, 2022.⁵

If You Test Positive

Testing positive does not disqualify you from playing. The NCAA treats sickle cell trait as a condition to manage, not a bar to competition, and trait-positive athletes compete at the highest levels of collegiate sport.⁶ The point of screening is to let coaches and athletic trainers build a conditioning plan around your status.

Standard precautions include gradual preseason conditioning rather than peak-intensity starts, self-paced workouts during timed runs and sprints, longer rest between high-intensity repetitions, and stopping activity immediately at the first sign of muscle pain, abnormal weakness, undue fatigue, or unusual breathlessness. Hydration matters, especially in heat, and high-caffeine energy drinks should be avoided. Altitude counts too: even a rise of 2,000 feet can affect a trait-positive athlete, so training modifications and supplemental oxygen should be available at elevation. Schools are expected to keep an automated external defibrillator and supplemental oxygen accessible at practices and conditioning sessions.⁶

Privacy of Your Test Results

Your sickle cell trait status is a medical record and is protected. Athletic departments at colleges and universities are generally subject to FERPA, which covers most student health and medical information the school maintains. Athletic training staff cannot release your information to media, professional scouts, teammates, or even your parents without proper authorization. Information about your trait status is typically shared with a head coach only at the direction of the head athletic trainer or team physician. Some athletic departments also run HIPAA-covered health clinics, which adds another layer of protection. Either way, your screening results are not public and should reach only the medical and coaching staff who need them to keep you safe.

1
NCAA. Sickle Cell Trait
2
The Hematologist. Division (I): ASH Opposes NCAA Requirement for Screening
3
NCAA. Report of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports
4
National Athletic Trainers’ Association. Consensus Statement: Sickle Cell Trait and the Athlete
5
NCAA. Report of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports
6
NCAA. NCAA Sports Medicine Handbook