* Mandatory

*1. Are you aware that organs can be donated to save a life of another person?

Yes  No

*2. When Can Organs be donated?

During Life  After Death   Both

*3. Which organs can be donated?

Eye Skin Heart Lungs Pancreas Kidney Bones Liver All

*4. Do you have a relative whose organs have been donated?

Yes  No

*5. Can we sell our organs (like kidney)?

Yes  No  Not Sure

*6. Have you heard of brain death?

Yes  No

*7. As the next of kin, would you be willing to donate the organ(s) of a brain dead relative?

Yes  No

*8. Are you aware that a parliamentary law in India recognizes brain death as a form of death so that organs like kidneys, heart, liver and lungs can be donated to needy patients?

Yes  No

*9. Do you know what is an organ donor card?

Yes  No

*10. Are you willing to carry an organ donor card and express your desire about organ donation after your death?

Yes   No

Personal Details
*Country :	Afghanistan Albania Algeria American samoa Andorra Angola Anguilla Antarctica Antigua and barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and herzegovina Botswana Bouvet island Brazil British indian ocean territory Brunei darussalam Bulgaria Burkina faso Burundi Cambodia Cameroon Canada Cape verde Cayman islands Central african republic Chad Chile China Christmas island Coco (keeling islands) Colombia Comoros Congo Cook islands Costa rica Cote d'ivoire (ivory coast) Croatia (hrvatska) Cuba Cyprus Czech republic Denmark Djibouti Dominica Dominican republic East timor Ecuador Egypt El salvador Equatorial guinea Eritrea Estonia Ethiopia Falkland island (malvinas) Faroe islands Fiji Finland France France (metropolitan) French guiana French polynesia French southern territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bissau Guyana Haiti Heard and mcdonald islands Honduras Hong kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (north) Korea (south) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands antilles New caledonia New zealand Nicaragua Niger Nigeria Niue Norfolk island Northern mariana islands Norway Oman Pakistan Palau Panama Papua new guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto rico Qatar Reunion Romania Russian federation Rwanda S. georgia and s. sandwich isls Saint kitts and nevis Saint lucia Saint vincent and the grenadines Samoa San marino Sao tome and principe Saudi arabia Senegal Seychelles Sierra leone Singapore Slovak republic Slovenia Solomon islands Somalia South africa Spain Sri lanka St. helena St. pierre and miquelon Sudan Suriname Svalbard and jan mayen islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and tobago Tunisia Turkey Turkmenistan Turks and caicos islands Tuvalu Uganda Ukraine United arab emirates United kingdom United states Uruguay Us minor outlying islands Uzbekistan Vanuatu Vatican city state (holy see) Venezuela Viet nam Virgin island (british) Virgin island (us) Wallis and futuna islands Western sahara Yemen Yugoslavia Zaire Zambia Zimbabwe
*Email :	Privacy Policy**
*Your Age:	(You should be over 15 years to take this survey)
*Sex:	Male  Female
Designation	(If you are working or self employed, Please indicate your designation - this would help us to create in-depth reports on the issue.)
*Education Qualification	UG	PG	PhD	Others
*Religion:	Hindu	Muslim	Christian	Others	Not Interested
(If you feel too sensitive and do to wish to disclose this information - please mark not interested)
Name of Organisation	(If you belong to any school, college, hospital or corporate, please mention it. Invite others in your group and we can send you a customized report.)
Any suggestion to improve organ donation in India -
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