2108.10 Anatomical gift forms.

(A) The document of gift provided for in division (B)(1) of section 2108.04 of the Revised Code shall conform substantially to the following form:

“ANATOMICAL GIFT OF

...................................

(Print or type name of living donor)

In the hope that I may help others upon my death, I hereby give the following body parts:

.............................................. for any purpose authorized by law: transplantation, therapy, research, or education.

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

Witness

This is a legal document under the Uniform Anatomical Gift Act or similar laws.”

The statement of an anatomical gift provided for in division (B)(3) of section 2108.04 of the Revised Code and section 2133.16 of the Revised Code shall conform substantially to the form provided in division (B) of section 2133.07 of the Revised Code.

(B) The document of gift provided for in division (E) of section 2108.04 of the Revised Code shall conform substantially to the following form:

“ANATOMICAL GIFT BY A RELATIVE

OR THE GUARDIAN OF

THE PERSON OF A DECEDENT

I hereby make this anatomical gift from the body of …................. (name) who died on …................. (date) in …................. (city and state)

The marks in the appropriate squares and the words filled into the blanks below indicate my relationship to the decedent and my desires respecting the anatomical gift.

1. I survive the decedent as:

1. [ ] spouse;

2. [ ] adult son or daughter;

3. [ ] parent;

4. [ ] adult brother or sister;

5. [ ] grandparent;

6. [ ] guardian of the person;

7. [ ] person authorized to dispose of the body

2. I hereby give the following body parts:

[ ] heart [ ] liver [ ] skin [ ] middle ear

[ ] kidneys [ ] lung [ ] heart valves [ ] other …...

[ ] pancreas [ ] eyes [ ] bone/ligament

for:

[ ] any purpose authorized by law

[ ] transplantation

[ ] therapy

[ ] medical research and education

3. After the donated organs, tissues, or eyes are removed, the remains of the body shall be disposed of in the following manner:

........................; at the expense of the following person:

........................

Date

........................

City and State

........................

Witness

........................

Signature of Survivor

........................

Witness

........................

Address of Survivor”

“Upon my death, I make an anatomical gift of organs, tissues, and eyes for any purpose authorized by law.”

The statement may be included on an application for a driver’s license, commercial driver’s license, motorcycle operator’s license or endorsement, or state identification card. The donor shall sign the statement or the application containing the statement. If the donor is under eighteen years of age, a parent or guardian of the donor also must sign the statement or the application containing the statement.

Effective Date: 11-21-2001; 09-16-2004