This Anatomical Gift (Organ Donation) Revocation is for use when an organ donor changes his or her mind and decides to revoke a prior anatomical gift donation. This revocation sets forth the name of the donor, date of the organ donation and date of revocation of the organ donation. It also sets forth the ways in which this donation can be amended such as by a signed statement, oral statement in the presence of two witnesses or communication to a physician or surgeon during a terminal illness. It is imperative that this revocation agreement be clearly set forth in writing. A written Anatomical Gift (Organ Donation) Revocation Agreement will ensure that your wishes regarding donation of your organs are carried out after your death. This Anatomical Gift (Organ Donation) Revocation Agreement includes: Donor Information: Sets forth the name of the donor, date of original donation and date of the revocation; Revocation: Sets forth that this is a written revocation of Anatomical Gift; Signatures: This revocation must be signed by the organ donor and contains an optional notary acknowledgment which is required in certain states. Protect yourself and your rights by using our attorney-prepared forms. This attorney-prepared packet contains: Instructions and Checklist General Information Anatomical Gift (Organ Donation) Revocation Agreement State Law Compliance: This form complies with the laws of all states