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University of Toledo Body Donation Program Form

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ANATOMICAL DONATION PROGRAM
AUTHORIZATION FORM FOR ANATOMICAL DONATION

Mr., Mrs., Ms. (Print or type full legal name of Donor)

I, the Donor, being eighteen years of age or older and of sound mind, with the intention of helping others, do hereby willfully and voluntarily make an anatomical gift of my body to take effect upon my death. This gift is made to the Anatomical Donation Program of The University of Toledo, College of Medicine (the “University”), which is housed in the Department of Neurosciences, 3035 Arlington Avenue, Toledo, OH 43614-5804. I reserve the right to void this donation at any time through written notification to the University.

I understand that, through this donation, my body will not be available for any public or private memorial or funeral service at the time of my death, because my body will need to be immediately transported to the University. I also understand that bodies are not suitable for educational or scientific purposes following an autopsy. If an autopsy is required by the Coroner, the Anatomical Donation Program will still accept my remains, but they may not be used for educational or scientific purposes and will be cremated immediately.

I direct that immediately following my death, the person or institution in charge of my body notify the Anatomical Donation Program at the University by telephone (419-383-4109 or 419-383-3770) in order to carry out this gift.

The exact use of my anatomical gift will be at the discretion of the University. I understand that my body may be used for education, research, or advancement of medical science and health care conducted at the University, or may be loaned to other health centers, or educational institutions for use in their education or research endeavors. The Anatomical Donation Program reserves the right to retain tissues and organs of interest for educational and/or research purposes.

I further understand that the University may also use my anatomical gift in the development and dissemination of educational media/products that may have a commercial value, to which I agree to give up any and all rights that may be claimed by my estate and heirs.

I understand that after the University has finished using my donated body for education and research purposes, it will be cremated. I will read and sign the Cremation and Disposition Authorization Form. On the Cremation and Disposition Authorization Form, I will express my wishes as to how my cremated remains will be handled.

Plastination. Plastination is a process by which anatomical donations can be converted into plastic anatomical models that can be used permanently. I have the opportunity (by indicating below) to have my donation used as a permanent anatomical model. I understand, however, that should my body be used as a permanent model, it will not be available for cremation and will not be returned to my family or be available for burial. When plastinated, my body will become the permanent property of the University and used at the University’s discretion.

Permanent Anatomical Model
I consent that my body may be used as a permanent anatomical model.
If I answer “YES”, my body will NOT be returned to my survivors.
Use of Recognizable Likeness
In the development of educational media products, The University of Toledo, College of Medicine MAY make use of my recognizable likeness.
If I answer “YES” to Permanent Anatomical Model (above), the “YES” box for “Use of Recognizable Likeness” must also be checked.

SIGNATURES

DONOR

Date

Social Security Number

Date of Birth

Donor’s Legal Signature

Telephone

Street Address

WITNESSES

The Donor signed this Donation form, and we, in his/her presence and at his/her request, have provided our names as witnesses to his/her signature. We attest that the Donor is at least eighteen years of age and appears to be of sound mind and not under or subject to duress, fraud, or undue influence. We further attest that we are at least eighteen years of age and not related to the Donor by blood, marriage or adoption and not a student or employee of The University of Toledo, College of Medicine.

Witness 1

Name (Please Print)

Signature

Street Address, City, State, Zip Code

Witness 2

Name (Please Print)

Signature

Street Address, City, State, Zip Code

IN PLACE OF TWO WITNESSES – NOTARY ACKNOWLEDGMENT

State of Ohio

County of SS.

On , before me, the undersigned notary public, personally appeared , known to me or satisfactorily proven to be the person whose name is subscribed as the Donor, and who has acknowledged that he or she executed this written Authorization for the purpose of making an anatomical gift to the Anatomical Donation Program of The University of Toledo, College of Medicine. I attest that the Donor is at least eighteen years of age and appears to be of sound mind and not under or subject to duress, fraud or undue influence.

Signature of Notary Public:

My Commission Expires On:

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What the University of Toledo Body Donation Program Form Is

The University of Toledo Body Donation Program Form is a written authorization that documents an individual's decision to donate their body for anatomical education, research, or training. It captures the donor's identifying information, consent language, disposition preferences, and contact details for next of kin or an agent. Completion of the form establishes the donor's intent and helps the receiving institution plan transportation, timing, and lawful use. The form is typically retained by the university and becomes effective under the terms stated on the form and applicable state anatomical gift laws.

Why This Form Matters for Donors and Institutions

A clear, signed donation form protects donor intent, documents consent, and helps universities comply with anatomical gift statutes. It streamlines acceptance, reduces confusion at time of death, and documents contact and medical information necessary for safe handling.

