• December 2019
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Refuse Organ Donation Form

When to use Refuse Organ Donation Form

Too often, loved ones and medical providers are not made explicitly aware of a patient’s preferences concerning organ donation. When that patient passes away, it is his or her closest loved ones who are tasked with deciding whether to allow that individual’s organs and other tissues to be harvested. If you have strong feelings about organ donation and want to make sure that your loved ones and medical team are aware that they should not authorize the harvest of your organs and tissues once you have passed away, you should consider filling out a refuse organ donation form. Once completed, you can have it placed on record in your medical chart and can make your loved ones aware of your preferences. That way, your wishes will ultimately be respected and your loved ones will not have to grapple with the uncertainty of not knowing whether they should donate your organs or not.


If you have not yet formally articulated your wishes concerning your desire to withhold permission in regards to organ donation, you can use this form to do so. If you had previously authorized permission and would now like to revoke it, you can use this form to accomplish that aim as well. Once completed, make sure to save a copy for your records. You may also wish to have your medical providers include a “refusal to become an organ donor” alert in your chart and may benefit from educating your loved ones about your wishes. That way, you can better ensure that your preferences are respected once you are gone.

Alternative Names

Refuse Organ Donor Verification
Refuse Organ Donation Verification Form
Organ Donor Refusal Form
Organ Donor Refusal Notification
Organ Donor Refusal Notification Form