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
 

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