Register for Card

Fill out the on-line form below to receive a HOD Society donor card in the mail. The HOD Society membership card is not a legal document but rather is used to convey your intentions to donate. Ultimately, your family will make the final decision for you, so please inform your family of your decision to donate. There will be a minimum $18 membership registration fee at the end of this process.

Click here to see which Rabbis have organ donor cards.

(In addition to registering on-line below, you can print this registration form out and give it to a friend. Black & White.)

1. Complete the Form Below
All fields must be completed unless otherwise indicated.

* Optional Field
First Name:
* Middle Name:
Last Name:
Are you a Rabbi?
 Yes No
If you are a Rabbi, can we publish your name and picture on our advertisements and on our internet site?
 Yes No
Birth Date:
* Blood Type:
Gender:
Male Female
Height:
Feet  Inches
click to enter height in cm
Eye Color:
Address Line 1:
* Address Line 2:
City:
State:
(If not in U.S. or Canada, leave blank)
Country:
Zip:
Phone:
* Email:
Emergency Contact Family Name:
Home Phone:
* Work/Mobile:
Emergency Contact Family  Name:
Home Phone:
* Work/Mobile:

2. Please read the text below, and check one of the boxes.

I agree to donate my organs for immediate transplant, not for research, provided it is done in accordance with Jewish law as dictated below:

I agree to donate my organs only after:

irreversible cessation of breathing, which is confirmed by brain-stem death. [Medically, this allows for donation of all organs. This criterion is the position of the Chief Rabbinate of Israel.]
irreversible cessation of heartbeat, provided that no invasive preparatory procedure is done prior to cessation of heart beat. [This option reduces the possibility of  being an organ donor and limits the number of organs that may be donated.]

Any and all preparations for transplant should begin after consultation with a family-appointed rabbi. Transplants may commence only after a medical team, who is independent of the attending physicians and who is unaware that I am a potential organ donor, determines death as I have dictated above. All medical procedures must be done with proper respect, and minimum damage, to the cadaver.

I understand that the HOD Society will share my donor information with domestic and international databases provided that my specific requests are accurately conveyed.

If you wish to have your picture on your organ donor card, you may email a scanned photographic jpeg to pictures@hods.org or you may upload your picture by clicking on the link below.

Upload Picture

Payment Info
(This form is websecure and encrypted to protect your credit card information.)

Card Type:
 
Card No.:
 
Expiration:
 
Registration Fee (Choose an option):
   $18 Minimum Registration Fee
     $50 Friend
     $100 Sponsor
Enter any other amount here:
 

 

 
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