Declined to Donate Survey

Tell us what you think...

At Gift of Hope we believe that donation is equally as good for donor families as it is for transplant recipients. We understand that sometimes there are things that get in the way of a family's ability to say yes to donation, and we want to learn from these experiences. Though you were not able to choose donation for your loved one in this instance, you still have an important and meaningful opportunity to help countless others by sharing your feedback and helping us improve our process and practice so that we are meeting and exceeding the expectations of all families. Thank you for taking the time to share your thoughts and opinions with us.

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* 1. Please tell us about the person who passed away. (name, date of birth, date of death, location of death/hospital)

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* 2. Prior to this experience, what was your opinion about donation?

Extremely positive

Positive

Neither positive nor negative

Negative

Extremely negative

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* 3. What factors most influenced your decision to decline donation for the
person who passed away? (select all that apply)

I/we did not accept that brain death is death

If you'd spoken to us sooner maybe we could have said yes, but we were ready to be done

The process of donation would take too long

I/we didn't believe that the person who passed away was healthy enough to be a donor

I/we didn't want the person who passed away to suffer any longer

I/we wanted the person who passed away to be buried whole

I/we believe that donation is against our culture or religion

I/we never spoke about donation with the person who passed away so I didn't know what they would want

The person who passed away had previously expressed a wish not to donate

The person who passed away spoke negatively about donation

Some other reason

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* 4. If you said "some other reason" to the previous question, tell us about that:

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* 5. How do you feel about donation following your recent experience with Gift of Hope?

Extremely positive

Positive

Neither positive nor negative

Negative

Extremely negative

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* 6. What recommendations do you have for us that would help us better support families in the future?

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* 7. Would you like someone from Gift of Hope to contact you about this survey,
or any other issues related to your recent experience with donation?

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 8. Would you like to volunteer as an Advocate for Hope? (select all that apply)

Administrative support volunteer

Workplace partners volunteer

Special events volunteer

Outreach & education volunteer

Gift of Hope speakers bureau (sharing your personal story)

No thanks

Question Title

* 1. Please tell us about the person who passed away. (name, date of birth, date of death, location of death/hospital)

Question Title

* 2. Prior to this experience, what was your opinion about donation?

Question Title

* 3. What factors most influenced your decision to decline donation for the person who passed away? (select all that apply)

Question Title

* 4. If you said "some other reason" to the previous question, tell us about that:

Question Title

* 5. How do you feel about donation following your recent experience with Gift of Hope?

Question Title

* 6. What recommendations do you have for us that would help us better support families in the future?

Question Title

* 7. Would you like someone from Gift of Hope to contact you about this survey, or any other issues related to your recent experience with donation?

Question Title

* 8. Would you like to volunteer as an Advocate for Hope? (select all that apply)

* 3. What factors most influenced your decision to decline donation for the
person who passed away? (select all that apply)

* 7. Would you like someone from Gift of Hope to contact you about this survey,
or any other issues related to your recent experience with donation?