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Organ Donor Declaration

Complete this form to build an Organ Donor Declaration.

Click here for a sample. All information appearing in bold type are the form fields that are either automatically completed by the program or completed based on information you supplied in this form.

Donor:
(Your name)
Donation:
a)Any needed organs.
b)Only the following organs for purposes of transplantation, therapy, education or medical research:
(list organs you want to donate)
c)My entire body, for anatomical or medical study, if needed.
Limitations or special wishes:
(Use this optional space to list any special wishes or limitations you have in donating your organs.)

This is not a substitute for legal advice and it is suggested that an attorney be consulted.

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