Transplant Support Group

Transplant Support Group (Malta)

Online Registration to Become an Organ Donor

NOTE: A printed copy of this form will be sent to you to be signed and returned together with a donor card. 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