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022- 22679044(Hosp.)
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Annex - X
Format for Tissue Transplantation Data for Registered Transplant & Retrieval Center
Name & Address of the Hospital :
Appropriate Authority Reg. Valid Upto : State :
Name of Tissue
Cornea

No. of Eyes / Cornea Collected

No. of Cornea Transplants done

Signature of Tn-charge with Name & Designation

Email :
Contact No.

Year
(Jan- Dec)

Annex - III
PROFORMA FOR MONTHLY REPORTING OF TRANSPLANT OF CORNEA
Appropriate Authority Reg. Valid Upto :
Hospital Name :
Name of Tissue : CORNEA
State :
Month :
Sr. No.

Date of Recipient's Name &

Age & sex CR No. TYP
theer(aO
peputitc:
i /
Operation
Address

No. of Cornea Transplanted / utilized :

(In the month under repordng)

Number of Cornea
Transplanted

Signature of In-charge with Name & Designation

Email :
Contact No.

Annex - IV
PROFORMA FOR MONTHLY REPORTING OF TRANSPLANT OF CORNEA
(For Eye Banks Only)
Hospital Name :
Appropriate Authority kg. Valid Upto :
State :
Name of Tissue :
Month :
Sr. No.

Date of
retrieve!

Donor's Name &

Address

No. of Cornea Transplanted / utilized :

(In the month under reporting)

Age & sex

CR No.

Cause of Death

No. of Cornea One /

Both)

Signature of In-charge with Name & Designation

Email :
Contact No.

Next of kin name, .

address & Contact
Number

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VASANTH

(91 her NATIONAL ORGAN AND TISSUE

TR A.NSPI.P.,11- ORGAN ISATIO!.:
& 5" Floors, ICMR
Safdarjung Hospital Campus

NA.t.
W-10 Fellow Minimal Access Sviv.,;11.7

ta;;i!"1

lurkern;

DIRECTOR

NEW DELHI - 110029

/fr'"

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DO. No. Director MOTTO/2014/105/ 651

Dated: 05.11.2014
/1-4 '

Greetnos from NOTTO .

e ar

The National Organ and Tissue Trarspant Organization (NOTTO) has been estaclished under the
Directorate General of Health Services. Ministry of Health & FanMy Welfare, Government of India, located in the
1:h and Sth
National InstiLte of Patho'ogy Building, Safdarjung Hosoital, New Delhi The objective of
NOTTO is :he implementation of the prov'sicrs of the Transolatation of Hun-an Organs (Amendment) Act,
2011, promotirg deceased organ donation ard providing a system for procurement & distribution of organs &
tissues as per the Act. It is also a mandate of NOTTO to fJnction as an Apex organization of the country for
collection of data on organ and tissue transplantation from ai/' the States & Union Territories of the country in
der to develop a National Registry.

'
In view of the above, you are requested to kindly furnish the comOlete details of the registered
Transplant & Retrieval Centres as well as the issue banks/ Bic-material Centres in your State of Maharashtra,
including the dates when they were initially registered and the current valid registration. On expiry of current
registration it wou'c' be mandatory to update the.r certificate of registration with Appropriate Authority of the state
and the same be communicated to NOTTO. This will facilitate their registration with NOTTO and allocation of a
unique ID Number by NOrls.d..Lepieetentatinn nn the-NOT.Z.0
--websike-11-is-aleasmandated that all ongoing
transplant activity information be recorded and forwarded to NOTTO on monthly basis. For this purpose, it is
requested to depute a senior Nodal Officer whom we can contact for further information.

In this context a D.O. Letter Dated 12/12/2011 (copy enclosed) was

sent from the then Joint Secretary
X\ Dr. Arun Kumar
Panda as alsc subsequent reminders on the sane subject, However, full data has not been
received till date fromyour state.
Kindly find enclosed the proforma fdr collection of transplant related data of organs
.and ,
ti:sue
sth
o:'
o
nthl basis nnexure
as well as earl basis Annexure 7-_
I
registered Transnintrefrieval hospitals and 'tissue banks of voLiiState You are requested to alsb furnish the
pe.t hive! transplant data from the centres performing transplant prior to 2011 since their date of first registration.
..a required information (hard & softcopy) from all the registered Centres in your state may kindly be sent to
)) the above address by 30th November 2014 & hence forth on a monthly basis by the
7th of the following month. It
would also be pertinent to bring to your notice that the NOTTO Website has been created and would
. be
. functional shortly 'after which'it is requested that the information may kindly be. provided online. I seek your
S cooperation in this national etideavor for developing a National Level Registry.

A /M

(\!

ntAyainy.

Ak
Astks
Yours sincerely,
avViret.
(Dr. Vasanthi Ramesh)

Sujata Sounik
Principe/ Secretary

(Public Health & Family Welfare),

Government of Maharashtra,
.;0!1i Floor, El Wits' CT Hospital CwnruI! 13uilouip
N.:umbel -400001, felaharashtra
End: As above.

1,,te

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1,:ame & Address of the Hospital:

State.:

Appropriate Authority Reg. Valid Upto:.

_

Year

Year

wile of Tissue

(Jan Dec)
-----------

i.Di nea

No. of Eyes / Cornea collected

!...eart 'valves

No. of Cornea Transplants done

Collected
Utilized
Collected
Utilized
Collected
Utilized

Lone
low Other Tissue (Please specify)
Total (all Tissues )

Email id & Mobile no. of the designated official

Signature & Seal

Nsisik,AvAknowar

-r-

PROFORMA FOR MONTHLY REPORTING OF TRANSPLANT 0 I? CORNEA

Appropriate Authority Reg. Valid Upto:
Name Of Tissue: CORNEA
Month:

S. No.

Dale of
Operation

Recipient's Name &

Address

4coc -111

Hospital Name: .
State:
Age 4c Sex

CR Nu.

Type
(Optical/ therapetti le)

Number of (.ornea
Transplanted

No. of cornea transplanted/utilized :

(In the month under reporting)

Signature of In-eluirgc- .eilh Name & I )esignmiiin

MO FORMA Folk MONTHLY REPORTING of vow R OP CU RNEA

(FOR EYE BANKS ONLY)
Appropriate Authority Reg. Valid Upto:
Name of Tissue:
NIonth:
S.
No.

Date of
retrieval

Donor's Name & Address

Hospital Name:
State:
Age & Sex

CR No.

.._
No. of CorIlea
One/I3oth

Cause of
death'

Nexl of kin name, mitlress

& Contact moldier

Total No. of cornea collected:

([n the month under reporting)
Signature of ln-charge with Name & DeNignalitin
Email
(.1oniaci No
c: