In early February, I walked through a light drizzle to visit the anatomy lab at UC San Francisco. Of course I wanted to see the medical school's new high-tech Anatomy Learning Center, with its iPad textbooks and surgery telepresence room. But I was also there to hand over possession of my dead body. And I wanted to know what that would mean.
The UCSF medical center sits atop one of San Francisco's steep hills, Mount Parnassus, which overlooks Golden Gate Park's fat band of trees, a long rectangle of green dividing the Sunset and Richmond neighborhoods from each other. If you look to the east, you can see the Haight, and if you look really far to the west you can see the ocean.
I looked at those views a lot in the fall of 2002, when my mother was here in the ICU, dying of a sudden bacterial infection that literally ate the lining around her heart over a period of several weeks.
When you are watching somebody die, you focus on trivia. That way you can forget the big thing, your mother's tiny body hooked up to a heart pump the size of a dorm room refrigerator. And what I remember most are snatches of conversations I had with all the doctors and surgeons who came by to offer insights into my mother's unusual case. One was a thin, talkative man who told me how much he wished he had a DNA microarray that would allow him to instantly diagnose my mother's ailment. Another was a woman with her hair in geeky disarray, who explained how heart pumps work while troubleshooting the one whose rubber tubes were threaded inside my mother's chest. UCSF is a teaching hospital, and they were trying to learn things from this death.
Some people might feel like a statistic in the hands of doctors like these, but I felt cared for. I liked it when people who were doing studies would stop by my mother's room and ask permission to include her in their work. I found myself hoping that her death would wind up in a medical journal as a piece of evidence — a data point that would one day become part of a hypothesis that could prevent somebody else's mother from dying.
And so, as I walked into the bright hallway of the anatomy lab from the rain last month, I thought about how I wanted to do what my mother had done. I wanted my death to be something that people could learn from.
Why Do People Donate Their Bodies?
Not surprisingly, most people who donate their bodies to UCSF have personal reasons for it. When I met with Kimberly Topp, who runs the anatomy lab, she said she was donating her body because she wanted to "give back." So many people had given their bodies to help her students learn that she couldn't imagine doing it any other way. A physical therapist with curly hair and an open smile, Topp helped design both the physical layout of the new anatomy lab and the teaching philosophy underlying the classes students take there.
The entire lab, built into the upper floors of one of UCSF's tall buildings, is designed to be open and full of light — just the opposite of what you'd expect from a place where medical students learn their craft on corpses. And this openness extends to the classroom style, too. Here, medical students work alongside physical therapy students, dental students, and nursing students. Topp emphasized that part of what students learn in the anatomy lab is how to relate to their colleagues, as well as how to make an incision or locate important leg bones.
She and I talked in one of the lab's meeting rooms at a broad table. Flanking of the table were two large, wall-mounted monitors that could be used to livestream a surgery happening next door or across campus. Students meeting in here have a chance to witness important surgeries up close, and even ask the surgeons questions, without ever having to scrub in.
We were joined by Andrew Corson, director of UCSF's Willed Body Program, a tidy, soft-spoken man who looked more like the manager of a startup than a person who helps people donate their bodies to medicine. It's very simple to fill out the forms, which are available online. It's a lot harder to commit to handing over your body — even if you know rationally, as I do, that you'll hardly care when the time comes.
Corson said one of the main questions that people have for him is what will happen to their bodies or the bodies of their loved ones. The answer is that almost all of them wind up in that top-floor anatomy lab, which we were about to visit.
Where Deaths Become Lessons
UCSF's anatomy lab reminded me of the starship Enterprise, circa Next Generation. It was all muted colors, curved surfaces, and chrome, its walls punctuated by monitors on one side and enormous windows on the other. Though the windows looked out on the park instead of a local nebula, you still got the feeling of a vast and gorgeous world ready to be explored just outside.
Adding to the starship feeling was the room's perfectly-calibrated ventilation system — very important when people are working with preserved bodies — that constantly draws air downward and out of the room through a series of vents running along the baseboards. Though there was a faint aroma of formaldehyde, mostly the place had that new consumer electronics smell, plastic and polystyrene.
And of course, there were the bodies.
The anatomy lab is a classroom where groups of students cluster around stainless steel tables topped by corpses. That day, class was not in session. Each body was carefully covered by a thick, white plastic sheet. Shelves beneath each body occasionally held big plastic containers, one of which was labeled "pelvis" in permanent marker. The tables were completely networked, with their own small monitors for watching video or broadcasting. Every student here works off an iPad, which holds textbooks as well as tools for accessing data on the progress they're making in anatomy lab. All that was missing were medical tricorders.
As high-tech as the place was, there were a lot of unexpected human touches. Paperwork was stored on music stands next to each table, and instruments were kept clean in an industrial dishwasher in an adjoining room where non-embalmed bodies are kept in refrigerators. Some procedures, Topp explained, require bodies that don't have the rigidity of embalmed ones.
Embalmed bodies like the ones I saw under wraps in the classroom will last for an entire year. Students at UCSF who take the year-long anatomy course are assigned to one body, which they stick with. Topp and Corson talked about how attached the students get to their subjects. "Often, it's their first everything," Topp explained — their first dead body, their first surgical procedures, their first view into the realities of a career in medicine.
