Scott White Center for Healthcare Policy OpEd February 2008 by vfe12263


									Scott & White Center for Healthcare Policy
Op/Ed February 2008

                     “Informed Consent for Human Bodies Used
                        for Medical Education and Research”

                                Marisa Martin, J.D., L.L.M.,
               Associate Director, Scott & White Center for Healthcare Policy

If you have relatives or friends who have donated their body for medical education and research,
or considered it yourself, you have probably wondered, what happens to the body?
Today as in the past, human bodies (referred to as cadavers) are used by first year medical
students in their gross anatomy class. These cadavers are usually donated to a specific institution.
In Texas, there are eleven schools that accept bodies donated for medical education and research.
The cadavers are dissected, beginning with the hands and working up the arm to the shoulder.
The students dissect the torso, then the face, and end with the lower limbs. In the process of
dissection, students remove almost all of the body's skin and all of the internal organs, including
the brain. They bisect the spine and saw the head in half to examine the sinuses.i There is no
good substitution for these students- they need a cadaver in order to learn how to effectively
practice medicine. Part of that first year medical school education is to teach about death and
dying that includes solemn ceremonies medical students participate in that thank those persons
who have donated their bodies. Computer simulated anatomy programs which are available do
not adequately teach those fundamental emotions of holding a dead body.

Other donated bodies could be used by forensic science programs, or on exhibit for educational
purposes. In Texas, a Forensic Anthropology Research Facility is currently being planned by the
Texas State University-San Marcos Department of Anthropology. They plan to have it
operational by late Spring 2008, and will be part of the Forensic Anthropology Center at Texas
State (F.A.C.T.S.).ii The goal of the facility is to study the effects of the environment on human
remains with the goal of improving forensic techniques to solve criminal cases.

Body Worlds is a private company that uses exhibits featuring plasticized human bodies for
educational purposes. Relatively new, the exhibit began in 2005 and travels the globe from
museum to museum, drawing large crowds and much revenue for the host museums as well as
Body Worlds. There is now a competitor using the same process to display human remains as

How to Donate

The Texas Anatomical Gift Act, effective September 1, 1989, regulates the donation of bodies in

The wish to donate may be recorded by will or other document such as a donor card with two
witnesses’ signatures. For those under 18 at the time of death, a parent or legal guardian must

consent to the donation. Also, a family member or guardian may consent to donate a decedent’s
body as long as no other family member or guardian or the decedent oppose the donation.

Organ banks, hospitals, people who need a transplant, and forensic science programs can all
receive gifts of bodies. The Anatomical Board is technically the donee of all bodies donated for
education or research, unless the bodies are going to a forensic science program, in which case
the forensic science program must submit a report to the Anatomical Board quarterly that lists
the number of bodies and how they were used for education or research.

Donors are free to specify a donee for their gift; otherwise vascular organs suitable for
transplantation are given to organ procurement organizations first. Each hospital is required to
have a protocol in place to identify potential donors.

In Texas, most if not all institutions accepting bodies for medical education and research rely on
people to donate directly to their institution. To encourage donation, some institutions, such as
the University of Texas A&M Health Science Center College of Medicine (“A&M”) maintain
their own forms for people to use and dedicate staff and resources to process requests.iv

There are three forms available on A&M’s website: a physician’s form, a form to donate a
decedent’s body by a third person, and a bequest form to donate your own body. The form for
the donor’s physician authorizes him or her to provide medical records to A&M for purposes of
fulfilling the donation. Both the form to donate a decedent’s body and the bequest form
authorize the Anatomical Board to transfer the body to other research or teaching institutions in
or outside of Texas if there is an excess of bodies. Both forms also authorize the release of
medical records and include a blanket waiver of liability for the Anatomical Board and the
receiving institution. Two witnesses must sign the bequest form and the form to donate a
decedent’s body.

A donor must be 21 years old to sign a bequest form for A&M. The bequest form also states that
A&M will pay for embalming and transportation up to 100 miles, and that the body will be
cremated. The donor must list his or her social security number, date of birth, height and weight.

According to A&M, they do not typically have shortages of bodies and most bodies are donated
directly to the school utilizing the process outlined above.v

Who can Donate?

A&M (and most if not all of the other educational institutions) does not accept bodies that have
been used as organ donors (except for the eyes) or have been autopsied. Bodies with amputations
are usually accepted. Severe trauma, bodies over 6’ 4”, contagious disease, decomposition, and
extreme obesity or emaciation or some of the reasons a body may be rejected for use at the
medical school. If a family member opposes the donation, A&M will not accept the body. If the
body is rejected, the family must make other arrangements to dispose of the body.

Bodies are typically used for four years and then cremated. The family can request that the ashes
be returned to them for a fee of $100.00.

