Register as donor – Organ Donar(Organ, Skin, Body and Eye)

Organ Donation Online Form

"*" indicates required fields

Name*

First Fathers/Spouse Name

Date of Birth(Only persons above 18 years are eligible)*

Blood Group*

Please tick as applicable

Organs to Pledge*

Heart

kidney

Lungs

Liver

Pancreas

Intestinal Tract

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

Corneas/Eye Balls Skin

Bones

Heart Valves

Blood

Vessells

Tissue

Are you willing to donate entire entire body after death

Entire Body(Entire body can be donated after death)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone/Mobile*

Witness Name

Alternate Mobile Number for Reference or Witness*

Email*

Aadhar Card

Accepted file types: jpg, jpeg, png, gif.

Volunteer Photo

Accepted file types: jpg, jpeg, png, gif.

How do you came to know about organ donation

Social Media

Newspaper

Rotary Club

Friends

Referral

Others

Digital Signature

Consent*

I agree to the privacy policy.

1. 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.
2.One copy of the pledge form/pledge card to be with respective networking organization, one copy to be retained by institution where the pledge is made and one copy to be handed over to the pledger.
3.The person making the pledge has the option to withdraw the pledge.

I am organ donar

Organ Donor ID card will be received shortly after submission of this form

Download ORGAN DONATION FORM