In one classroom, there are posters and cards that the students created in the spring of last year for the people whose bodies they learned on in anatomy class. "We have a ceremony at the end of the year where students talk about their experiences, and some play songs," Topp said. "It gets very emotional." After the ceremony, the anatomy lab bodies are cremated and their ashes scattered at sea. Every person who donates their body to UCSF gets two funerals: One from their loved ones, and one from the students whose education would have been impossible without the donation.
Though UCSF will promise to handle all body donations with respect, one thing they won't promise is that a body will be put to a specific use. "We don't want to promise what we can't be certain about," Corson emphasized. The university needs the flexibility to place a body where it is needed most by the students. A body donation may wind up embalmed in the anatomy lab, or in the non-embalmed area. It may become the year-long companion of dental students, or physical therapists who need to understand how joints work. In some cases, people developing new medical devices for healing bones may test them on the body.
That said, UCSF always cremates the bodies and scatters them to sea when they are finished. The donor's ashes don't go back to loved ones. In fact, Corson warned that it's often a red flag when a group taking body donations promises to return the ashes. Given the nature of the medical procedures, it's almost impossible to insure that such remains are from a specific person. It's better to be transparent and promise what is possible: That your donation will help medical students become better doctors, and will eventually be scattered to sea.
The Legal Gray Areas
Whole body donations are not regulated by very many laws, and these vary from state to state. Most of the laws, like the Uniform Anatomical Gift Act, are broadly focused on things like how people can will a whole body to medicine, as well as issues like transplants and organ trafficking. There are also a handful of health regulations that focus on tissue and organ donors (partial body donations), and are intended to ensure that these donations are kept clean and healthy before they are implanted in another living person. So how can you be sure your body will be used wisely?
Corson told me that UCSF and many other medical schools have adopted a set of best practices governing how bodies will be used. These recommendations come from the American Association of Clinical Anatomists (AACA), and include rules about forming oversight committees to make sure bodies are shipped and disposed of appropriately, as well as used only in the ways that the institution has described to the donors or their families.
One of the big concerns that Corson and his colleagues have is with the practices of "third party brokers," or intermediaries, companies that acquire bodies and then sell them to medical device companies or other businesses. (Just search online for "donate my body to medicine," and look through the sponsored links for these groups.) Often, such brokers make outlandish promises to donors, claiming that their bodies will be used for specific fields of research and that their ashes will be returned. Then, they sell the bodies to the highest bidder and make a tidy profit. There is no way for loved ones to verify that the bodies were used in the ways they hoped, or that the ashes they receive are authentic. Because there are so few laws regulating whole body donations, none of this is strictly illegal — just unethical.
Brandi Schmitt, councilor and co-chair for Anatomical Services group of the AACA, told me via email:
The AACA's concern with intermediaries . . . primarily has to do with the potential for loss of oversight of anatomical materials that can jeopardize the reputation of the donation program and may betray the trust of our donors. Whole body donations are valuable resources, integral to the advancement of medical and scientific education and research . . . The AACA is concerned that these third party interests in donation are about profit rather than about the advancement of medicine and science. This type of altruism is often the reason people choose to gift their bodies in the first place and we want to honor their wishes and uphold their trust.
The difference between donating your body to an intermediary, versus to a place like UCSF, is knowing that your gift will be used for educational purposes. Nobody is accusing intermediaries of doing things like selling organs on the black market. And it's not as if medical device and biotech companies shouldn't have access to whole body donations. But when there's a profit motive, sometimes ethics get a little gray.
There are many good reasons to donate your body to medicine, often personal ones. I picked UCSF because I know it can fulfill its promise to make my donation into something that is educational. But there are many other places to donate, and all of them will benefit enormously from it.
The Future of Anatomy Labs
Topp said she thought a lot about the future of medical procedures when planning the design of the new anatomy lab. At some point, people may actually be conducting surgeries remotely, using robots, and this facility could easily be retrofitted to help prepare students for that kind of experience. Already, they are learning how to do surgeries by looking at a 2D screen and guiding a laproscope. In ten years, they might be looking at 3D screens and guiding a robot.
Anatomy labs and surgical suites are going to look more and more like the Enterprise over the coming years. A surgical robot could download the latest information on a procedure in real time, while the surgery is taking place, to avoid complications. Or a surgeon in India could use video conferencing to guide a surgeon in Canada through a difficult tendon repair.
Already, UCSF's new anatomy lab seems almost impossibly futuristic, with every student's desk converted into a multimedia research station. But there will be no incredible breakthroughs, no new therapies without one, old-fashioned ingredient: altruism. The kind of altruism that's required to donate your extremely analog, extremely low-tech body to the doctors of tomorrow. Sign me up.
Are you considering a whole body donation to medicine?
Your local medical school will probably have a body donation program or willed body program, just like UCSF (usually medical schools prefer to take donations only from their local area, to cut down on transportation costs). The University of Florida has a good list of body donation programs. You can also call your local medical school, or search their website, to find out if they have a body donor program.
Nolo Press has a good article on the legal ins and outs of donating your body to medicine.
Top illustration by CLIPAREA l Custom media via Shutterstock. All other images courtesy of UCSF Anatomy Lab.