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15/10/2009 17:20
Cofrestrwch fy manylion ar
Gofrestr Rhoddwyr Organau’r GIG
Defnyddiwch BRIF LYTHRENNAU gan ddefnyddio beiro ddu.
*rhaid llenwi’r maes.
Fy enw a’m cyfeiriad
Cyfenw*
Enw(au) cyntaf*
Dyddiad geni* /
/
Dyn * Menyw *
Cyfeiriad*
Ffôn
Symudol
E-bost
Cofrestr Rhoddwyr Organau’r GIG
Mae Cofrestr Rhoddwyr Organau’r GIG yn cofnodi
manylion pobl sydd wedi cofrestru eu dymuniadau
i roi organ a/neu feinwe ar ôl iddynt farw.
Defnyddir yr wybodaeth gyfrinachol hon gan staff
meddygol awdurdodedig i gadarnhau a oedd
unigolyn am roi.
Cod post*
Fy nymuniadau
Rwyf eisiau rhoi: (Ticiwch y blychau perthnasol)
A. unrhyw un o’m horganau neu fy meinwe neu
B. fy arennau calon
afu/iau
coluddyn bach
llygaid ysgyfaint pancreas meinwe
ar gyfer trawsblaniad ar ôl i mi farw.
Gall unrhyw un gofrestru. Nid yw oedran yn eich
rhwystro chi rhag rhoi organ neu feinwe – mae pobl
yn eu 70au a’u 80au wedi dod yn rhoddwyr ac wedi
achub llawer o fywydau. Nid yw’r rhan fwyaf o
gyflyrau meddygol yn eich eithrio chi ychwaith.
Gall un rhoddwr achub neu weddnewid hyd at naw
bywyd. Drwy haelioni pobl fel chi mae modd achub
bywydau.
Llofnod
Dyddiad
Ticiwch yma os hoffech gael gwybodaeth yn y dyfodol gan Wasanaeth Gwaed
a Thrawsblaniadau’r GIG am roi gwaed, organau a meinwe.
Fy nharddiad ethnig
Cofrestrwch yn awr
Dywedwch wrth y rhai agosaf atoch chi beth
yw eich dymuniad am roi organau.
TEAR AND MOISTEN EDGE OPPOSITE
ewch i www.organdonation.nhs.uk
n
Mae hi’n fwy tebygol y ceir cyfatebiad agosach a
thrawsblaniad llwyddiannus os daw’r rhoddwr a’r derbynnydd
o’r un grwˆp ethnig. Ticiwch y grwˆp ethnig sy’n eich disgrifio
chi orau.
Gwyn: Prydeinig
Gwyddelig
Arall
Cymysg: Caribïaidd Du/Gwyn
Asiaidd/Gwyn
Affricanaidd Du/Gwyn
Arall
Asiaidd neu Asiaidd Prydeinig: Indiaidd
Pacistanaidd
Bangladeshaidd
Arall
Du neu Ddu Prydeinig: Caribïaidd Affricanaidd Arall
Cefndir cymysg arall: Tsieineaidd
Arall
Ni nodwyd:
Designed and produced by NHS Blood and Transplant 2009
Mae trawsblaniadau’n achub bywydau
Byddai 96% ohonom yn cymryd organ pe byddai angen
un arnom.
Ac eto dim ond 27% ohonom sydd wedi gweithredu
ac wedi ymuno â Chofrestr Rhoddwyr Organau’r GIG.
Os ydych chi’n credu mewn rhoi organau,
profwch hynny.
Mae Cofrestr Rhoddwyr Organau’r GIG yn rhoi gobaith
i dros 10,000 o bobl o bob oed ledled y DU y mae angen
trawsblaniad organ arnynt.
Ac eto mae llawer o bobl – tri y diwrnod ar gyfartaledd –
yn marw cyn iddynt allu cael trawsblaniad oherwydd nad
oes, yn syml iawn, ddigon o organau ar gael.
Ydych chi’n credu mewn rhoi organau? Os ydych chi’n
fodlon cymryd organ, a fyddech chi’n fodlon rhoi un a
helpu rhywun arall i fyw ar ôl i chi farw?
Cofrestrwch yn awr.
Sut mae cofrestru
Mae’n hawdd ymuno â Chofrestr Rhoddwyr
Organau’r GIG drwy ddefnyddio un o’r dulliau
canlynol:
ffoniwch 0300 123 23 23
n
Data Protection Assurance. Completion of this form is for the purpose of
recording your wishes to become an organ donor. All information provided to
NHS Blood and Transplant is used in accordance with the Data Protection Act 1998.
Your data may be handled on our behalf in a country not normally covered by
EU Data Protection law. If so, we will ensure that the data will be protected by the
EU requirements. More information on how we look after your personal details
can be found at www.nhsbt.nhs.uk or by calling 0300 123 23 23.
n y
sgrifennwch SAVE mewn neges
destun i 84118
complete and post this leaflet
Sicrwydd Diogelu Data. Unig bwrpas llenwi’r ffurflen hon yw cofnodi eich
dymuniadau i fod yn rhoddwr organau. Caiff yr holl wybodaeth a roddir i Wasanaeth
Gwaed a Thrawsblaniadau’r GIG ei defnyddio’n unol â Deddf Diogelu Data 1998.
