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Register as a Donor
Name and Donation Preferences
Step 1 of 5
First Name
Middle Name
Last Name
Donation Preference
Please remove me from the organ donation registry.
I wish to donate any needed organs and tissue.
I wish to specify limitations.
Donate Organs
Heart
Lungs
Liver
Kidneys
Pancreas
Small Intestine
Donate Eyes
Whole eyes
Corneas
Donate Tissue
Skin
Bone
Veins
Tendons & ligaments
Heart Valves & associated cardiovascular tissue
Medical Research
Should it be determined that the consented gifts are unsuitable for transplantation...
Authorization is granted for these gifts to be placed for medical research/education purposes.
I do not give consent for these gifts to be placed for medical research/education purposes. The gift should be appropriately discarded.
Duke Miracles in Sight (MiS) BioSight Research Program
I agree to donate my eyes/corneas for the Duke-MiS BioSight research program.
I do not agree to donate my eyes/corneas for the Duke-MiS BioSight research program.
Eye Disease
Macular Degeneration (AMD)
Glaucoma
Keratoconus
Myopia
Fuch's Dystrophy (and other cornea disease)
Retinitis Pigmentosa
No known eye disease
Other
Other Eye Disease
Eye Clinic/Provider
Step 1 of 5: Name & Preferences
1
Name & Preferences
(current)
2
Address & ID
(pending)
3
Personal Info
(pending)
4
Account Setup
(pending)
5
Consent
(pending)