Serving Medical Researchers and Educators

LifeLegacy Application Request

LifeLegacy is committed to ensuring all donated organs and tissues are used properly and professionally, and that the donor and donor family's wishes are met. LifeLegacy procures, prepares and distributes donated human organs and tissues to only research institutions that have been pre-approved through the LifeLegacy Application and Approval Committee. This review process usually takes less than two weeks.

To receive a LifeLegacy Application, please complete this form and submit.

Application Request Form Name: Title: Institution/Company: Address 1: Address 2: City: State: Zip: Telephone Number(s): (enter each on a separate line) Fax Number: E-mail Address:   How would you prefer to receive the application?: email fax mail Type of Organ or Tissue Required:   How did you learn about us? We look forward to working with you. If you have any additional questions, please call 888-774-4438 or 520-575-5200.