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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 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
 

 

 

 
Bank of Valletta plc