Georgetown University medical students attend a donor memorial service. Credit: Giuliana Cortese
Donald Truhe of Elk Point, South Dakota, never went to college. But someday, the 62-year-old co-op manager will go to medical school.
Not as a learner, though. Truhe has decided to donate his body to science. When his time comes, he will help medical students develop the foundation of their anatomical knowledge.
“At that point, you’re just a bag of skin and bones,” Truhe says. “You might as well help medical students learn.”
Both of Truhe’s parents were donors. At his father’s memorial service 10 years ago — held at the South Dakota Sanford School of Medicine — Truhe decided he wanted to follow in his footsteps.
The school holds memorial services for its donors, and Truhe was in awe of the ceremony, attended by hundreds of medical students in their black suits and dresses who wanted to pay their respects.
“It was just a really incredible event,” Truhe says. “I decided I wanted to do the same.”
Spurred in part by high funeral costs, greater social awareness, and dwindling observance of religious customs, whole body donation is on the rise across much of the United States. MedCure, one of three national body donation organizations, reports a 36% increase over the last five years.
As of 2016, Science Care, a national tissue bank, was getting roughly 5,000 donations a year — a doubling in cadavers since 2010. And several medical schools, including the University of Minnesota Medical School, University of California (UC), Davis, School of Medicine, Icahn School of Medicine at Mount Sinai, and the University of Arizona College of Medicine in Tuscon and Phoenix, have seen significant growth over the last several years.
“It’s something that’s become much more socially acceptable,” says Jeffrey Laitman, PhD, director of anatomy and functional morphology at the Icahn School of Medicine at Mount Sinai and former president of the American Association of Anatomists (AAA), a group of biomedical researchers dedicated to the advancement of anatomical science. “So the donation of the body isn’t just for someone who’s poor or indigent. It’s seen as a socially important thing to give.”
And the importance of cadavers in medical school can’t be overstated, says Richard L. Drake, PhD, professor of surgery and director of the body donation program at the Cleveland Clinic Lerner College of Medicine.
“I think it’s very important from an educational standpoint,” Drake says. “The student is actually seeing what the anatomy is going to look like in a human body, so when they get to the rotations in the third year it’s not a complete surprise.”
A student’s first patient
The use of human bodies for medical training began in Europe in the late Middle Ages and became more widespread during the 18th and 19th centuries. Today, all medical students have the opportunity to work with human cadavers during their first-year anatomy courses.
Each year, Mark Cicchetti, managing director of the anatomical gift program at Harvard Medical School, introduces 180 first-year students to their cadavers for the first time and gives them his “lab intro spiel.”
“They’re all so different, but the one thing they have in common is they all chose to be here,” he tells the students. “It’s important for students to know that because many, many years ago the way they were procured for medical schools was nothing like it is now.”
A Georgetown University medical student presents a flower to a donor’s loved one. Credit: Giuliana Cortese
Back in the 18th and 19th centuries, anatomists used the gallows, jails, and poorhouses as a source for bodies — sometimes even resorting to graverobbing, Cicchetti notes. It wasn’t until 1968, with the passage of the Uniform Anatomical Gift Act, that the sale and purchase of human body parts was officially prohibited.
In 2012, the International Federation of Associations of Anatomists further published recommendations for the donation and study of human bodies that call for willed body donation and for an end to other practices such as the use of the bodies of executed persons and unclaimed bodies. The AAA released similar guidelines in 2009.
Anyone can sign up to be a body donor — all it takes is registering with a national or state agency or medical school. The viability of the body, however, is determined at the time of death. Some conditions can preclude someone from being a donor. For example, anyone who has an infectious disease is excluded. No traumatic accidents. No suicides. If someone is notably overweight, or, by the same token, emaciated, the body will likely be turned away.
But those that are accepted become integral to each student’s learning experience.
“I think a lot of the students look at their cadaver as their first patient,” Cicchetti says. “What they learn from them is immeasurable. It’s not something you could ever learn from a book.”
Some areas see shortages
Because there is no central repository for body donations — most donors register with their state or local medical school — there are occasionally regional shortages, says Drake.
Friday, April 05, 2019
Though technology will never take the place of learning on a real cadaver, some campuses are experimenting with different anatomical learning tools.
The Cleveland Clinic and Case Western Reserve University are opening a new Health Education Campus in 2019, featuring several cutting-edge technologies to enhance anatomy classes for medical students.
The Sectra Table will enable users to explore clinical cases by visualizing skeletal tissue, muscles, organs, and soft tissue and then virtually slicing off layers of tissue. HoloAnatomy uses the Microsoft HoloLens, a mixed-reality device, to allow students to view detailed 3D holograms of the human body.
There will also be a U/S Mentor, which is a medical simulator for training in ultrasound-related examinations and interventions. The technology combines 3D virtual cases and clinical scenarios featuring reconstructed ultrasound scans of anatomy.
“We’ve added in on the technology side an ultrasound simulator and include things like virtual reality, so they can manipulate it a little differently,” said Jennifer McBride, Ph.D., associate professor of surgery and director of virtual anatomy education at the Cleveland Clinic Lerner College of Medicine. “We’re trying to figure out the best tools.” But, she added, “There’s no replacement for the human cadaver.”
“Shortages sort of come and go and they’re very regionally placed,” Drake says. “They’ll just pop up every now and then.”
For instance, in 2018, New York City only had 100 donations across five medical schools. Columbia University alone uses 40 bodies a year, says Paulette Bernd, Ph.D., professor of pathology and cell biology and director of the course on clinical gross anatomy and the anatomical donor program.
“It’s very odd but New York City gets very few donations compared to upstate New York,” Bernd says. “We rarely have enough.” That almost always leads to borrowing from upstate institutions.
The University of South Dakota Sanford School of Medicine has seen a steady decline over the last three or four years. In 2018, there was a 25% decrease from the previous year, says Sara Bird, program assistant for the school’s body donation program.
“It has an effect on classes here,” Bird says. “Typically, in classes we have a certain student-to-donor ratio. We have to rearrange that ratio so we can accommodate the students.”
Many schools are engaging in some form of outreach to get the word out.
At the Cleveland Clinic, hospital public relations staff reach out to the media to pitch donor-related stories. Hospitals often have memorial services for donors, which allows friends and families to come and learn more about the process for themselves.
At times, schools will send advanced-level anatomy and physiology students out into the community to educate people on what it means to be a body donor.
“Any time we have a shortage in science it’s all about public awareness,” says Jennifer McBride, Ph.D., associate professor of surgery and director of virtual anatomy education at the Cleveland Clinic. “When people aren’t aware of something they’re less likely to donate.”
Meanwhile, other institutions have plenty of donors. Tufts University School of Medicine alone has 7,000 donors in its database.
The Willed Body Program at the University of Arizona has seen a roughly 30% increase in body donation over the last 10 years. At the UC Davis School of Medicine, there has been a 25% increase in the last several years. And the University of Minnesota Medical School has seen a whopping 300% increase since 2002.
“The more donations you receive, it starts to increase the donation awareness in the community,” says Angela McArthur, MPH, director of the anatomy bequest program at University of Minnesota Medical School.
Adds Drake: “It’s very important from an educational standpoint to get donors. It helps move medicine ahead and helps the learning of everyone.”