Puerto Rico Donor Registry

YES! I wish to donate my organs, tissues, and eyes to save or enhance someone's life through transplantation.

First Name*

Middle Name

Last Name*

Mother's Maiden Name*

Driver's License Number/ ID#

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Most Recent Address*

City*

State*

ZIP Code*

Date of Birth* (ex: MM/DD/YYYY)

Gender*

Ethnicity

Continue to Step 3

Phone

E-mail Address*

Password*

Passwords must be 6 characters long.

(Retype Password)*

Would you like to specify donation limitations? A donation limitation is a particular donation you wish to exclude from the Registry and explicitly states you do NOT give your legal consent for those organs and/or tissues to be recovered. Limitations may include: heart, lungs, liver, kidneys, pancreas, intestine, eyes/cornea, skin grafts, heart valves, bones and soft tissue (i.e., tendons).

Yes, I would like to specify limitations for my donation.

By submitting this registration I affirm that I am the applicant described on this application and that the information entered herein is true and correct to the best of my knowledge. This registration will serve as a document of gift. A document of gift, not revoked by the donor before death, is irreversible and does not require the consent of any other person. It also authorizes any examination necessary to ensure the medical acceptability of the anatomical gift.

Yes, I accept the Terms and Conditions.*

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