Every year, thousands of lives are saved as a result of the generosity of donors and families like yours. It has been a privilege for Alabama Organ Center to meet and work with your family since your loss. We are continually working to improve the care and support provided to families during and after donation. As a family that made the decision to help others through the gift of life, it is important for us to understand your experience. We are asking for your assistance in evaluating your experience with Alabama Organ Center by completing this questionnaire. Reflecting upon your experience may be difficult for you; we encourage you to complete the survey as you are comfortable.

* Your Loved One's Name:

* Your Name:

* Your Address:

* Email:

* Your phone number:

* Your relationship to your loved one?

* What influenced you or your loved one's decision to donate? (check all that apply)

* Who introduced the subject of donation to your family?

* Was there something that was done during this time that was particularly helpful or supportive to your family?

* Please rate the following:

  Strongly Agree Agree Disagree Strongly Disagree
Overall, my experience with donation was positive.
My loved one's donation has provided me with some comfort.
I was treated with compassion and respect by AOC staff at the time of my loved one's death.
I was treated with compassion and respect by AOC after care staff since the time of my loved one's death.
My questions and concerns about my family's experience with donation have been answered to my satisfaction.

* The following aspects of Alabama Organ Center's After Care program have been helpful to me:

* Looking back, would you have made the same decision about donation?

* Follow up:

Please feel free to contact Carrie Ellis, Donor Family Liaison at 800-252-3677 or cellis@alabamaorgancenter.org
On behalf of the families that will follow you on this journey, we thank you for your thoughts and suggestions.

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