Schedule-14

Schedule-14
(Relating to Clause (b) of Rule 8)
Deed of consent to be given by person to donate kidney after death


Whereas, I consent to extract the kidney from my body after my death  and transplant the same into the body of any patient who is in need of kidney;  Now, therefore, I have knowingly and voluntarily given this deed of
consent, pursuant to Clause (b) of Sub-section (1) of Section 16 of the Human Body Organ Transplantation (Regulation and Prohibition) Act, 2055 (1998) and Clause (b) of Rule 8 of the Human Body Organ Transplantation
(Regulation and Prohibition) Rules, 2058 (2002).
Donor of kidney after death:
Name:
Grand-father’s name:
Father’s name:
If married,
husband’s or wife’s name:
Age:
Address: Thumb impressions
Right Left Signature: