On the March afternoon when her wife Sandy Swanson died of cancer, Liz Mattern knew who to call.
A few hours later, two technicians arrived to remove Swanson’s body. As planned, her remains were bequeathed to a medical school through its whole-body donation program.
Partners for 39 years and spouses for five, Swanson and Mattern, of suburban St. Paul, Minn., were inseparable and “on the same page about everything,” according to Mattern. More years ago than she can count, the couple agreed that they each wanted to donate their body after death, to be used by physicians-in-training at a nearby university.
“It was my idea, but Sandy was on board right away. At the time we signed up, we sent letters to our families explaining that this was our choice,” said Mattern. “It’s the ultimate recycling.”
While no agency is charged with tracking what’s known as whole-body donations, it’s estimated that approximately 20,000 Americans donate their bodies to science every year. These donors give their bodies to be used to study diseases, develop new medical procedures and train surgeons and med students.
Beyond the classroom and the anatomy lab, cadavers have been used by auto manufacturers to test safety features in simulated crashes, by forensic anthropologists who study decomposition to train law enforcement and by the military to test protective gear and the impact of weapons.
Body Donations Helping Advance Science
Eighty percent of donors bequeath their bodies to academic programs. The Anatomical Board of the State of Florida maintains a list of university-affiliated medical schools that accept donated bodies.
Donors can also choose to work with for-profit companies or nonprofits. The American Association of Tissue Banks (AATB) inspects and accredits seven nonprofit, non-transplant, anatomical donation organizations that voluntarily submit to its rigorous standards.
While they’re still alive, prospective whole-body donors who work with AATB programs must provide them with authorization, kept on file until the time of their death.
“The authorization process is required to include a discussion of ways in which the donation may be used,” according to an email from Deanna Puglia, the AATB’s communications manager. “Donors have the right to stipulate how they would like their donation used. These recorded wishes are then honored by the organization coordinating the donation,” she says.
Puglia added that all AATB-accredited organizations are required to adhere to a strict “non-transplant code of ethics,” which includes a pledge to “honor and treat with respect the gifts of donated human tissue.”
“The point of donating a body is to advance science and contribute to the education of the next generation of students. People who do this make a gift to mankind,” says Richard Drake, director of anatomy and professor of surgery at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.
Drake explained that donated bodies in an academic setting are used beyond the classroom and lab — for research, for new devices and techniques and to prepare surgeons practicing new procedures. At the Cleveland Clinic, work with cadavers has been instrumental in pioneering innovative new face transplant and hand transplant surgeries.
“An embalmed body does not have the texture and feel of a live one, but it is the best way to study anatomy,” Drake says. “Today we have 3D imaging techniques and virtual reality learning coming in, but nothing takes the place of the cadaver.”
History of Using Bodies for Medical Education
The use of dead bodies for medical education has a long and colorful history. Their first recorded use of cadavers was by two Greek scientists in the third century. However, dissection was forbidden by the Roman Empire, then considered sacrilegious. The practice wasn’t revived until the Renaissance when cadavers became part of the study of anatomy, and not just by medical students: Leonardo da Vinci and Michelangelo reportedly dissected cadavers for their artistic renderings of the human form.
At the time, the bodies of executed criminals were used for these scientific lessons, a practice that continued in Europe and then the U.S. As medical education programs expanded in the 18th and 19th centuries, a shortage of bodies arose and grave robbing became common, practiced by professional thieves and sometimes by doctors, medical school professors and students.
Later, unclaimed bodies procured from prisons, poorhouses and asylums were used for educational purposes.
Starting in the last century, academic programs adopted ethical practices and procedures to formalize body donations and have continued to update them. In 1968, the first Uniform Anatomical Gift Act was passed to protect the interests of organ and whole-body donors and their families.
At the Oregon Health Science University (OHSU) in Portland, between 120 and 150 whole-body donors are accepted each year. They are referred to as “first patients” by the 300 medical, dental, physician assistant and radiation therapy students who learn from them in the classroom. An additional 200 practicing physicians and researchers also work with the donated bodies.
Before any of them lay a gloved hand on a cadaver, they’ve sat through an orientation from Tamara Ostervoss, OHSU’s Body Donation Program director.
“Remains here at our program are treated with the dignity they deserve,” says Ostervoss, who calls herself a “guardian of the gift.”
“Working with these donors is a privilege and we want them to appreciate that. This was a person, they had a family that cares for them,” she says.
In his first semester of medical school at the University of Minnesota, Austin Pickup, 23, spent eight to 10 hours a week with his cadaver.
