Fill-in the required information of experience for procurement, participation, offering and/or sharing organ and tissue donors. Use as many forms as you consider.

Indicate date of donation (day/month/year), donor identification (ID), city of procurement, total number of organs and tissues procured, indicating with an "x" the corresponding one(s):

Organs: KI: kidney (1 or 2), LI: liver, HE: heart, LU: lung; PA: pancreas; IN: intestine. Tissues (For tissues count the type of tissue procured as one, do not count by the number of tissues of any type extracted, e.g. bones is one independently of the number of bones procured): CO: corneas; HV: heart valves; BO: bones; SK: skin; OT: other tissues.