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A Model for Anatomical Gifting Outside the Traditional Medical School Setting

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A Model for Anatomical Gifting Outside the Traditional Medical School Setting DESCRIPTIVE ARTICLE Regarding the Dead: A Model for Anatomical Gifting Outside the Traditional Medical School Setting Janet M. Cope, 1* Cynthia C. Bennett,2 Gytis Balilionis,1 Dianne M. Person3 1 Department of Physical Therapy Education, School of Health Sciences, Elon University, Elon, North Carolina 2 Department of Physician Assistant Studies, School of Health Sciences, Elon University, Elon, North Carolina 3 Anatomical Gift Program, School of Health Sciences, Elon University, Elon, North Carolina In 2017, Elon University became one of very few universities in the United States with- out a medical school to have an in-house Anatomical Gift Program (AGP). The program accepts first-person-consenting individuals only and within 2.5 years has become self- sufficient, supporting anatomy curricular needs of its physical therapy, physician assistant, and undergraduate biology and anthropology programs (n = 21 donors annually). This paper describes the timeline, costs, and benefits of developing an in-house AGP at a uni- versity without a medical school. Policy development, public outreach, equipment needs, and cost benefits are discussed. Within 2.5 years of program opening, the AGP Director delivered 161 educational outreach presentations at 86 different venues across the state providing information on anatomical gifting. The program registered 320 individuals (60% female, 40% male) and enrolled 41 deceased donors (69% female, 31% male; average age of 74.6 at time of registration and 74.8 at donation). During the first seven months of the program, donor preparation costs (with outsourcing for transport/donor preparation/ document filing/serology testing/cremation) averaged US$ 2,100 per donor. Over the past 23 months, donor preparation has been completed on site, lowering the cost per donor to US$ 1,260. Other costs include personnel salaries, legal fees, and outfitting of the anatomy laboratory and preparatory room. Program benefits include support of anatomy education on campus, assurance that all donors have given first-person consent, and faculty/student access to donor-determined health, social, and occupational information. Faculty, staff, and students contribute to the daily operations of the AGP. Anat Sci Educ 0: 1–10. © 2020 American Association for Anatomy. Key words: physical therapy education; physician assistant education; anatomical gift program; registered donor; bequest program; anatomy INTRODUCTION specifically to Anatomical Gift Programs (AGPs) is a fairly recent (1968) phenomenon (Dalley et al., 1993; Garment et al., As the demand for anatomical specimens increases so does the 2007). The past 50 years have seen a significant increase in the need for whole-body donation. Body donations are an import- number of healthcare education programs, fresh human tissue ant contribution to anatomy education, scientific research, and laboratories, research opportunities, and anatomy education the education of healthcare providers on the use of new surgical programs, which in turn has caused an increase in the need for technology and techniques (Garment et al., 2007; Gunderman, human anatomical resources (Berube et al., 1999; Asad et al., 2008; Ghosh, 2017). While cadavers have long been used in 2014). anatomy education, willed body donation by individuals Anatomical Gift Programs have been in existence since the latter half of the 20th century promoting whole-body dona- *Correspondence to: Dr. Janet M. Cope, Department of Physical tion to fulfill the demands for anatomy teaching, skills train- Therapy Education, School of Health Sciences, Elon University, Elon, ing, and research (Dalley et al., 1993; Garment et al., 2007; NC 27244. USA. E-mail: [email protected] Ghosh, 2015). According to the Anatomical Board of the State Received 4 October 2019; Revised 14 May 2020; Accepted 21 May of Florida, there are 142 documented body donation pro- 2020. grams in the United States (ABSF, 2020), and yet the demands Published online ## ### ## in Wiley Online Library (wileyonlinelibrary. extend beyond the abilities of these entities to secure dona- com). DOI 10.1002/ase.1985 tions to match the increasing need. In efforts to meet the need © 2020 American Association for Anatomy for whole-body anatomical donation, researchers around the Anatomical Sciences Education ### 2020 Anat Sci Educ 0:1–10 (2020) world have assessed donor demographics, reasons for donation assigned to graduate healthcare provider programs. Elon felt and regional cultural differences to develop successful body strongly that human donor dissection and prosection study bequest programs (Park et al., 2011; da Rocha et al., 2013; was of significant benefit to its students and should be con- Bajor et al., 2015; Saha et al., 2015; Jones, 2016; da Rocha et tinued, but, because of the North Carolina State Commission al., 2017; Cornwall et al., 2018; Champney, 2019) outside of of Anatomy’s policies described previously (NCOCME, for-profit body acquisition entities (Anteby, 2010; Champney, 2019), the University