Those who wish to donate their body to Bodyworlds may do so by filling out a consent form,
available online or at two body donation facilities, one in Germany and the other in California.
The body must be shipped to these facilities in a timely manner after death. These costs are borne
by the donor or his representatives. There are no burial costs as the remains are never

Informed Consent

While some people are horrified at the thought of mutilation taking place to their own body or
their loved ones after death, others feel it makes no difference what happens to a body once the
person is dead. Obtaining informed consent from the donor becomes critical because of these
differences in opinion and belief, as well as future legal consequences of the donation if promises
to the family are broken or body parts are illegally sold or displayed. Informed consent is the link
between ethics and science when it comes to the human body.

Informed consent in medical research became a prominent issue after World War II because of
the 1947 Nuremberg trials.vii The Nuremberg Code, which emerged from the trials, abandoned
the paternalistic view of physicians practicing medicine and research and replaced it with the
centrality of patient self-determination by asserting that the voluntary consent of human subjects
is a necessary component of research. This notion became known as “informed consent.”
Today, the President’s Council on Bioethics advises the President on ethical issues related to
advances in biomedical science and technology.

A donor’s consent is violated when his or her body is mishandled—if parts are illegally sold or
displayed in ways the donor may not have intended, or ashes requested by loved ones are lost.
Unfortunately this is a nationwide as well as a state problem, a problem at medical education
facilities and beyond. The head of UCLA’s Willed Body program illegally sold bodies and body
parts for $1 million to more than 20 private medical, pharmaceutical and hospital research
companies in and outside of California before he was arrested in March of last year.viii Recently
in Texas, the head of UTMB’s willed body program sold human fingernails and toenails from the
cadavers donated for medical education to a lab in Utah for $18,000. Ashes from cadavers that
were supposed to be returned to loved ones were commingled, resulting in a barrage of lawsuits
against UTMB.ix

Controversy arose over the source of the plasticized bodies on exhibit by Bodyworlds as to
whether or not proper consent was obtained. An American competitor, Premier Exhibitions, said
it obtained all the remains in its shows legally from Chinese medical and scientific organizations
but does not know the identities of the donors. The use of Chinese bodies raised eyebrows for
some because of that country’s history of human rights violations and the cultural beliefs of
many Chinese, which include resistance to organ and blood donation and desire for full body
burials.x Bodyworlds states that it uses no bodies from China and can provide consent and
identification forms for each body in its shows.xi

Would the donor have made the donation if he or she had known what would happen? Should
living loved ones have recourse?


The notoriety of the Bodyworlds and Premier exhibits led some leaders to pursue legislation
regulating the practice. California Assemblywoman Fiona Ma filed legislation, AB 1519, in
February 2007 to prohibit any person from displaying human remains to the public for
commercial purposes, as defined, without first obtaining a permit from the county. Civil fines
would be imposed to violators. The bill has passed out of the California House and has been
referred to the California Senate Judiciary Committee.xii

Great Britainxiii, Floridaxiv, and the City of San Franciscoxv have all passed legislation or
regulations addressing this industry, while Scotland has prohibited the display of any human
remains at all. xvi

In Texas, legislators should allocate more resources to the Anatomical Board to enforce current
law. There should be no exceptions to the Anatomical Board’s designation as donee of bodies
donated for medical education and research. Also, there should be more regulation and stricter,
specific penalties for people who mishandle and/or sell body parts from donors. These people
chose to make a gift of themselves to help others, and that gift, and the consent provided, should
be preserved and respected.

  Rachel Pearson, “Lost Bodies, Broken Promises,” The Daily Texan, Oct. 27, 2004.
  Jayme Blaschke, “Texas State Forensic Research Facility to locate at Freeman Ranch,” University News Service,
Feb. 12, 2008, avail. at
     Tex. Health & Safety Code Ann. § 692.001- 692.017
    Texas A&M Health Science Center Willed Body Program,
(last visited March 20, 2008).
    Interview with Tami Seydler, Willed Body Administrator, Texas A&M Health Science Center College of Medicine
(Mar. 13th, 2008).
     Body Donation for Plastination, (last
visited March 20, 2008).
     George J. Annas, & Michael Grodin. “The Nazi Doctors and the Nuremberg Code,” (1992).
     Cynthia Lee, “Two arrested on charges of selling body parts after lengthy UCPD investigation,” UCLA Today
Online, March 7, 2007.
     Rachel Pearson, “Lost Bodies, Broken Promises,” The Daily Texan, Oct. 27, 2004.
   Marc Lifsher, “Cadaver Exhibit: Who said ok?” LA Times, Jan. 25, 2008 at,1,607310.story
    Marc Lifsher, “Cadaver Exhibit: Who said ok?” LA Times, Jan. 25, 2008 at,1,607310.story
     AB. 1519 (2007-2008) avail. at
     Human Tissue Act 2004, avail. at:
     SB 2554 (Fl. 2007).
    Marc Lifsher, “Cadaver Exhibit: Who said ok?” LA Times, Jan. 25, 2008 avail. at,1,607310.story
     Human Tissue Scotland Act 2006, avail. at:


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