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Form - 11
A A A Print
TRANSPLANTATION OF HUMAN ORGANS
THE TRANSPLANTATION OF HUMAN ORGANS RULES, 1995
The Transplantation of Human Organs Act, 1994
The Transplantation of Human Organs Rules - 1995 (GSR 571(E), dt.31-7-2008)
The Transplantation of Human Organs Rules - New Forms - 1995 (GSR 571(E), dt.31-7-2008)
The Transplant of Human Organs Act - Review Committee
APPLICATION FOR REGISTRATION OF HOSPITAL TO CARRY OUT ORGAN TRANSPLANTATION
The Appropriate Authority for organ transplantation ........................ (State or Union Territory)
We hereby apply to be recognized as an institution to carry out organ transplantation. The required data about the facilities available in the hospital are as follows: -
Name ........................................................................
Location ...................................................................
Govt. /Pvt..................................................................
Teaching/Non-teaching.................................................
Approached by:
Road: Yes No
Rail: Yes No
Air: Yes No
Total bed strength: .....................................................
Name of the disciplines in the hospital .............................
Annualbudget .............................................................
Patient turnover / year .................................................
Surgical Team
No. ofbeds ................................................................
No. of permanent staff members with their designations. .........................................................................
No. of temporary staff with their designations ................ .............................................................................
No. of operations done per year ............................................................
Trained persons available for transplantation (Please specify organ for transplantation)
No. of beds ............................................................
No. of permanent staff members with their designations ....................................................
No. of temporary staff members with their designations. ..............................................................................
Patient turnover per year ............................................................…................
No. of potential transplant candidates admitted per year .................................................
No. of permanent staff members with their designations..............................................................
No. of temporary staff members with their designations.................................................................
Name and No. of operations performed ..............................
Name and No. of equipments available .............................
Total No. of operation theatres in the hospital ....................
No. of emergency operation theatres ................................
No. of separate transplant operation theatres .....................
I.C.U./H.D.U. Facilities
ICU/HDU facilities: Present .............. Not present .............
No. of ICU beds	..................
Nurses	....................
Technicians	..................
Name and number of equipments in ICU	...........................
Other supportive Facilities
Data about facilities available in the hospital ......................
No. of permanent staff with their designations. ...................
.	No. of temporary staff with their designations.	..................
Names of the investigations carried out in the Deptt.........................................................
Name and no of equipments available.	..............................
No. of permanent staff with their designations ....................
No. of temporary staff with their designations ....................
Names of the investigations carried out in the Deptt........................................................................
Name and no of equipments available................................
Haematology services
No. of permanent staff with their designations....................
No. of temporary staff with their designations.....................
Names of the investigations carried out in the Deptt...............................................
Blood Bank Facilities Yes ................ No .................
Dialysis Facilities Yes ................ No .................
Other Personnel
Nephrologist Yes/No
Neurologist Yes/No
Neuro-Surgeon Yes/No
Urologist Yes/No
G.I. Surgeon Yes/No
Paediatrician Yes/No
Physiotherapist Yes/No
Social Worker Yes/No
Immunologists Yes/No
Cardiologist Yes/No
The above said information is true to the best of my knowledge and I have no objection to any scrutiny of our facility by authorized personnel. A Bank Draft / Cheque of Rs. 1,000/- is being enclosed.
