I consent to the donation and removal of organs, eyes and tissues from my body by surgeons and technicians authorized by LifeShare of Oklahoma and/or Oklahoma Lions Eye Bank. I understand this consent authorizes tests, examinations, or procedures that are necessary to assure medical acceptability of all organs, eyes and tissues. These tests are to assist in matching organs, eyes and tissues with appropriate recipients in accordance with current medical standards. This includes, but is not limited to, removal of lymph nodes, spleen and blood, testing for HIV and other transmissible diseases. I also understand these test results may be the basis for not using organs, eyes and tissues for transplantation.

I consent to the release of my complete medical record, as necessary, to those individuals involved in the organ, eye and tissue donation, recovery and transplantation process. I understand that this release of information includes medical records, autopsy reports, serological test results (including, but not limited to HIV) of infectious diseases, and documentation of mental health or substance abuse treatment. I expressly agree that the above stated recovery agencies may disclose such information as it deems necessary.

I understand that all hospital and medical expenses incurred prior to signing this consent or which are unrelated to organ, eye and tissue donation will be the responsibility of my financial provider. I further understand that there will be no charge for hospital or medical services relating to the organ, eye and tissue donation from the time of brain death, or cardiac death diagnosis, or when LifeShare of Oklahoma and/or Oklahoma Lions Eye Bank has accepted financial responsibility through the recovery of the organs, eyes and tissues.

In consideration of compliance with my wishes described in this registration, I hereby release all parties including, but not limited to the hospital, OPO, Tissue Bank and Eye Bank and their respective directors, officers, employees, agents and designees, from any and all liability or responsibility of any nature whatsoever in connection with any procedure performed in conjunction with this donation.

I understand and agree that my donations can be limited to certain portions of my body and/or for certain purposes (transplantation, therapy, research, non-research). I also understand and agree that it is unlawful for anyone to sell organs or tissue for any reason. Further, I understand and agree that any donations I allow are made to LifeShare Transplant Donor Services of Oklahoma Inc. and/or the Oklahoma Lions Eye Bank to be used in accordance with Oklahoma law regardless of whether the entity receiving or processing my donations is considered a non-profit or profit entity.

I Understand and Agree