REGISTER - Texas Donor Registry

THANK YOU for taking the important step to register with Donate Life Texas as an organ, eye and tissue donor!

Please provide all the required information below, then please click in the box that says “I’m not a robot.” You should see a blue circle that then turns into a check mark. This is a security feature of the website that helps ensure that you are a real person, not a suspicious computer program trying to enter the system.

Then click on the CONTINUE button. The following screens will have a few more questions, then click SUBMIT to complete your registration.

Entering your email address allows you to receive a registry confirmation and enables you to log in anytime to update or change your record. If you don’t have an email address, you can create one for free using Yahoo or Google.

Gender*

male female

First Name*

Middle Name

Last Name*

Date of Birth (ex: MM/DD/YYYY)*

Most Recent Address*

City*

State*

Not from Texas? Visit Donate Life America to find the registry for your state.

ZIP Code*

Phone

E-mail Address*

Place of Birth (City, State)

Ethnicity

PLEASE PROVIDE ONE OF THE FOLLOWING:

SSN# (Last Four Digits)

Texas Driver License/Personal ID:

Mother's Maiden Name

How did you learn about the Texas Donor Registry?

Please Specify

I would like to donate:

all organs and tissues for transplant and for research, education or therapy purposes if they are determined unsuitable for transplant
all organs and tissues for transplant only
to specify my gift of donation on the next page

Have you signed up for a Body Donation Program? If so, please indicate which program:

Electronic Signature Certification
I understand this online registration remains binding after my death. I do solemnly swear, affirm or certify that I am the applicant described in application, and that the information entered herein is true and correct. By clicking the submit button I affirm that I wish to be a potential organ donor and/or tissue donor upon my death.

Yes, I accept the Electronic Signature Certification.

Donate Life Texas

Registered Donors

Transplant Waiting List