My parents are getting to the stage where every week, it seems, they hear of a friend who has died, or had a near-fatal incident and becomes confined to a hospital or nursing home. My father has a dose of prostate cancer, my mother is not as sharp as she once was. Today, they are both healthy enough and get by with little external help. However, neither wants to spend too much time away from home any more, and they are becoming more aware of their own mortality. Dad was born in 1927, while Mum arrived in 1932. Both grew up in the war.
Neither of them is especially religious and although today they are financially comfortable, they have spent a large portion of their lives scrimping, saving and struggling with money.
Recently, they watched a TV progamme in which some medico bemoaned the lack of bodies being donated for medical research. That is to say, not so much for research, as for the instruction and education of the next generation of medics. For dissection. By 22-year-old students.
Having lived through more than three-score years and ten, they have been to a large number of funerals recently. These have varied from the grand in high churches, to the intimate where the preacher knew the deceased well and was able to make a moving and meaningful speech about the life that had just ended, to pagan ceremonies, where the body was buried in a field on the side of a favourite hill.
They do not like the idea of an anonymous church ceremony, where the preacher makes some catch-all remarks about how the deceased led a decent, God-fearing life, while the friends and family feel vaguely short-changed. In some ways they would prefer to have a hole dug in their back garden and the bodies slung in, inside a cardboard box. The TV programme solved their dilemma.
Not only does it help the system to train more medics and it solves the problem of whether to go for burial or cremation or some other means of disposing of the body, but it also saves money -- it appears a standard funeral nowadays cost nearly as much as a wedding. - say £5000 / $10,000 or so. Although the medical school will not pay for the party afterwards, they do pay for all disposal costs. While my parents have plenty in their estate to cover such expenses, it goes against their lives and wartime upbringing to spend £1000 on a wooden box which will be seen for a few moments and then buried or burned. They want to release their children from such burdens.
How do I donate my body for medical use?
This applies to the UK only, though I expect most countries have similar arrangements. Everything to do with organ donations and whole body donations is handled by the UK Human Tissue Authority, and that organisation's website has excellent information for the prospective donor.
First, the donor has to formally write down the request. This is something -- in the UK at least -- that no-one else can do. The UK Human Tissue Act 2004 says that the bequest of a body must be made by the donor in writing and signed in the presence of at least one witness. There are official forms available, called consent forms. While there is no compulsion to use these, it greatly helps to use them, as they provide all the information that might be needed in the event of death. One of the spaces on the form, for example, seeks permission for photographs to be taken of the body, both in its complete state and during dissection. it is possible to omit this permission if the official forms are not used, and this may make it difficult for a medical teaching school to accept the donation. Another seeks permission to keep organs for longer than three years.
Once the person is dead. Once the living, breathing soul has transmuted into a cadaver, then the relatives must inform the medical school quickly. The school will want the body as fresh as possible, before it starts to decay. However, medical schools will only accept donations of cadavers on normal working days. A cadaver offered for donation on the first day of a long weekend is unlikely to make it into the cold room until the Tuesday, by which time, it might be too late.
It might be possible to get the body stored in the cold storage room of a local undertaker or funeral parlour, for later despatch to the medical school, but if there are costs associated with this, then the medical school will not pay them.
It appears that these basic guidelines are followed in most of the developed world: UK, U.S., Australia and other countries. As I understand it, in India, there is a culture which allows medical schools to take bodies as they need them from the mortuary, so the shortages there are not so severe. I doubt popular culture would permit such actions in the UK.
What happens to the body?
I'm no medic, but it seems that at the beginning of the human anatomy course at medical school, each student is (in theory) presented with a cadaver, which they will use over the next year or so, to explore the various organs, bones and soft tissue. As the year progresses, they take it apart, organ by organ, muscle by muscle, learning which bits fit where and how the different bones, veins, muscles and organs interact in a complex, three-dimensional jigsaw.
Medics tell me that the act of taking the body apart, and understanding which organs overlap in three dimensions, helps the lessons sink in much more effectively than any number of revision sessions with Gray's Anatomy, or even the modern, computerised aids to learning.
Heisenberg says: I can tell you that after spending eight months with two lovely dead people in the anatomy course, that you grow to like them and somehow adopt them into your family. It was always nice to meet them and you would get to learn more about their life the deeper you burrowed into their bodies. I've had the pleasure of learning heaps from them, so my body will hopefully give a bunch of students just as much fun. I'm thinking about swallowing a little 'surprise' sign before I die :-)
Other cadavers are used to help experienced surgeons develop new surgical techniques, while new surgeons also need cadavers upon which to practice more basic operations. All in all, having just emerged from the surgeon's knife, I feel rather glad that others before me have allowed their dead bodies to be used in this way.
Once the body has been used, it is, according to the website, cremated individually and a short service is given by a local priest. The ashes may then be returned to the family, if that service has been requested.
The HTA's website is at pains to point out that all bodies are treated with due respect. So those tales of medical students slicing off the penis (or other organ) and using it for a game of catch, are all myths, then? Hmmm. In any case, it appears that a significant number of the bodies donated to medical schools come from old alumni - medics, surgeons and others who underwent the training and wish to ensure that the next generation of students gets the full-on anatomical opportunity afforded only by the dissection of a real cadaver. So maybe there is some respect for the cadaver after all. But I would not bet my life on it.
Addendum: I just spoke to a doctoring friend who related a tale of extreme 'funniness'. The penis and testicles had been removed from the cadaver earlier that day, and during a drinking session in the evening, he went to the urinal. During the process of urination, when there were other men standing by, the penis and testicle pair (threesome?) was allowed to drop into the urinal amid screams, first of his simulated shock, and then of real shock from the err, by-standers. Yeah - best not to bet on all organs being treated with total respect.
A shortage but not a crisis
The number of donations in the UK has fallen from 670 to about 600, since about 2000. By contrast, about 6000 students embark on their medical training each year.
It's not clear why the numbers are declining, but lack of publicity is certainly one factor. Following a TV programme, interest jumped, and certainly my parents would not have hit upon this solution to their problem without the aid of the TV programme makers. Other factors include tighter restrictions on the type of bodies which may be donated. Following the scare over mad cow disease, anyone with dementia (prior to death) is rejected, while all cadavers which suffered from some types of hepatitis are also rejected, due to potential contamination of the blood.
Furthermore, the rules requiring potential donors to prepare a signed witnessed form in advance are a definite obstacle to the supply of bodies.
In the US, the shortage is becoming more acute, as a new industry -- the human tissue industry -- develops. These are commercial companies which aggressively pursue donations, and then dismantle them, selling hearts, livers, kidneys and other organs to institutions at significant profit. These restrict the suply of cadavers to the legitimate medical schools, which rely on low-key communications, word of mouth and other non-aggressive techniques.
Sources, further information
http://cw2.trb.com/news/kwgn-cadaver-count,0,3216853.story
http://student.bmj.com/issues/08/01/news/004.php
http://www.hta.gov.uk/about_hta/donating_a_body_to_medical_science.cfm (UK)
http://www.ehow.com/how_110893_donate-body-science.html (General)
http://www3.fhs.usyd.edu.au/bio/bodybequest.html (Australia)
http://www.bios.niu.edu/body_donation.pdf (U.S. - Illinois)
http://biogift.org/03_faq.html A commercial service, competing with the medical schools