Please fill out the form below to register as an organ, eye and tissue donor. By registering as a donor you consent to donate your organs, corneas and tissues at the time of your death. Organs and tissues will be recovered for the purpose of transplantation; however, in the event a donated organ or tissue cannot be used for transplant, an effort will be made to use the donation for research.
Registration Section:
*Select One:
Your Full Name (Enter legal name as it might appear on your government issued ID):
*First Name:
Middle Name:
*Last Name:
*Date of Birth:
Residential Address
*Street Address:
Address 2:
*City, State, Zip:
Contact Information:
*Email Address:
(for confirmation of your donor registration)
Last four digits of your Social Security Number (for ID verification purposes only):
*Last four SS#:
If there are specific organs and tissues you do NOT wish to donate, list them here. Also, indicate here if you do not wish your donation to be used for research.
*How did you hear about the Nevada Donor Registry?
Registering in memory of:
Information Contacts:
Nevada Organ and Tissue Donor Task ForceNevada Donor Network
775-784-6171855-NVDONOR (855-683-6667)
Donor Network WestIntermountain Donor Services
Sierra Donor Services
Please click on the "Submit Information" button below to continue with the registration process.