Additional Information
HOW TO ENROLL AS A TEMPORAL BONE DONOR
If you have any type of ear as hearing impairment,
dizziness, facial paralysis, infection, tumor, or injury -- the scientific study of your
ears could be of great medical value. If you do decide to donate your temporal bones, also
consider donating the brain tissue related to hearing and balance. Over 6,000 people have
registered as temporal bone donors.
In order to be registered as a
temporal bone donor one must fill out a donor consent form, and medical
history form. The next of kin must also sign a consent. One can obtain
these forms either by contacting the Registry to request the forms be sent
out via US Mail, or one can print them from this web site.
A.
Print the forms from this web site. The forms are available
from this Web site as Portable Document Format (PDF) files. You must have
Adobe Acrobat Reader to open, read and print these forms. If do not have
Adobe Acrobat Reader you can obtain it free, from Adobe Products at www.adobe.com.
On the home page of Adobe you will see the following image/button.
Click this button on the Adobe page and you
will be walked through the steps to acquire Adobe Acrobat Reader. Click on
the link below if you already have the reader and would like to view and
print the enrollment forms.
Donor
Enrollment Forms (PDF file) (Click to view and print)
(If you do not know if you
have the reader or not, click on the link above. If Acrobat Reader opens
up and you can view the documents, then you have it. If you are not able
to open the document, then you do not have the reader and will have to
download it from www.adobe.com.)
B. Request
forms from the Registry: Contact the Registry for
enrollment forms:
-
Call our 24-hour hotline (800) 822-1327 (voice)
-
Call our TDD line (617) 573-3888
-
Fax us at (617) 573-3838
-
Email us at tbregistry@meei.harvard.edu
Write to us at:
The NIDCD National Temporal Bone Registry
Massachusetts Eye & Ear Infirmary
243 Charles Street
Boston, MA 02114-3096.
We will send you a donor enrollment packet,
which includes a medical history questionnaire and a donor consent form.
Once you
fill out your forms:
1. Return
the completed medical history and consent forms and the Registry will send you a wallet
size Donor Card that states you are a temporal bone donor. This card also states
that at the time of your death, your caretaker or next of kin should call the Registry day
or night at (800) 822-1327.
2. The
Registry keeps a computerized record of all donations. We also forward a copy of
your pledge to the collaborating laboratory that is located nearest to you. This
laboratory will eventually receive your temporal bones for study.
3. Tell
your family and doctors about your plans to donate. Your next of kin makes the
final decision about donation, so make certain they know of your wish to donate your
temporal bones. Please be sure they understand that their cooperation is needed at the
time of your death.
4. Keep
the Registry informed of any changes of address or change in your next of kin.
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