“It was my first experience seeing the body in such detail,” he says. “I’d looked at drawings in textbooks and done clinical shadowing, but nothing quite prepared me for seeing a human body on the first day in the anatomy lab.”
In the course of his study, the cadaver gave Pickup a close-up view of tendons, ligaments, nerves, muscles, bones and organs.
“Through the process of dissection you understand how it feels to work with human tissue, what the structures feel like. It really cements the learning,” he says.
Pickup admits that he and a number of his classmates had to leave the lab to “get some air” on several occasions when the dissection work felt too intense. He believes that reflects the weight of responsibility the students feel to the bodies before them.
“You develop a connection to your cadaver,” he says. “From day one, our professors stress these people gave the ultimate final gift that passes through us and goes to our future patients.”
While altruism is the No. 1 reason donors list for bequeathing their bodies, some benefactors choose to donate to save money. Although it varies by program, death-related expenses, including body removal and transport, embalming and cremation can be covered by the medical school or nonprofit that takes possession of the corpse; the for-profit companies typically pay all the costs.
Liz Mattern’s desire to donate her body traces back to her childhood.
“My motives (for donating) are not entirely noble,” she says. “I was 11 when my father died of a heart attack. My mother got the sales pitch and went top shelf on an expensive casket. Thousands of dollars went in the ground. I’ve been opposed to doing something like that ever since.”
Mattern was given options for her wife’s final disposition once her donated body has served its last function for students and researchers.
“They told me I could have her cremains returned, but I chose — well, Sand and I chose — for the university to deal with them. They have a place where they bury them, with no individual marker, and that’s fine with us,” she says.
Since Mattern plans to donate her body to the same program at the time of her death, she imagines that someday, her cremains will be interned in the same place.
“I like that idea. Sand and I are big believers that these are the bodies we are using and when we’re gone, somebody else can use them,” Mattern said. “I would like to see more people be comfortable doing this.”
Making the Choice
I have long harbored the idea that I would like to be what I now know is called a whole-body donor. I recall mentioning it to at least one of my children at some point, but in the course of reporting this story, I took steps to formalize my wishes.
I found the process remarkably simple.
The anatomy bequest program affiliated with the medical school in my community sent me its standard forms. I checked the box to allow the university to use my body “to support medical education” and also agreed the program could retain portions of my body for long-term research. The agreement I signed indicated that my remains will not leave the state where I reside.
My sister and brother-in-law signed the form as witnesses. As the program requested, I also updated my advance care directive and sent that to the program.
Most importantly, I had conversations with my three children, my sister and my cousin, whom I have designated as my health care agent. I also wrote them each a letter stating my wishes, and have placed that letter and copies of the paperwork in what I call my “death file,” alongside my will and other pertinent documents.
While I hope my plan won’t be executed for many years, I will rely on my family to carry it out.
“I can’t stress how important it is for donors to make their wishes clear to their next of kin,” Drake says. “We don’t read the obituaries looking for names of people (who’ve registered for) our program. If a family doesn’t call at the time of the death, the wishes of the deceased may not be observed.”
When I’ve mentioned my donation plan to acquaintances, I’ve been surprised to see several of them recoil. The same people who themselves are proud to have indicated a willingness to be organ donors seem to find whole-body donation macabre.
Fortunately, no one in my close familial circle raised any such objections; I feel confident they understand both what I want and why I want to be a donor. No matter what I may or may not achieve in this life, I see this decision as my legacy that will leave this world better in ways I can’t possibly know.
In my letter to my family, I cited this quote as the sentiment driving my decision: “A society grows great when old men (or women!) plant trees in whose shade they know they shall never sit.”
Of course, making such a solemn plan requires a little humor to leaven it: “This way, I’ll finally go to medical school,” I told my kids. “One way or the other, I’ll be there!”
Interested in Making a Whole-Body Donation?
If you’re interested in whole-body donation, here are a few fast facts
- Programs vary in their policies and procedures, from how long they expect to keep the remains to their final disposition. Read the fine print and feel free to compare.
- Whole-body donors can sometimes still donate their eyes or other tissue for transplantation in a living recipient.
- There are no upper age limits for donors. The oldest adults may not be good candidates for organ donation, but their whole bodies continue to have value.
- For the safety of students and researchers who will dissect the cadavers, programs usually can’t accept donors who had infectious diseases including sepsis, HIV/AIDS or hepatitis B or C. Prospective donors who died as a result of physical trauma are also usually excluded.
- No money can change hands in the transaction; it is against the law in all 50 states to buy and sell bodies.
- For centuries, many religions preached against bodies being used for scientific purposes after death, but today, the practice of body donation is approved and regarded by most as an ethical decision.
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