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Manner of making anatomical gifts.
UNIFORM DONOR CARD
The undersigned hereby makes this anatomical gift, if medically acceptable, to take effect on death. The words and marks below indicate my desires:
I give:
(a) any needed organs, tissues, or eyes;
(b) only the following organs, tissues, or eyes
[Specify the organs, tissues, or eyes]
for the purpose of transplantation, therapy, medical research, or education;
(c) my body for anatomical study if needed. Limitations or special wishes, if any:
(If applicable, list specific donee;
this must be arranged in advance with the donee.)
Signed by the donor and the following witnesses in the presence of each other:
(Signature of donor) (Date of birth of donor)
(Date signed) (City and State)
(Witness) (Witness)
(Address) (Address)