Transplant Support Group

Transplant Support Group (Malta)

Online Registration to Become an Organ Donor

NOTE: A donor card will be referred to you upon receipt of this application. Always carry the donor card with you. Also inform your family of your decision.

Full Name

Full Address

Sex

Male Female

ID Card No

Date of Birth

E-mail

Tel. No

I hereby consent to the following donation after my death:

(Please check with (*) ONE BOX only.)

All organs and tissues needed for transplant;

All organs and tissues needed for transplant except the following. (Mark with * where applicable)

Heart	Kidneys	Corneas
Liver	Pancreas	Lungs

In case of my death please inform:

Tel. no.

Please enlist my name in the Organ Donation Register so that, following my death, my organ/s can be used in the care of others

* required fields