The Transplantation of Human Rules - 1995 - new


1[FORM 3

[Refer rule 4(1) (c)]

I, Dr./Mr./Mrs.. ... working as at and possessing qualification of .. certify that Shri / Smt. Km. . S / o, D / o, Wo Shri / Smt. . aged .. the donor and Shri / Smt. . S / o, D /o, W/o, Shri / Smt .. aged the proposed recipient of the organ to be donated by the said donor are related to each other as brother / sister / mother /father /sons /daughter as per their statement and the fact of this relationship has been established / not established by the results of the tests for Antigenic Products of the Human Major Histocompatibility Complex. The results of the test are attached.

Place .


(To be signed by the Head of the Laboratory)

Date .


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