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Register to be an organ, eye and tissue donor

For residents of Louisiana only. Not in Lousiana? You can register to be a donor at Registerme.org.
 
* = Mandatory Information

Your registry entry will be associated with: LOPA website

Basic Information
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Month: Day: Year:
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Donation Information

I authorize my organs and tissues to be used for transplant, medical therapy, research and medical education.

Account Information

Confirmation

By submitting this registration I affirm that I am the applicant described on this application and that the information entered herein is true and correct to the best of my knowledge. This registration will serve as a document of gift as outlined in the Louisiana Uniform Anatomical Gift Act. A document of gift, not revoked by the donor before death, is irreversible and does not require the consent of any other person. It also authorizes any examination necessary to ensure the medical acceptability of the anatomical gift.

In order to complete the electronic signature, please type your first and last name and the last four digits of your Social Security Number. All information submitted will be used only for official Registry business and will be kept completely confidential. We will not share, sell or otherwise compromise this information.

  • The main job of your kidneys is to filter your blood. They remove waste, control your body’s fluid and keep your electrolytes balanced. The recovery of the kidney includes the vessels needed to transplant the organ into the recipient.
  • The 2 most common reasons people need a kidney transplant are diabetes and high blood pressure. Over 80% of those waiting for an organ need a kidney.
  • The main job of your heart is to pump enough blood to deliver a continuous supply of oxygen and nutrients to your brain and organs. The recovery of the heart includes the vessels needed to transplant the organ into the recipient.
  • Common reasons people need a heart transplant include cardiomyopathy, coronary artery disease and birth defects.
  • The main job of your lungs is to help you breath by moving fresh air through your body and removing carbon dioxide. The recovery of the lungs includes the vessels needed to transplant the organ into the recipient.
  • Common reasons people need a lung transplant include cystic fibrosis, COPD and pulmonary hypertension.
  • The main job of your pancreas is to produce insulin in order to regulate blood sugar, in addition to helping to convert food into fuel for your body. The recovery of the pancreas includes the vessels needed to transplant the organ into the recipient.
  • The most common reason people need a pancreas transplant is Type I Diabetes. Often a kidney transplant is required along with a pancreas transplant since diabetes can harm both organs.
  • TThe liver is a complex organ, but a few of the main functions include production of bile (which helps carry away waste and breaks down fats), storage of vitamins and minerals, and blood detoxification and purification. The recovery of the liver includes the vessels needed to transplant the organ into the recipient.
  • Common reasons people need a liver transplant include hepatitis, cirrhosis and diseases affecting the bile duct.
  • The main job of your intestines is to digest food. In addition, the intestines play an important role in fighting germs. The recovery of the intestines includes the vessels needed to transplant the organ into the recipient.
  • Common reasons people need an intestine transplant include Crohn’s Disease, ulcerative colitis and short bowel (gut) syndrome.
  • The main jobs of your skin include regulating body temperature and protection against infection, ultraviolet rays and chemicals.
  • Common reasons for a skin graft (transplant) include deep burns, large/open wounds and bed sores/ulcers.
  • The main job of your heart valve(s) is to prevent the backward/reverse flow of blood through your heart.
  • Heart valve replacements (transplant) are usually performed when the valve develops stenosis (stiffness) or a leak. Infants/children also require a heart valve replacement for congenital heart defects.
  • The main jobs of your bones are to provide body structure, facilitate movement, protect internal organs and storage of minerals and fat. Tendons help to move the bones (ie: Achilles tendon). Ligaments connect bones to other bones (ie: Anterior Cruciate Ligament).
  • The bones recovered in the lower extremities include the bones of the legs (femur, tibia and fibula) and the pelvic bone (iliac).
  • Donated bone can be transplanted in many ways and can be used in different types of surgeries. Some of these include facial reconstruction, back/neck surgeries, birth defects and dental procedures. Common reasons for a ligament or tendon transplant include sports injuries, total joint replacements and spinal surgeries.
  • The main job of your veins is to return deoxygenated blood back toward the heart.
  • The most common reason veins are transplanted is to bypass clogged arteries in the heart and throughout the body.
  • The main jobs of your bones are to provide body structure, facilitate movement, protect internal organs and storage of minerals and fat. Tendons help to move the bones (ie: Achilles tendon). Ligaments connect bones to other bones (ie: Anterior Cruciate Ligament).
  • The bone donated in the upper extremities (arms) is the humerus.
  • Donated bone can be transplanted in many ways and can be used in different types of surgeries. Some of these include facial reconstruction, back/neck surgeries, birth defects and dental procedures.
  • The main job of bone marrow (taken from the vertebral bodies) is to facilitate stem cell production, which in turn produces blood cells.
  • The bone marrow from donated vertebral bodies can be stored for future use. It is often used for people who need transplants to treat blood cancer, improve organ transplants and repair damage caused from radiation.
  • Whole eye donation can give sight to two people through cornea transplants and the sclera, or white part of the eye, helps others who may suffer from glaucoma or other eye diseases.
  • A cornea is the clear outer layer at the front of the eye. The main job of your cornea is to focus light so you can see clearly.
  • Common reasons for a cornea transplant include scarring of the cornea (injury), genetic disease, severe infections and vision loss.