found its options for obtaining ana- 2016; Champney et al., 2019). tomical donors to be quite limited. While medical schools Most US medical schools have their own dedicated AGPs and anatomy boards of some other states had been willing to where individuals can register to become anatomical donors share their resources in exchange for a cost- recovery expense after their death. Recent research shows that physical therapy per donor, this process became quite expensive once trans- (PT) and physician assistant (PA) education programs, which portation costs were considered. In addition, out-of-state typically do not have their own AGPs, rely heavily on medi- human anatomy resources became more and more limited cal schools and state anatomy boards to support their needs, as these states’ own donor needs grew. By this time, some and very few universities that do not have an on-site Doctor of medical schools had eliminated all sharing of their donors to Medicine (MD) program have in-house willed body programs ensure that they were able to meet their own programmatic (Cope et al., 2017; Precht et al., 2017; ABSF, 2020). and research needs. As this shift intensified, critical issues Within the context of this manuscript the term “cadaver” is arose related to Elon’s ability to access anatomical specimens used when it is not known that an individual provided first-per- in numbers necessary to sustain curricular needs. son consent to partake in anatomy education or research, In addition to solving its curricular needs, Elon’s anatomists whereas the term “donor” is used when first-person consent has were troubled by the idea of non-consenting individuals (the been provided by the individual prior to death. The term “reg- “unclaimed dead”) being present in their anatomy laboratories, istrant” refers to an individual who has registered with an AGP. feeling that absence of direct consent was contrary to the ethics of In 2015, the State of North Carolina had 13 different uni- caregiving and patient autonomy being taught to its graduate-level versities offering the degrees of PT, PA, MD, and doctor of oste- healthcare students (Jones, 1994; Halperin, 2007; Jones and opathy (DO), and had one community college offering degrees Whitaker, 2012; Jones, 2014; Wilkinson, 2014; Cope et al., 2017). in mortuary sciences; all of these programs had required While many AGPs in the United States accept registered donors, curricula that included learning from cadavers. At that time, they also accept next-of-kin donations as well as unclaimed dead. there were six AGPs in North Carolina, all housed at the uni- In 2017, there were eight AGPs operating in North Carolina, six versities with medical schools and the mortuary sciences tech- using next-of-kin donations and four using unclaimed dead to nical school. All of these entities were members of the North meet anatomy education, research and training needs. Two of the Carolina Commission of Anatomy which was established in schools in North Carolina enlisted only first-person-consenting 1975 and charged both with ensuring enough human bodies individuals, Elon University and the Brody School of Medicine at for anatomy education and managing the disposition of the Eastern Carolina University in Greenville. unclaimed dead in the state (NCOCME, 2019). Schools not Sources willing to share cadavers could not guarantee that attached to these institutions were not permitted membership all individuals were consenting. Utilizing the “unclaimed dead” on the commission, and because the schools belonging to the struck the anatomists as inconsistent with Elon’s stated mission North Carolina Commission of Anatomy were not willing to to “foster respect for human differences, passion for a life of share cadaver resources with any entity not on the Commission, learning, personal integrity, and an ethic of work and service” these non-member schools were forced to seek cadavers from (EU, 2020). out-of-state sources to meet their anatomy education curricular As the issues of donor ethics and availability dovetailed needs. Elon University, located in North Carolina, was one of in 2014 and 2015, Elon University formulated several goals these schools seeking cadavers from out-of-state resources. regarding anatomical education at the institution. In summary, Elon University had human anatomy curricula at the Elon sought to undergraduate and graduate levels, with two anatomy lab- oratories employing human anatomical specimens. Human • Discontinue the uncertainty of year-to-year out-of-state con- anatomy dissection and prosection laboratory experiences tracting to access anatomical specimens, and gain more cer- had been integral in the delivery of anatomy curriculum at tainty that curricular needs would be met year to year; Elon University since 1999, fulfilling the University’s stated • Enroll consenting individuals exclusively, with no ‘unclaimed mission to “nurture a rich intellectual community character- dead’ or next-of-kin donations; ized by active student engagement” (EU, 2020). In a given • Offer autonomy to Elon’s donors regarding the personal/med- year at Elon, 21 human donors teach anatomy in a variety of ical information they would be able to share with students.
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