NYS Donate Life Organ and Tissue Donor Registry Enrollment Form
By enrolling in the Donate Life Registry, you are giving legal consent for the recovery of your organs, tissues and eyes for the purposes of transplantation and research at the time of your death. Registry information is kept strictly confidential and can only be accessed by a) Department of Heath employees when required for the performance of their official duties, b) federally regulated organ procurement organizations, c) New York State licensed tissue and eye banks and d) other entities formally approved by the Commissioner. Such access can only be for the purpose of identifying potential organ and tissue donors at or near the time of death.
In order for your Donate Life Organ and Tissue Donor Registry Enrollment Form to be filed as a legal document with the New York State Department of Health, we ask that you please print out the form, fill out all the required information, and sign at the bottom. Please mail your completed enrollment form directly to the address provided.
Download Donor Registry Form (PDF)
