ORGAN RETRIEVAL BANKING ORGANIZATION (ORBO)

All India Institute of Medical Sciences

Ansari Nagar, New Delhi-110029

ORGAN(S) AND TISSUE(S) DONOR FORM

Enter the Category
Regn. No.
D
* Name
 
Gender
Organ Name
         
Tissues
 
(Tissues can also be donated after Brain Stem Death as well as Cardiac Death)
Blood Group
* Date of Birth

 
* Address
 
City
State
Email

* Mobile No

 
Choose Identity Proof
Enter Identity Card No
Emergency Contact No.
Details of witnesses
Witness 1
Name
Address
Mobile No
Witness 2
Name
Address
Mobile No
  I uneqivocally authorise the removal of the above organ(s) and/or tissue(s), from my body after being declared brain stem dead by the board of medical expperts and consent to donate the same for therapeutic purposes.

 
For Further Information Click Here www.orbo.org.in
 

Computer Facility@aiims 2018