Post Donation Survey

1.Optional. Enter your information for an opportunity to win a gift card(Required.)

Your name

Your title

Your unit

Your email

2.My feedback pertains to an...

Organ Donor

Tissue Donor

Unsure

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3.Donor Information (this helps us identify the correct process)(Required.)

Hospital

Week of donation

Patient age, sex, initials or bed number

4.Check all that apply(Required.)

I was involved in the referral process

I was involved in the brain death testing or DCD evaluation process

I was involved/observed with the family care process

I was involved/observed with the clinical care of the organ donor

I was involved/observed during the surgery

I was involved in some other way

5.Indiana Donor Network did a good job of communicating and kept me included during the organ donor process.(Required.)

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6.Indiana Donor Network staff introduced themselves and outlined the plan for the organ donor process clearly.(Required.)

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7.I was consistently clear on my responsibility in the donation process.(Required.)

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10.Indiana Donor Network staff were professional at all times.(Required.)

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11.In general, Indiana Donor Network staff were knowledgeable.(Required.)

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12.Indiana Donor Network responded to any questions and/or concerns timely.(Required.)

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14.Other comments/feedback:

Hospital Staff Post Donation Survey