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Join the Registry

Thank you for registering on the Donor Registry of Nebraska, maintained by Nebraska Organ Recovery System, the federally designated organ procurement organization for Nebraska and Pottawattamie County, Iowa.

Please read the following information carefully and then complete the requested information to join the registry. If you have any questions or would prefer to receive an enrollment form by mail, please contact us at 402-733-1800 or 1-877-633-1800.

Donor Registry of Nebraska Statement of Anatomical Gift

It is my desire to be included on the Donor Registry of Nebraska. Upon my death, I authorize Nebraska Organ Recovery System and its authorized representatives (collectively 'NORS') to remove all recoverable organs, eyes and tissues from my body for the purposes of transplantation, therapy, research or education unless restricted by me below. Useable organs/eyes/tissues include: heart, lungs, liver, kidneys, pancreas, small intestine, eye tissue, heart for valves, pericardium, and bones and tissues of the upper and lower body. Bones and tissues of the upper body include the humerus, radius, and ulna. Bones and tissues of the lower body include the peroneous longus, patella and achilles tendons with the calcaneous and talus, anterior and posterior tibialis, fascia lata, femoral vein/artery, femur, fibula, gracilis, hemi-pelvis, meniscus, patella, saphenous vein, semitendinosis, and tibia.

I authorize NORS to obtain my complete medical record and autopsy report. I authorize all tests and other examinations, including but not limited to infectious disease testing, to determine the medical suitability of my anatomical gift. I authorize NORS to disclose all information, as necessary, to individuals and entities who receive or use my anatomical gift.

I understand that my estate, next of kin or other survivors shall be responsible for all of my hospital, medical and funeral expenses and that NORS shall be responsible for all costs and expenses incurred after my death that are directly related to the recovery of my anatomical gift.

I understand that making this statement electronically has the same effect as signing a written statement.

I am at least sixteen (16) years old.

Donor Information

Fields marked with a * are required.

* Please select one of the following:
* First Name:
Middle Name:
* Last Name:
* Gender
* Date of Birth:

Residential Address

* Street Address:
Address 2:
* City, State, Zip:

Contact Information

* Email Address:
(for confirmation of your donor registration)

Donor Restrictions

The Registry will only accommodate restrictions related to individual organs or tissues that can be removed for purposes of transplantation. Organs are distributed according to national regulations.

Anatomical Gift Restrictions (no narrative):

Other Information

* How did you hear about us?
  
NORS recommends that you communicate your decision to make an anatomical gift to your family and loved ones, as your presence in the Donor Registry of Nebraska will serve as legal consent for donation. NORS' representatives will attempt to contact your family at the time of your death to notify them of your decision to make an anatomical gift and to request information about your social and medical history.
  
Please click on the "Submit Information" button below to continue with the registration process.