20 05 OPTIONAL ORGAN AND TISSUE DONATION
| Jurisdiction | Arkansas |
| Library | Arkansas Form Book - Complete (2023 Ed.) |
20-05 OPTIONAL ORGAN AND TISSUE DONATION
I, [name], hereby authorize the donation for transplantation and/or medical research of the following anatomical gifts:
Body
Bone
Eyes
Heart
Heart Valves
Kidneys
Liver
Lung
Pancreas
Skin
All of the Above
Other __________
I further consent to the removal of any blood and tissue samples needed for lab tests. I also consent for the procurement coordinator and physicians to have access to medical records related to the donation.
Signed this ___ day of ___.
Signature...
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