Head of the Institution
TRANSPLANTATION OF HUMAN ORGANS ACT
THO Act
Chapter - I
Chapter - II
Chapter - III & IV
Chapter - V
Chapter - VI
Chapter - VII
THO Rules
THOA - Review Committee
Part - I
Part - II
Organ Procurement Program
Fund To Promote Cadaver Organ Donations
Annexure-A To The Sub-Committee-II
Chart Showing Status Of Forms
FORM 1(A)
FORM 1(B)
FORM 1(C)
Form - 1(a)
Form - 1(b)
Form - 1(c)
Form - 2 & 3
Form - 6
Form - 12 & 13
Tho Adoption
Tho Suggestions
7th Annual Workshop
Nurses Workshop
J Place: Chennai
Place: Chennai
Sant Sangama 2012
Place: Bengaluru
Honouring Donor Families
Life Before Ashes - English
Dur: 2:05 secs
MOHAN Foundation's Transplant Coordinators' Training Programme - English
SBI MOHAN Foundation Video - English
An Art Installation On Why India Needs More Organ Donors - English
Dur: 2.39 secs
Qutub Minar turns green to create awareness for organ donation - English
Prof. Rutger Ploeg speaking at National Organ Retrieval Workshop March 2017 - English
Dur: 28:12 secs
Dr. Harsha Jauhari speaking at the National Organ Retrieval Workshop - English
Dr. Philip G. Thomas speaking at 2nd Oxford Organ Retrieval Workshop Bangalore 2016 - English
A/V about Mrs. Lalitha Raghuram - Telugu
Live Beyond Life by Shweta Gupta - English
Kiran Rao, Anand Gandhi at MOHAN Foundation's Pledge to Donate Organs Initiative - English
Dur: 30.05 secs
Public Education Film on Organ Donation - Chennai - English
Religion and Organ Donation - English
Public Education Film on Organ Donation - Kannada
Public Education Film on Organ Donation - Telugu
Maraiya Uyirodu (Short Film -- 3rd Prize Winner) - Tamil
Uyirkodu (Short Film -- 1st Prize Winner) - Tamil
Unnul Thudikiren (Short Film) - Tamil
Nee Naan Naam (Short Film) - Tamil
Naan Eranthapin (Short Film -- 2nd Prize Winner) - Tamil
Kannil Oru Uyir (Short Film) - Tamil
Uyirin Thaedal (Short Film) - Tamil
Heart Beat (Short Film) - Tamil
Old is Gold (Ad Spot) - Tamil
Still Can Use It (Ad Spot -- 2nd Prize Winner ) - Tamil
Recycle (Ad Spot) - Tamil
Blind ( Ad Spot ) - Tamil
Eye Donation ( Ad Spot ) - Tamil
Vizhithidu (Ad Spot -- 3rd Prize Winner) - Tamil
Outstanding (Ad Spot) - Tamil
Donate Organ and Light Life (Ad Spot -- 1st Prize Winner) - Tamil
Poster Competition during Organ-o-Cultural 2010 - Tamil
Actor Sivakumar Pledging for a Donor Card - Tamil
Dignitaries lightining the Kuthuvilakku - Tamil
Organ-o-Cultural - Tamil
Baba Ramdev Promotes Organ Donation - Hindi
Velicham - Tamil
Vote of Thanks - Lalitha Raghuram - English
Address by Chief Guest Additional Chief Secretary, Govt. of Tamil Nadu - Mr. Syed Munir Hoda - English
Address by Principal Secretary & Transport Commissioner, Tamil Nadu - Mr. Manchandranathan - English
Accelerate Organ Donation through Driving License - Dr. Sunil Shroff - English
Release of Resource Manual for Organ Transplantation - English
Encouraging Words By Ms. Revathi Menon - The 1st Donor Card Holder - English
Release of Life... Pass it on Newsletter by Dr. Mohamed Rela - English
Participants, voluteers and Organisers receiving momento - English
Rally Members Introduction & Presentation
Rally Convernors Experience - Mr. Kamal Hasan - English
Welcome Address - Mrs. Malathi Venkatesan - English
Kicking off signature campaign by dignitaries - English
Rally for Life - Memorial Service at Loyola College - English
Rally for Life - Flag off the Rally : Thiru. T. Rajendran IPS - English
Rally for Life - Address by Chief Guest Thiru. T. Rajendran IPS - English
Rally for Life - Deceased Donation in TN : Dr. Amalorpavanathan - English
Rally for Life - Address by Principal of Loyola College Dr. A. Albert Muthumalai - English
Rally for Life - Introduction of Rally Members : Dr. Sumana Navin - English
Rally for Life - Welcome Address : Dr. Sunil Shroff - English
REAL HEROES - English
Release of Mohan Foundation Publications - English
Video A - Inauguration of the Function - English
Dur: 54 secs
Trauma and Organ Donation from Hyderabad - Telugu
Trauma and Organ Donation from Hyderabad - English
Cine star Madavan and Organ Donation - Tamil
Cine star Madavan and Organ Donation - Hindi
Cine star Madavan and Organ Donation - English
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Section - Concepts Related to Organ Donation
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Section - Consent for Organ Donation
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Section - Marginal Kidney donors
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Section - Kidney Transplants
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Section -CAPD
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Section - Brain Death
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Mohan Foundation
Charity Status: MOHAN Foundation is a registered non-profit charitable trust and the Registration No. 285 of 98 dated 4th August 1997. All contributions are exempt under section 80-G of the Income Tax Act 1961.
1800 103 7100 (Toll Free)
3rd Floor, Toshniwal Building,
267 Kilpauk Garden Road,Chennai-600 010.
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