Write to the Transplant Recipient
Your Name
*
First Name
Last Name
Contact Email
*
example@example.com
Donor's Name
*
First Name
Last Name
Contact Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Donation
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Donation Hospital
*
For which recipient is the letter intended? (check as many as apply)
Kidney
Liver
Heart
Cornea
Pancreas
Lung
Intestine
Tissue
All recipients
If we have any questions, how do you prefer we contact you? Please make sure you provide us with this method of contact.
*
Email
Phone
United States Mail
Your Message
*
Please upload up to 5 photos you would like us to share with recipient(s).
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Permission to Share My Letter*
At times, Gift of Life may share letters from families of donors with our community partners for awareness and education related to organ and tissue donation. It can be very meaningful to hear, in their own words, what donation means to the family of the donor. Please indicate if you authorize Gift of Life Donor Program, its affiliated organizations, and community partners to reprint or share the contents of your letter as described. Personal identifying information such as full names will not be shared.
I grant Gift of Life Donor Program permission to reprint or share the contents of my letter for awareness and education related to organ and tissue donation.
I do not grant Gift of Life Donor Program permission to reprint or share the contents of my letter for any purpose other than providing to my family member’s recipients.
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