2SLGBTQIA+ Patient & Public Advisory Team
for Equity, Diversity & Inclusion in Organ Donation and Transplantation in Canada

We are seeking 2SLGBTQIA+ individuals and 2SLGBTQIA+ allies with personal experience of the Canadian organ and tissue donation and/or transplantation system. We hope you will consider joining a new patient/public advisory team to help make organ and tissue donation and transplantation more equitable for 2SLGBTQIA+ people.

If you are interesting in receiving more information or participating please include your name and contact information in this short questionnaire. There are a few questions to help us better understand your interest and eligibility. This is your chance to make your voice heard and contribute to meaningful structural change in the health system. We are based in Manitoba but pan-Canadian in scope. Please consider using your voice and your life experience to make a better, more inclusive world!

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* 1. What is your name (first and last)?

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* 2. What is the best email address for us to contact you with a follow-up e-mail? (Your email will be kept private and not shared with any other organizations)

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* 3. If email doesn't work what is the best phone number and/or mailing address for us to contact you with a phone call or letter?

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* 4. In what Province/Territory do you live?

British Columbia

Alberta

Saskatchewan

Manitoba

Ontario

Quebec

Nova Scotia

Newfoundland

New Brunswick

Prince Edward Island

Yukon

North West Territories

Nunavut

None of the above

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* 5. Have you been an organ donor or worked up as a potential organ donor?

Yes

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* 6. Have you been an organ transplant recipient or worked up as a potential transplant recipient?

Yes

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* 7. Have you been closely involved as the family or a substitute decision maker of a 2SLGBTQIA+ person who has donated organs or tissue?

Yes

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* 8. Have you been closely involved as the family or a substitute decision maker of a 2SLGBTQIA+ person who has received a solid organ transplant?

Yes

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* 9. Have you registered your intention to donate (or not donate) your organs either with an organ donation card or an electronic registry?

Yes

Prefer not to answer

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* 10. Do you identify as a 2SLGBTQIA+ ally?

Yes

Prefer not to answer

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* 11. Do you identify as a 2SLGBTQIA+ person?

Yes

Prefer not to answer

2SLGBTQIA+ Patient & Public Advisory Teamfor Equity, Diversity & Inclusion in Organ Donation and Transplantation in Canada

Question Title

* 1. What is your name (first and last)?

Question Title

* 2. What is the best email address for us to contact you with a follow-up e-mail? (Your email will be kept private and not shared with any other organizations)

Question Title

* 3. If email doesn't work what is the best phone number and/or mailing address for us to contact you with a phone call or letter?

Question Title

* 4. In what Province/Territory do you live?

Question Title

* 5. Have you been an organ donor or worked up as a potential organ donor?

Question Title

* 6. Have you been an organ transplant recipient or worked up as a potential transplant recipient?

Question Title

* 7. Have you been closely involved as the family or a substitute decision maker of a 2SLGBTQIA+ person who has donated organs or tissue?

Question Title

* 8. Have you been closely involved as the family or a substitute decision maker of a 2SLGBTQIA+ person who has received a solid organ transplant?

Question Title

* 9. Have you registered your intention to donate (or not donate) your organs either with an organ donation card or an electronic registry?

Question Title

* 10. Do you identify as a 2SLGBTQIA+ ally?

Question Title

* 11. Do you identify as a 2SLGBTQIA+ person?

2SLGBTQIA+ Patient & Public Advisory Team
for Equity, Diversity & Inclusion in Organ Donation and Transplantation in Canada