ORGAN RETRIEVAL BANKING ORGANIZATION (ORBO)
All India Institute of Medical Sciences
Ansari Nagar, New Delhi-110029
ORGAN(S) AND TISSUE(S) DONOR FORM
 
     
Regn. No.
D  
 
   
* Name

 
Gender
Organ Name
              
Tissues
             
(Tissues can also be donated after Brain Stem Death as well as Cardiac Death)
Blood Group
* Date of Birth
 
* Address  
City State
Email
* Mobile No

 
Choose Identity Proof Enter Identity Card No
Emergency Contact No.    
       
Details of witnesses      
Witness 1      
Name Address
Mobile No    
       
Witness 2      
Name Address
Mobile No    
       
I uneqivocally authorise the removal of the above organ(s) and/or tissue(s), from my body after being declared brain stem dead by the board of medical expperts and consent to donate the same for therapeutic purposes.
 
For Further Information Click Here www.orbo.org.in