Page:United States Statutes at Large Volume 84 Part 1.djvu/326

 268 Uniform donor card form.

PUBLIC LAW 91-268-MAY 26, 1970

[84 STAT.

(2) Any such document referred to in paragraph (1) of this subsection may be in the following form and contain the following information: UNIFORM DONOR CARD of p r i n t or type name of donor

In the hope that I may help others, I hereby make this anatomical gift, if medically acceptable, to take effect upon my death. The words and marks below indicate my desires. I give: (a)—any needed organs or parts (b)—only the following organs or parts specify the organ (s) or part (s)

for the purposes of transplantation, therapy, medical research, or education; (c)—my body for anatomical study if needed. Limitations or special wishes, if any: (Other side of card)

Signed by the donor and the following two witnesses in the presence of each other: Signature of donor

Date of birth of donor

Date signed

City and State

Witness

Witness

This is a legal document under the District of Columbia Anatomical Gift Act or similar laws. Donee provi-

Surgeon or p h y s i c i a n, designation.

Recorded message.

(c) The gift may be made to a specified donee or without specifying a donee. If the latter, the gift may be accepted by the attending physician as donee upon or following death. If the gift is made to a speciiied donee who is not available at the time and place of death, the attending phj^sioian upon or following death, in the absence of any expressed indication that the donor desired otherwise, may accept the gift as donee. The physician who becomes a donee under this subsection shall not participate in the procedures for removing or transplanting a part. (d) Notwithstanding section 7(b), the donor may designa^ in his will, card, or other document of gift the surgeon or physician to carry out the appropriate procedures. In the absence of a designation, or if the designee is not available, the donee or other person authorized to accept the gift may employ or authorize, any surgeon or physician for the purpose. (e) Any gift by a person designated in section 2(b) shall be made by a document signed by him, or made by his telegrapnic, recorded telephonic, or other recorded message.

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