Gallai eich data gael ei drin ar ein rhan mewn gwlad nad yw fel rheol yn rhwym wrth
gyfraith Diogelu Data’r UE. Os felly, byddwn yn sicrhau y caiff y data ei ddiogelu yn
unol â gofynion yr UE. Ceir rhagor o wybodaeth am sut yr ydym yn gofalu am eich
manylion personol yn www.nhsbt.nhs.uk neu drwy ffonio 0300 123 23 23.
n
99mm
llenwch y ffurflen hon a’i phostio
text SAVE to 84118
Perforation
n
n
99mm
1885
call 0300 123 23 23
Fold
Os ydych chi’n dymuno newid eich cofnod neu ei dynnu oddi ar Gofrestr Rhoddwyr
Organau’r GIG cewch wneud hynny drwy ffonio’r Llinell Rhoddwyr Organau ar
0300 123 23 23, drwy fynd i www.organdonation.nhs.uk/ukt/welsh/welsh.jsp
neu drwy ysgrifennu atom yn y cyfeiriad dros y ddalen.
n
Please let those closest to you know your
wishes about organ donation.
Register now
My ethnic origin
Postcode*
99mm
RHWYGWCH A GWLYCHWCH YR YMYL GYFERBYN
go to www.organdonation.nhs.uk
There’s a better chance of getting a closer match and a
successful transplant if the donor and recipient are from the
same ethnic group. Please tick the ethnic group which best
describes you.
White: British
Irish
Other
Mixed: White/Black Caribbean
White/Asian
White/Black African
Other
Asian or Asian British: Indian
Pakistani
Bangladeshi
Other
Black or Black British: Caribbean
African
Other
Other mixed background: Chinese
Other
Not stated:
Please tick here if you would like to receive future information about blood,
organ and tissue donation from NHS Blood and Transplant.
Signature
Date
One donor can save or transform up to nine
lives. It’s only through the generosity of people
like you that lives can be saved.
I want to donate: (Please tick the boxes that apply)
A. any of my organs and tissue or
B. my kidneys heart liver
small bowel
eyes lungs pancreas tissue
for transplantation after my death.
Anyone can register. Age isn’t a barrier to
becoming an organ or tissue donor – people
in their 70s and 80s have become donors and
saved many lives. Most medical conditions
don’t rule you out either.
My wishes
Telephone
Mobile
Email
NHS Organ Donor Register
Please register my details on the
Perforation
Dyluniwyd a chynhyrchwyd gan wasanaeth Gwaed a Thrawsblaniadau’r GIG 2009
21307 Registration Leaflet-Bilingual General Issue.indd 1
1885
If you wish to amend or withdraw your record from the NHS Organ Donor
Register you can do so by calling the Organ Donor Line on 0300 123 23 23,
visiting www.organdonation.nhs.uk or writing to us at the
address overleaf.
n
It’s simple to join the NHS Organ Donor Register
using one of the following methods:
How to register
Register now.
Do you believe in organ donation? If you would take
an organ, would you be willing to give one and help
someone live after your death?
Yet many people – on average three a day – die before
they can have a transplant because there are simply
not enough organs available.
The NHS Organ Donor Register gives hope to more
than 10,000 people of all ages across the UK who
need an organ transplant.
This confidential information is used by
authorised medical staff to establish whether
a person wanted to donate.
If you believe in organ donation, prove it.
Surname*
Forename(s)*
Date of birth* /
/
Male * Female *
Address*
Yet only 27% of us have taken action and joined the
NHS Organ Donor Register.
The NHS Organ Donor Register records the
details of people who have registered their
wishes to be an organ and/or tissue donor
after their death.
My name and address
96% of us would take an organ if we needed one.
Please complete in CAPITAL LETTERS using a black ballpoint pen.
*indicates that a field must be completed.
NHS Organ Donor Register
Transplants save lives
99mm
Fold
99mm
Perforation
99mm
Fold
99mm
Perforation
99mm
ODR070W
Would you take
an organ if
you needed one?
99mm
Perforation
99mm
FREEPOST RRZK-SHUX-SBCK
NHS Blood and Transplant
Fox Den Road
Stoke Gifford
Bristol
BS34 8RR
Have you joined
the Organ Donor
Register?
Fyddech chi’n
cymryd organ pe
byddai angen un
arnoch chi?
Does dim angen
i chi ddefnyddio
stamp, ond
byddai gwneud
hynny’n ein helpu
i arbed arian.
If you believe in organ donation,
prove it. Register now.
ODR070W
Cofrestr Rhoddwyr Organau’r GIG
FREEPOST RRZK-SHUX-SBCK
Gwasanaeth Gwaed a Thrawsblaniadau’r GIG
Fox Den Road
Stoke Gifford
Bryste
BS34 8RR
Ydych chi wedi
ymuno â’r
Gofrestr Rhoddwyr
Organau?
10/2009
21307 Registration Leaflet-Bilingual General Issue.indd 2
Fold
10/2009
99mm
You don’t
need to use
a stamp, but
doing so
helps save
our funds
Perforation
Os ydych chi’n credu mewn rhoi organau,
profwch hynny. Cofrestrwch yn awr.
99mm
NHS Organ Donor Register
15/10/2009 17:21