Why This Form Matters for Donors and Institutions

Who Typically Completes and Processes This Form

Healthcare providers, funeral directors, and legal advisors may also consult or hold copies to ensure timely acceptance and transfer.

  • Prospective Donors — Individuals who wish to donate their body for teaching, research, or training purposes.
  • Authorized Representatives — Next of kin, health care agents, or persons with legal authority to sign on the donor's behalf.
  • Program Administrators — University faculty or staff who verify eligibility and arrange logistics.

Step-by-Step: Completing the University of Toledo Form

Follow these sequential steps to complete, verify, and submit the donation authorization correctly.

  • 01
    Gather Documents: Collect ID, medical summary, and contact details.
  • 02
    Complete Form: Enter all fields clearly and legibly.
  • 03
    Sign and Date: Sign in ink, or use permitted e-signature methods.
  • 04
    Submit to Program: Send original or certified copy to program address.

How Acceptance and Transfer Typically Work

This overview describes the flow from completed form to acceptance and final disposition under typical university procedures.

  • Form Receipt: University logs and reviews consent documentation.
  • Eligibility Review: Medical and legal criteria are assessed for acceptance.
  • Logistics Arrangement: Transportation and timing are coordinated with providers.
  • Use and Disposition: Body is used per consent and disposed as specified.

Digital Workflow Settings for Online Completion

If you create an online version, configure these core settings to protect integrity and maintain compliance.

Field Configuration
Authentication Method Email link or SMS code; consider stronger ID where required
Template and Versioning Lock template fields and track version history for audits
Notification Rules Email confirmations to donor, next of kin, and program staff
Secure Storage Encrypted storage with restricted access controls

Technical Requirements for eSubmission and Handling

Ensure any eSignature provider meets applicable legal and privacy standards before accepting electronic consent.

  • File Formats: PDF and Word DOCX supported
  • Integrations: Works with major systems like Salesforce
  • Device Support: Desktop and mobile compatible

Comparison: eSignature Vendor Pricing and Core Limits

Key vendor pricing and feature differences when selecting an eSignature provider to collect donation consent. signNow appears first by design to show a representative option.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies Varies Varies Varies
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Essential Information to Include on the Form

Donor Name: Full legal name
Date of Birth: MM/DD/YYYY
Contact Info: Phone and full address
Next of Kin: Name and phone
Medical History: Major conditions
Signature: Signed and dated

Potential Risks and Legal Consequences

Invalid Consent: Refusal to accept
HIPAA Breach: Civil penalties
Transportation Delay: Use may be compromised
Revocation Issues: Family disputes possible
Recordkeeping Failure: Regulatory risk
Improper Signer: Legal challenge

Common Mistakes to Avoid When Preparing the Form

  • Using an abbreviated or informal name that does not match government ID, which can delay verification and acceptance.
  • Failing to list a reliable next-of-kin or agent phone number, causing missed pickup windows and logistic failure.
  • Omitting required medical or infectious-disease disclosures that determine eligibility and safe handling for the receiving institution.
  • Not confirming witness or notarization requirements for the donor's state, resulting in an unsigned or noncompliant authorization.

Example Scenarios Illustrating Typical Use

Realistic scenarios show how the form is used and what practical issues can arise during completion and acceptance.

Case Study 1

A retired nurse signs donation consent during a routine visit

  • The program confirms medical history prior to acceptance
  • The university coordinates transport and uses the donation for student dissections, then follows the stated disposition preferences.

Case Study 2

An executor attempts to submit a donor form after death

  • Acceptance requires prior signed authorization or clear legal authority
  • Without a preexisting signed form, the university declines and advises next steps under state anatomical gift law.

Practical Tips for Accurate and Efficient Completion

Adopt these practices to reduce processing delays and ensure the donor's intent is recorded clearly and legally.

Use Consistent Legal Names
Always match the donor name to government-issued identification; inconsistency can prevent verification and acceptance.
Provide Clear Contact Information
List at least one reliable next-of-kin or agent with daytime and evening phone numbers to expedite time-sensitive pickups.
Confirm Witness/Notary Rules
Check your state requirements for witness or notarization and satisfy them before submitting the form to the university.
Keep a Copy Accessible
Retain a signed copy with your personal records and give copies to designated contacts to avoid confusion at time of death.

Timing Considerations and Typical Deadlines

While there are no universal filing deadlines, timing matters for acceptance, revocation, and transport coordination.

Form Effectiveness:

Generally effective upon donor's death or as stated in the authorization

Revocation Window:

Donor may typically revoke consent at any time before death in writing

Notification Timing:

Notify program promptly at time of death to arrange timely transfer

Transport Schedule:

Universities set pickup windows; delays can affect acceptance

Record Retention:

Program retains records per institutional policy and legal requirements

Frequently Asked Questions About the Form

Practical answers to common questions donors and representatives ask when completing or submitting the authorization.


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