Awaiting Transplant

Fill out the form below to submit your Story of Hope. If you would prefer, you can download this word document and email it to us at info@donatelifenw.org.

Your Information

First Name

Last Name

Birth Date

Country

Street Address

City

Postal Code

State/Province

Phone Number

Pronouns

She/her

He/him

They/them

Other

If you have a different way to refer to yourself, enter it here.

Transplant Information

Please tell us about your need for transplant.

Organ(s), Eye(s) and/or Tissue(s) needed

List the organ(s), eye(s), and/or tissue(s) you hope to receive.

How long have you been waiting / on the waitlist?

Your Story

The following questions are meant to help you focus on the most compelling parts of your story. From the information you provide, Donate Life Northwest will build a cohesive written piece that tells your Story of Hope. Please provide no more than 100 words per question.

Photo

Please upload a photo of you and your family if you wish.
One file only.
60 MB limit.
Allowed types: gif, jpg, jpeg, png.

Video link

Provide a URL weblink to a video if you have one

Describe your life before you got sick.

Give a brief description in layman’s terms of what caused your need for a transplant.

Since being on the waiting list, choose a moment when you were sickest. What was your life like? Did you experience any physical/activity restrictions?

How do you feel waiting? How have your emotions changed throughout the wait? How long have you been waiting?

Describe the effect that being on the waiting list has had on your family.

Describe what it means to you that people make the choice to be an organ/tissue donor. What would you like to say to them?

How will a transplant change your life physically and mentally?

What is your advice to people who are unsure if they want to register as a donor?

After hearing your story, what message do you want people to walk away with?

Additional comments

Choose ONE that best describes your reason for submitting your story.

I'd like to share my story so it might be used to support Donate Life Northwest's mission.

I have attended a Volunteer Orientation, and I'd now like to join the Speakers Bureau.

Terms & Conditions

By submitting personal stories to Donate Life Northwest, individuals agree to the following statements:

Submission Statement 1

1) I agree that by submitting this personal story and photographs (optional), I authorize Donate Life Northwest to review submitted materials and determine use for publicizing transplantation, donation and to promote the need for organ, eye and tissue donors. Donate Life Northwest will notify me (using the contact information I have provided in this form) in the event that my story and/or images will be used.

Submission Statement 2

2) By clicking "Submit", I understand that my story may be used in the media (TV, newspapers, magazines, radio, etc); online (website, social media, etc.), and more generally as part of Donate Life Northwest’s outreach and promotional purposes.

I agree to the submission terms.

Stories of Hope

— Gloria Little

Awaiting Transplant