MAKE YOUR FREE Organ Donation Form
What is an Organ Donation Form?
When to use an Organ Donation Form:
- You want written documentation to help assure that your wishes are honored.
- You want to specify which organs may, or may not, be donated.
- You want to specify a certain person to receive your organ donation.
Sample Organ Donation Form
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for any purpose authorized by law, including transplantation, therapy, research, or education.
Limitations or special wishes, if any:
If any provision in this document is held to be invalid, such invalidity shall not affect the other provisions which can be given effect without the invalid provision, and to this end the directions in this document are severable.
I witnessed that this document was signed in my presence by the Donor and certify that the Donor was of sound mind and memory and free of any undue influence and knew the objects of his bounty and affection. I am signing in the presence of and at the direction of the Donor and in the presence of the other witness:
I witnessed that this document was signed in my presence by the Donor. I am signing in the presence of and at the direction of the Donor and in the presence of the other witness:
in accordance with Indiana's Anatomical Gift ActI witnessed that this document was signed in my presence by at the direction of and in the presence of the Donor who was physically unable to sign. I am signing in the presence of and at the direction of the Donor and in the presence of the other witness:
I witnessed that this document was signed in my presence by at the direction of and in the presence of the Donor who was physically unable to sign and certify that the Donor was of sound mind and memory and free of any undue influence and knew the objects of his bounty and affection. I am signing in the presence of and at the direction of the Donor and in the presence of the other witness:
WeI and Parent(s) Guardian(s) and sign this document in the presence of the Donor and two additional witnesses who sign belowParent Signature: __________________________________________Guardian Signature: __________________________________________
I witnessed that this document was signed in my presence by the Donor. I am signing in the presence of and at the direction of the Donor and in the presence of the other witness:
I witnessed that this document was signed in my presence by the Donor and the Donor's I am signing in the presence of and at the direction of the Donor and in the presence of the other witness:
I witnessed that this document was signed in my presence by the Donor and the Donor's and certify that the Donor was of sound mind and memory and free of any undue influence and knew the objects of his bounty and affection. I am signing in the presence of and at the direction of the Donor and in the presence of the other witness:
WeI and Parent(s) Guardian(s) Parent Signature: __________________________________________Guardian Signature: __________________________________________
WARNING: One of the witnesses should be a parent or guardian who also consents to the donation.
This is a legal document under the Uniform Anatomical Gift Act or similar laws.
