At the outset, many of the callers are hesitant, even jittery — they are confronting their own mortality to discuss a most daunting topic: donating their bodies to science.
“It is very scary to talk about one’s death,’’ says Andrew Corson, director of the UCSF Willed Body Program. “We try to talk honestly and openly and plainly to people. We want people to feel good about making this decision. It is such an incredible gift they are making.’’
Since the earliest days of medicine, the complex study of human anatomy has been an integral part of health science training and research. For more than 60 years, the UCSF Willed Body Program has overseen the donation of bodies for medical education and research.
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“The need is great, and the gift is valued and honored,’’ says Corson, who has been with the program for 11 years, the last five as director. “The experience of working with the cadaver is extremely valuable — years later, many physicians talk about the important lessons they learned in the anatomy lab. For many medical students, the cadaver in the anatomy lab is the first dead person they’ve seen. Often they approach the cadaver with great trepidation, but soon that is replaced with a great compassion and appreciation for the donor.’’
The University of California has four other anatomical donation program locations — at UC Davis, UC Irvine, UCLA and UC San Diego. Altogether over the last five years, the various sites have received more than 1,000 donations annually, said UC Director of Anatomical Services Brandi Schmitt.
UCSF, which has the largest such program in the state, receives approximately 400 donated bodies a year.
An Intimate Look into Life of Donor
Ariel Sklar, a third-year medical student at UCSF, says she was “awestruck’’ by her time in the anatomy lab. Dissecting a human cadaver gave her an intimate and wondrous look into the life and generosity of the donor, she says.
“Gross anatomy is our first chance to learn anatomy hands on, to discover what holding the heart feels like,’’ says Sklar, who is currently in the midst of a surgery rotation. “It also offers us practice in using the tools to cut, to separate and to dissect. Most importantly though, it reveals to us a very profound individuality, one that comes from seeing the nail polish on your cadaver’s hands, discovering that she had a hernia, and recognizing that she has a variant of vasculature not seen in our textbook.
“Just yesterday I spent an hour talking to a patient before his surgery,’’ Sklar says. “During the operation, I held a piece of his liver and felt his vena cava beneath my fingers. The Willed Body Program first introduced me to this combination of anatomy and specific lives that underlies the process of becoming physicians.’’
Cadavers donated to UCSF are supplied to a number of programs including UCSF’s School of Medicine, School of Dentistry and School of Pharmacy, as well as the orthopedics, ophthalmology, otolaryngology and physical therapy departments. Additionally, UCSF provides cadavers to other UC campuses and approximately 50 non-UC schools in Northern California, research groups and emergency medical education programs. Each entity must adhere to strict protocol guidelines, and each application is vetted by the UCSF Anatomical Material Review Committee.
The process begins with enrollment. Interested donors fill out forms authorizing the donation of their bodies to science. Two witnesses are required, and donors are advised to discuss their plans with close relatives or friends so that their wishes are clearly understood. Additionally, donors are advised to notify their physician and attorney.
Enrollees must be at least 18, and there is no upper age limit — the oldest UCSF donor was 104. The upper weight limit is 250 pounds. Amputees may be accepted, but there are some medical conditions that preclude enrollment such as hepatitis, HIV, tuberculosis and Creutzfeldt-Jacob disease.
All Walks of Life, One Shared Motivation
Annually, about 550 people sign up, and the registry currently has some 11,000 would-be donors. They range in age and walks of life but all share the same altruistic motivation: They want to contribute to science.
Some donors enroll many years in advance; others sign up in their final days when they are in hospice. Some are medical professionals who remember with profound appreciation their student days in the anatomy lab; others are patients with chronic diseases who want to help unlock mysteries behind their illnesses.
“Occasionally people will want to donate specifically for a certain type of research, but we can’t allow specific requests. We may not be working with a particular type of research, and we don’t want to make promises to donors that we can’t honor,’’ Corson says. “Mostly people then say, ‘That’s OK. If I can be of help, that’s fine.’ ’’
Enrollees are given a donor identification card with instructions. The UCSF program covers all of northern California, from San Luis Obispo to the Oregon border, but most donors live in the Bay Area.
When a registered donor dies, program officials are notified, usually by a family member, hospice worker,nurse or other medical staff member. The donor is then moved to UCSF by a mortuary transport service, and the body is evaluated. Those that experienced significant trauma at the time of death or are in an advanced state of decomposition are deemed unsuitable for anatomical study.
“We look at the condition of the body — the height and weight, whether there are surgical scars, amputations,’’ Corson says. “We consider all these factors when deciding how to best allocate each donor. Some projects or courses have specific criteria, and evidence of previous medical procedures can help us in determining which donors are most appropriate for which projects.’’
Program officials draw a blood sample that is sent for testing of Hepatitis B and C and HIV. Approximately 60 percent of the cadavers are embalmed, extending the research period by several years.
“We try to match the requests with the most appropriate donors,’’ Corson says. “Some requests are very specific, some are wide open.’’
Once research is complete, every portion of the donated bodies is returned to the program. The remains are then cremated and the ashes scattered at sea — UCSF contracts with an East Bay crematorium to do the final disposition.
“Over much of the last century, our society worked to push death and dying out of our field of vision,’’ Corson says. “Only more recently has there been a shift toward acceptance of mortality and the inevitability of death. And only more recently has it again become acceptable to die at home or in hospice. Donating one’s body to science is becoming a viable alternative to burial or cremation. There is always a need.’’