Yet the indictment of the former Harvard Medical School morgue manager for allegedly stealing and selling body parts from anatomical donors has shaken medical school body donation programs like my own at the Western Michigan University Homer Stryker M.D. School of Medicine. The allegations show the need for more regulation and oversight of medical school body donation programs. They also make clear the need for better public understanding about the harrowed history of medical education and cadaver dissection.
“Mortui vivos docent,” or “the dead teach the living,” is a Latin phrase used for hundreds of years to justify the dissection of human bodies for medical education and research. As the need for physicians grows, so too does the demand for cadavers to support their education.
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In the present day, we accept that examination of a body after death can provide important information. Forensic pathologists routinely perform autopsies to determine cause and manner of death. Anatomy education comprises foundational training in the first two years of medical school. It is considered so important that the Association of American Medical Colleges shares information on its website about available anatomy resources broken down by specialty. However, the regular use of human cadavers for medical education, and their procurement, receives far less media attention.
Early physicians knew that knowledge of human anatomy was essential for training. They faced difficulty obtaining cadavers in a society that largely rejected the idea of anatomic dissection. The practice of human dissection was illegal in the United States until the 1800s and cadavers were usually procured by grave robbing. In 1832, the English Parliament passed the Anatomy Act allowing for those who died in public institutions, and whose bodies were not claimed within 24 hours, to be given to medical schools. The 2004 Anatomy Act established the Human Tissue Authority in the United Kingdom as a regulatory authority for the procurement, use, and disposal of human tissues. The HTA instituted a licensing requirement and defines the best practices for anatomical education programs, among other types of use.
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The United States passed laws modeling the English system beginning in 1834. In 1968, the Uniform Anatomical Gift Act was passed, addressing both organ donation and whole-body donation for anatomical dissection. It allows state anatomical boards to distribute unclaimed decedents to medical schools. Allocation of unclaimed bodies is ethically problematic — at a time when end-of-life expenses often start in the thousands of dollars, decedents from marginalized groups comprise many of the unclaimed. The practice therefore perpetuates social inequities and causes harm to living people. The term “unclaimed” itself suggests that families choose not to take responsibility for their deceased loved one. However, oftentimes financial limitations prevent families from being able to decide the final disposition of their loved one.
Although there is no specific accreditation or licensing for anatomic body donation programs in the United States, the majority are run professionally and in good faith with respect for the donors and their loved ones. At WMU’s School of Medicine where I direct the body donation program, policies and procedures ensure that donors are treated ethically while in our care.
The WMU School of Medicine program requires that donors register themselves while still able to consent and accepts donations made by next of kin only in rare circumstances, so as to ensure respect for the donor’s wishes. Permissions for research and retention of tissues are explicitly addressed on our forms, and we frequently talk with our donors and their families answering questions about donation. Our goal is to provide transparency and educate our donors about what happens after death when a body is donated to our medical school.
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Upon a donor’s death, we screen for factors that could interfere with embalming. The donor is then transported to the school and, after intake, decisions are made about how the donation will be used, for example for anatomy education or for training orthopedic surgery residents in procedures. For anatomy education, cadavers are embalmed by a licensed funeral director. The donor is then dissected by experienced staff according to standardized protocols to support upcoming courses. Medical students study the anatomical preparations over the course of one to three years. At the end of a donation period, we make certain all cadaver materials are consolidated and cremated. The next of kin are notified and cremains are returned to them or interred in the program’s memorial.
The WMU School of Medicine body donation program is small compared to other institutions, receiving about 40 donations per year. Despite being a smaller program, the logistics of supporting multiple labs and research projects requires meticulous record keeping and tracking of our donors and all of their tissues. We customized evidence management software to document all communications with donors and their families; track the physical location of each donor and associated materials; archive medical histories; document dissections; and record the donor’s wishes for final disposition. This allows us to protect the personal information of our donors, audit ourselves, and maintain a high standard of practice. Implementation of this level of accountability is essential to honoring our promise to the donors.
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The history of medical cadaver use is a tainted one that is particularly horrible for disenfranchised groups. As medical schools strive to address health inequities through recruiting diverse students, faculty, and staff, they ought to think about the first human bodies their students see. Many people, but especially those belonging to minority groups, are understandably uneasy about donating their body or a loved one’s to a medical school. It is the responsibility of the medical education community to demystify body donation and gain the public’s trust.
In addition to transparency about donation, medical educators should advocate for legislation that more clearly addresses whole-body donation for medical education purposes. There must also be an oversight mechanism to enforce these laws.
There is a model that works in the UK’s Anatomy Act of 2004, which regulates any organization that stores and uses human tissue for medical education and research, as well as many other agencies. Most body donation programs today would meet those standards. Opposition to these measures would only serve to increase public mistrust.
Ultimately the dead may teach the living, but it is the duty of the living to be the voice advocating for the dead.
Christine M. Pink is the director of the Body Donation Program at the Western Michigan University Homer Stryker M.D. School of Medicine.
Charges have shaken medical school body donation programs
