UNIFORM DONOR CARD
In the hope that I may help others, I hereby make this anatomical gift, if medically acceptable, to take affect
upon my death. The following indicates my desires:
I give
(a)_________any needed organs or parts
or
(b)_________only the following organs or parts
_______________________________________
(Specify the organ(s) or part(s))
for the purposes of transplantation.
_______________________________________
Signature of Donor
_______________________________________
Signature of Witness
_____/_____/_____
Date Signed
_______________________________________
City and State
This is a legal document under the Uniform Anatomical Gift Act or other similar laws.
Please remember to inform your loved ones about your decision to donate.
California Transplant Donor Network
888-570-9400
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