Mohan Foundation(Multi Organ Harvesting Aid Network)-THO Form

FORM 9
(See rule 4(3) (b))

I, Mr/Mrs....................................son of / wife of
....................... resident of ...........................hereby
authorise removal of the  organ/organs namely .......................for therapeutic purposes from the dead body of my son/daughter . Mr/Ms ...............................
aged......... whose brain stem death has been duly certified
in accordance with the law

Signature..............................

Name.................................
Place...................................
Date..................................

                                    FORM -10

     APLICATION FOR APPROVAL FOR TRANSPLANTATION
              LIVE DONOR OTHER THAN NEAR RELATIVE

Whereas I ....................................................
S/O, D/O, W/O, L/O. ............... aged residing..............................have been informed by
my doctor that I am suffering from.......................and
may be  benefitted by transplantation .........................
into my body. and  whereas I .....…………………… S.O. D.O. W.O............................. aged .................. residing at..............................by reason of affection and
attachment because :
..............................................................................
...............................................................................
(reason to be filled in) would like to donate my ..................
to ........................we................................. (donor) and ....................... hereby apply to authorisation committee
for permission      (Recipient) for such transplantation to be
carried out. We solemnly affirm that the  above decision has
been taken without any undue pressure, inducement, influence
or allurement and that all-possible consequences and options
of organ transplantation have been explained to us.
...................................................................................
.................................................................................... Signature and address of prospective

donor                                                        recipien