The National Health Insurance system operates a voluntary program for organ donation in the unfortunate event of your passing, the details of which are printed on the back of your health insurance card.
The translation is as follows:
In the space below, please indicate your wishes with respect to organ donation by circling the appropriate number.
In the event of my passing due to brain death or heart failure, I wish to donate my organs.
In the event of my passing due to heart failure, I wish to donate my organs.
I do not wish to donate my organs.
《 For those who chose either 1 or 2, please indicate which organs you DO NOT wish to donate with an X 》
【 Heart, Lungs, Liver, Kidneys, Pancreas, Small Intestines, Eyes 】
〔 Special Requests 〕:
Card holder date of birth: Year Month Day
Card Holder Signature: Family Member Signature:
Please handwrite both card holder and family member signatures.
In the area for special requests, you may input additional instructions on what to do with your body. For example you may write "give organs to family first" or "donate my body to science" or list any additional body parts you are willing to donate. The space provided is small and may be read by someone who is not proficient in English. Therefore please write your requests legibly and in a few, easy to understand words.