Secure Registration for Brain Donation (Adobe Acrobat Sign)

Brain Donor Registration

Becoming a prospective tissue donor is easy. Any person 18 years of age or older can contact the Harvard Brain Tissue Resource Center (HBTRC) at 800.BRAIN.BANK (800.272.4622) to learn more about becoming a donor.

There are three ways to register for brain donation:

1. Download a registration form here and mail or Fax it to the HBTRC at the following address:

   Harvard Brain Tissue Resource Center
   McLean Hospital
   115 Mill Street, Mail Stop 138
   Belmont, MA 02478
   Fax: (tel:1-617-855-3199)

2. Call the Harvard Brain Tissue Resource Center (HBTRC) at 1-800-BRAIN BANK (1-800-272-4622)
3. Secure Online Registration (Adobe Sign, see below)

It is most important to inform your family – next of kin or other legally authorized representative - that you have registered for potential brain donation at the HBTRC, and make sure they know to call the HBTRC (immediately) at the time of your death. HBTRC must rely on your legal next of kin/legally authorized representative to contact HBTRC in order to effectuate your request to donate your brain. HBTRC will not solicit donations or initiate a follow-up based on your registration.

Discussing your interest in brain donation with your family in advance is important. It helps families to understand and be prepared to honor the donor's wish, avoid any misunderstandings and facilitates the donation process.

During the Registration process, we will collect some information about yourself. This information is particularly useful. It will help during the brain donation process to quickly gather the information needed to carry out the process. Some of this information, such as medical conditions if applicable, will also be used for research purposes after brain donation. Please note that sensitive or personal information will never be shared with third parties and that research data will be strictly anonymized to protect your privacy.

A Registration for brain donation can be withdrawn at any time by writing to the HBTRC. All information related to your Registration will be destroyed and you no longer be included in the HBTRC Registry

Summary of key points

• Registering as a Prospective Donor with the HBTRC is a good way to let your family and care takers know about your intentions.
• Have a family discussion about brain donation. Don't forget to inform your health care providers and funeral professionals about your decision.
• A Registration helps the HBTRC to collect a small amount of information about the prospective donor. This information will be useful at the time of brain donation and for research purposes.
• All information about Registered Prospective Donors is kept strictly confidential. It is not shared with third parties other an as fully anonymized data after brain donation.
• A Registration is useful but not essential to proceed with a brain donation.
• A Registration to become a brain donor is not binding.
• A Registration to become a brain donor can be withdrawn at any time.