Forms for Cord Blood Donors

Cord blood is procured only in cases in which the mother has given explicit consent. In other cases, the placenta and the umbilical cord are simply destroyed alongside all other biological waste.

  • Letter for donor 
  • Informed Consent for Cord Blood Donation (print three copies)
    Carefully read and sign all three copies. One copy stays with you and the remaining two must be handed in at the time of reception to the delivery room (one stays in your patient history and the other is delivered to the Ana Rukavina Cord Blood Bank alongside the following two forms:
  • Health Questionnaire
    Please answer the questions truthfully. All the data is confidential and is used to protect the future cord blood recipient. Fill in the questionnaire no earlier than two weeks before delivery
  • Identification Form for Cord Blood Donors (print one copy) 
    This data is confidential and will only be used should the necessity to contact you arise.

The Bank organises the delivery of the procurement kit and the transport of procured blood to the Bank from the delivery centre whose staff have been educated by the Bank to conduct the procurement process. If you are planning to deliver in a delivery centre not on the list of delivery centres educated by the Bank, please contact us so that we could reach an agreement.

Here is list of delivery centres where cord blood donation is possible

More info:
Ana Rukavina Public Cord Blood Bank
Kišpatićeva ulica 12, 10000 Zagreb

phone: +385 1 23 88 708

Doc.dr. sc. Branka Golubić Ćepulić, dr. med.
Pročelnica Banke krvi iz pupkovine Ana Rukavina