Lifebanc Recovery Surgeon Application

Download the printable application and fax to 1.866.521.8352.


In order to comply with national regulations, Lifebanc must ensure every surgeon performing organ recovery procedures in our service area is credentialed and qualified.  Verification of qualifications must be on file and confirmed before any surgical recovery may be performed by the surgeon. 

Therefore, any surgeon performing organ recovery procedures must submit their qualifications to Lifebanc via the Qualifications for Deceased Donor Recovery Surgeons form, which is now available as a fillable PDF. This completed and signed form should be submitted, via email or fax to 866.521.8352, along with:

  • A copy of a valid medical license, and
  • Updated curriculum vitae including evidence of residency training/completion, faculty appointments, and board certification/eligibility in general surgery, urology or cardiothoracic surgery.

While Lifebanc will make every attempt to process the request as quickly as possible, please allow up to two business days to complete the verification.

Thank you for your cooperation in this process. 


Dan and Elaine were prepared to give consent for donation when they learned that Dan Jr. had already given consent – when he obtained his driver’s license at age 16, he joined the Ohio Donor Registry. “We were so impressed,” says Dan Sr. “How many 16-year-olds think about helping others if something happens to them?” "

Dan Gromada - Donor Father

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