FORM 7

FOR ORGAN OR TISSUE PLEDGING
(To be filled by individual of age 18 year or above)
[Refer rule 5(4)(a)]
ORGAN(S) AND TISSUE(S) DONOR FORM
(To be filled in triplicate)



Registration Number (To be allotted by Organ Donor Registry) :

 

Please tick as applicable

(Following tissues can also be donated after brain stem deathas well as cardiac death)

(Note: In case of online registration of pledge, one copy of the pledge will be retained by pledger, one by the institution where pledge is made and a hard copy signed by pledger and two witnesses shall be sent to the nodal networking organisation.)

(Details of Witness 1)

(Details of Witness 2)

(Note:

(i) Organ donation is a family decision. Therefore, it is important that you discuss your decision with family members and loved ones so that it will be easier for them to follow through with your wishes.

(ii) One copy of the pledge form/pledge card to be with respective networking organisation, one copy to be retained by institution where the pledge is made and one copy to be handed over to the pledger.

(iii) The person making the pledge has the option to withdraw the pledge.