Become An Organ Donor - Organ Donation Information in India | Donate Life

In the presence of person mention below hereby equivocally authorise the removal of following organ(s)d/or tissue(s), from the body after being declared brain stem dead by the board of medical experts and consent to donate the same for therapeutic purposes.

Please Tick as Applicable

(Tissues can also be donated after Brain Stem Death as well as Cardiac Death)

My Blood Group is(if Known)

Telephone No.

Email Id.^*

Address for correspondence^*

Name of Relative

First Name^*

Middle Name

Last Name

Aged

Telephone No.^*

Email ID^*

Gender^*

Male Female

Your Relation with applicant^*

Note:

Organ Donation is a family decision. So 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.
The person making the pledge has the option to withdraw the pledge.
After filling the form, Kindly send it to Donate Life, on address mention below.

Sample Donor Card:

Front Side:

Back Side:

"Donate Life"

Address:
Prime Shoppers, 428 to 430, 4th Floor, Near Happy Residency,
Opp. Safal Square, University Air Port Road, Vesu, Surat-395007.
Phone No: +91-7573011101/03/07/09
Email: [email protected]
Website: www.donatelife.org.in
Toll Free Number: 1800 200 1944

An initiative for organ donation

Become a Organ Donor

Personal Information