Fill and Sign the Sc Anatomical Form

REVOCATION OF ANATOMICAL GIFT I, __________________ , Declarant, having made an anatomical gift by virtue of that document of gift dated the _______ day of __________________ , 20 _______ ,, do hereby revoke such gift pursuant South Carolina Code § 44-43-345, which provides that an anatomical gift may be revoked as follows: (A) A person authorized to make an anatomical gift under Section 44-43-340 may make an anatomical gift by a document of gift signed by the person making the gift or by that person's oral communication that is electronically recorded or is contemporaneously reduced to a record and signed by the individual receiving the oral communication. (B) Subject to subsection (C), an anatomical gift by a person authorized under Section 44-43- 340 may be amended or revoked orally or in a record by any member of a prior class who is reasonably available. If more than one member of the prior class is reasonably available, the gift made by a person authorized under Section 44-43-340 may be: (1) amended only if a majority of the reasonably available members agree to the amending of the gift; or (2) revoked only if a majority of the reasonably available members agree to the revoking of the gift or if they are equally divided as to whether to revoke the gift. (C) A revocation under subsection (B) is effective only if, before an incision has been made to remove a part from the donor's body or before invasive procedures have begun to prepare the recipient, the procurement organization, transplant hospital, physician, or technician knows of the revocation. DATED this the __________________ day of __________________ , 20 _______ . Signature of Declarant: __________________________________________________________ Printed Name of Declarant:       Address of Declarant:       If the donor or other person is physically unable to sign a record, the record may be signed by another individual at the direction of the donor or other person and must: (1) be witnessed by at least two adults, at least one of whom is a disinterested witness, who have signed at the request of the donor or the other person; and (2) state that it has been signed and witnessed as provided in paragraph (1). WITNESS FORM The witnesses below declare that they are signing at the direction of the declarant after having witnessed the signature of the declarant, have no interest in the estate of the declarant under the laws of intestate succession or any will or the declarant or codicil thereto, and are not financially responsible for the declarant’s care. Witness Signature: _____________________________________________________________ Witness Name:       Address:       Witness Signature: _____________________________________________________________ Witness Name:       Address: