National LeioMyoSarcoma Foundation

Tissue Donation Forms

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Forms for Dr John Brooks

In 2005, the NLMSF gave a $30,000 research grant to Dr. Brooks at Pennsylvania Hospital to create the LMS Tissue Repository Bank. This is the only Repository/Library in the world and allows researchers around the world to have access to this great resource.

How can you be part of this research? After surgery (or even before) you can help researchers all over the world by participating following the steps below:


1. 
Inform yourself and read about how your tissue will be used & your rights to privacy. Print and read the HIPAA Notice of Privacy and the letter from Dr. Brooks below.


2. Print and Fill Out
the Informed Consent and Confidentiality & Privacy Rights forms below.


3.  FAX OR MAIL
both forms to

LMS Sarcoma Repository Tissue Bank

c/o  Dr. John S. J. Brooks, Chair of Pathology

Pennsylvania Hospital, 800 Spruce St., Phila. PA 19107

Fax      215-829-7564
Phone   215-829-3541 (Ms. Diane Flynn) 


Donating is simple and easy………..and now you’re done!


The NLMSF takes privacy very seriously and has measures in place to protect the privacy of those who participate in this project. 


In 2005, the NLMSF donated $100,000 (with over $200,00 in future research grants to follow) to Dr. Matt van de Rijn at Stanford University to begin an extensive DNA and Tissue Microarray analysis. This research was made possible by the LMS patients who donated over 300 tissue samples. Unique research that has never before been done by any researcher for Leiomyosarcoma was done through this collective effort. While Dr. van de Rijn no longer needs additional tissues, he supports this very important next step started by Dr. Brooks.


Donate your tissues and help researchers find treatments and cures of LMS through the use of this tissue repository. Your tissues can help find a cure!


A letter from Dr. John Brooks,

Founder & Director of the

LMS Sarcoma Repository Tissue Bank

Participate in New

LMS Repository Tissue Bank

Dr. John Brooks, a pathologist in Philadelphia, has been awarded a grant from the LMS Foundation to set up a LMS Repository Tissue Bank, to house tumor tissue blocks from LMS patients. 

He is now asking if you would like to participate in this collection process, which will provide the needed infrastructure for future research.  Basically, the Bank serves as a resource of material for investigators.  No research can be accomplished easily without such a resource.  Research projects on the blocks will be approved by a Scientific Advisory Committee, according to NIH guidelines.

Some of you have participated in the LMS Microarray Study by Dr. Matt Van de Rijn at Stanford and had your blocks donated there.  Dr. Brooks will need to have a consent form signed by you to hopefully allow your blocks to be sent to him by Dr Van de Rijn (rather than be sent back to the original hospital).  Thus, if you were involved, please look at the U of Penn Consent form, print it out, and fill it out; be sure to check yes in two places - yes to participate in the study, and yes in the spot asking for your material to be sent to Dr Brooks from Dr Van de Rijn.  When completed, please either fax the last page of the form to Dr Brooks (fax number is on it) or send/mail to the address on the Consent Form itself.

Others who may not have participated in the LMS Microarray Study may hopefully be willing to do so now.  All work of contacting the original hospital will be done by Dr. Brooks, once he has the information, so be sure to fill out the hospital's address.  We are trying to collect as many LMS tumor blocks as possible.

If you agree to participate, you can also fill out the last page of the informed consent forms, being sure to include the Hospital where the tumor was removed (as opposed to a small biopsy); this would be valuable information even if your block was sent to Dr Van de Rijn, as the hospital needs to be told your block is being forwarded to the bank.  If you would like, you could be sent an informed consent document by mail, for you to sign.  No one can participate without a signed consent form, as required by the IRB (Institutional Review Board). 

Your information will be kept confidentially, including in the future when your tissue block is sent to a researcher, who will only know tumor characteristics like location, size, etc..

If you need a paper copy of the Consent, please call 215-829-3541 and identify yourself as an LMS patient or family member and my secretary Diane Flynn will assist you. 

Thank you for considering participation in the new LMS Sarcoma Repository Tissue Bank.

John S. J. Brooks, M.D., Pathology Department, Pennsylvania Hospital

February 2006

click here to download Informed Consent Form

click here to download Confidentiality and Privacy Rights

click here to download HIPPA Notice of Privacy Practices

Click here or on the picture to take you to the Foundation Flower page.

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National LeioMyoSarcoma Foundation

4990 Northwind Dr Ste 121

East Lansing, MI 48823

1-888-449-6805

admin@nlmsf.org

Fax 1-251-971-3735 or 1-517-853-0434

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