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I consent to give the organs and/or tissues and/or eyes listed above. I hereby give consent to release any information and reports pertaining to the evaluation, use, and follow-up of my donated organs, eyes, and/or tissue to authorized personnel in order to determine the medical suitability and safety of these gifts. This information includes hospital records and post mortem examination reports.
Under the North Carolina Uniform Anatomical Gift Act (SB1372/The Heart Prevails), an anatomical gift not revoked by the donor before death is irrevocable and does not require consent or concurrence of any person after the donor's death. The law also authorizes any examination necessary to assure the medical acceptability of the anatomical gift.
In order to comply with my wishes, representatives from all organ, eye, and tissue procurement entities serving North Carolina are authorized to examine or remove copies of medical records, obtain blood and tissue samples to test for hepatitis, HIV, syphilis, and conduct any other examination to determine the medical suitability of the anatomical gift.
A different location may be needed to carry out the recovery of donated organs, eye and tissue. In that case, my body may be transferred to an alternative surgical facility such as a nearby hospital or surgery suite, for the recovery of organs, eyes, and tissue.
Should I wish to change or revoke this donation consent, I will need to do so through the Donate Life North Carolina website at www.donatelifenc.org. I may also indicate my consent to be a donor by having a heart placed on my license at the NC DMV, but this is a separate registration.
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