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Ch. 522
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2006 LAWS OF MARYLAND
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AFTER MY DEATH, DONATION OF ORGANS OR BODY
(THIS FORM IS OPTIONAL. FILL OUT ONLY WHAT REFLECTS YOUR WISHES.)
BY:_______________________________ DATE OF BIRTH: ___________________
(PRINT NAME) (MONTH/DAY/YEAR)
PART I: ORGAN DONATION
(INITIAL THE ONES THAT YOU WANT.)
UPON MY DEATH I WISH TO DONATE:
ANY NEEDED ORGANS, TISSUES, OR EYES. ________
ONLY THE FOLLOWING ORGANS, TISSUES, OR EYES: ________
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I AUTHORIZE THE USE OF MY ORGANS, TISSUES, OR EYES:
FOR TRANSPLANTATION ________
FOR THERAPY ________
FOR RESEARCH ________
FOR MEDICAL EDUCATION ________
FOR ANY PURPOSE AUTHORIZED BY LAW ________
I UNDERSTAND THAT NO VITAL ORGAN, TISSUE, OR EYE MAY BE REMOVED
FOR TRANSPLANTATION UNTIL AFTER I HAVE BEEN PRONOUNCED DEAD
UNDER LEGAL STANDARDS. THIS DOCUMENT IS NOT INTENDED TO CHANGE
ANYTHING ABOUT MY HEALTH CARE WHILE I AM STILL ALIVE. AFTER
DEATH, I AUTHORIZE ANY APPROPRIATE SUPPORT MEASURES TO MAINTAIN
THE VIABILITY FOR TRANSPLANTATION OF MY ORGANS, TISSUES, AND EYES
UNTIL ORGAN, TISSUE, AND EYE RECOVERY HAS BEEN COMPLETED. I
UNDERSTAND THAT MY ESTATE WILL NOT BE CHARGED FOR ANY COSTS
RELATED TO THIS DONATION.
PART II: DONATION OF BODY
AFTER ANY ORGAN DONATION INDICATED IN PART I, I WISH MY BODY TO BE
DONATED FOR USE IN A MEDICAL STUDY PROGRAM.
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PART III: DISPOSITION OF BODY AND FUNERAL ARRANGEMENTS
I WANT THE FOLLOWING PERSON TO MAKE DECISIONS ABOUT THE DISPOSITION OF
- 2592 -
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