Free Organ Donation Agreement by Living Donor

This Anatomical Gift by Living Donor is written notification that an individual wants to donate his or her organs upon death. This gift sets out the name of the donor, the specific organs to be donated and the donee. This Anatomical Gift by Living Donor must be signed and dated by the donor in the presence of two witnesses.

Disclaimer:This was not drafted by an attorney & should not be used as a legal document.




Anatomical Gift by Living Donor

On this __________________ day of _________________________________, 20___________, I ______________________________ of _______________________________________________ (the “Donor”), hereby gift the following organs, tissues, or parts only: ____________________________________________________________________________________________________________________________________________________________________upon my death to _________________________________________________________________ of ______________________________________________________________ (the “Donee”).
I gift the above mentioned organs for the following purposes ___________________________ _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.

SIGNATURE: ___________________________________
Date: __________________
Name: ______________________________________

FIRST WITNESS
SIGNATURE: ___________________________________
Date: __________________
Name: ______________________________________

SECOND WITNESS
SIGNATURE: ___________________________________
Date: __________________
Name: ______________________________________

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