1194                           LAWS OF MARYLAND                     [CH. 490

I hereby authorize a licensed physician or surgeon, or the State

Anatomy Board to remove and preserve for use my..............................................

for said purpose.

Witnessed this..................day

of...........................................................,19............ ............................................................................

(Donor)

......(Name and Address)                                (Address)

............(Name and Address)                               (Telephone)

The gift becomes effective immediately after the death of the donor.]

ANATOMICAL GIFT BY A LIVING DONOR
I am at least 18 21 years of age and hereby make this anatomical
gift to take effect upon my death. The marks in the appropriate
squares and words filled into the blanks below indicate my desires.

1. I give: □ my body; □ any needed organs or parts;
□ the following organs or parts........................................

2. To the following person , AGENCY (or institution): □ any
person, tissue bank, or institution authorized by law;
□ THE ANATOMY BOARD OF MARYLAND;
□ the following named physician, hospital, tissue
bank or other medical institution.............................—.....

8. For the following purposes: □ any purpose authorized by law;

□ transplantation; □ therapy; □ medical research

and education.

Dated.......................................................... City and State................-----------------

Signed by the Donor in the

presence of the following            ...................................................--------------------

who sign as witnesses:              Signature of Donor

Witness                                     Address of Donor

Witness

149-O.

(b) Civil liability for unknowingly violating subtitle.—A person
who, in good faith and acting in reliance upon and authorization
made under the provisions of this subtitle or under the anatomical gift
laws of another state or foreign country and without notice of re-
vocation thereof, takes possession of, performs surgical operations
upon, or removes tissue, substances, or parts from the human body;
or refuses such a gift; or any person who unknowingly fails to carry
out the wishes of the donor according to the provisions of this subtitle
or under the anatomical gift laws of another state or foreign country,
shall not be subject to prosecution in any criminal proceedings or
liable for damages in a civil action brought against him for such act.

SEC. 2. And be it further enacted, That this Act shall take effect
July 1, 1969.

Approved May 2, 1969.