How to deal with body donation wishes

It is important for GPs to be aware of the issues surrounding body donation, says Dr Linda Miller.

The GP must be sure the patient is competent to make the decision and that consent is fully informed (Photograph: JH Lancy)
The GP must be sure the patient is competent to make the decision and that consent is fully informed (Photograph: JH Lancy)

GPs are skilled at presenting a neutral expression in response to unusual complaints or requests from patients, but a request from a patient to donate their body to medical science could take a doctor by surprise.

Apart from the need to consider the practicalities, further thoughts might include the motivations and the ethical and philosophical issues arising from such a request.

Practicalities
The forms for a patient to donate their body to medical science are obtained from the local anatomy department. The donor signs the forms with at least one witness present and returns them to the anatomy department.

Their name is then put on a register and they are sent a card to carry. The card states their wishes and who should be contacted in the event of their death.

The GP should document the patient's wishes in the medical record and (with consent) make the other doctors aware. The GP needs to be sure that the patient is competent to make the decision and that consent is fully informed. The doctor should be satisfied that the patient is in a stable state of mind and not being influenced by a third party.

Asking the patient to take the information home to read and then return allows the doctor to check for understanding and commitment.

The Human Tissue Authority website is an additional source of information. The GP should encourage the patient to talk to their family or friends, if they have not done so already. This will ensure that their wishes are known and respected.

Motivations
In a world where body parts are viewed, by some, as marketable commodities (stem cell lines, bone for dental implants, organs for transplantation, blood for transfusion and oocytes for research),1 patients may donate their bodies for purely altruistic reasons.

A study of donor motivations in the Netherlands was prompted by an increase in whole body donor numbers, despite a drop in the number of organ donors. Bolt et al2 found that most were motivated by a wish to be of use after death, negativity about funerals or as an act of gratitude to the medical profession or for life and health.

Some did not want to burden others with funeral arrangements and a few cited the costs.

For one donor it was a vengeful act to antagonise a relative after a disagreement.

Even where altruistic motives are cited, reputation may be enhanced, there may be a direct personal emotional benefit and exerting a sense of control may also be a factor.

Bolt et al conclude that for some it is a final non-conformist, autonomous, act of personal conviction.2 Last-minute decisions to donate might be to compensate for a lack of other altruistic/charitable acts during their lifetime.

Some who consider themselves too old or infirm to be organ donors choose body donation as an alternative.

Religion and culture influence rates of body donation across the globe. In Holland, donation is expressed as a third option along with cremation and burial in legislation. Of Dutch donor respondents, 79 per cent were not affiliated with any church. Historically, in England 'pauper' corpses were sold to anatomists from the workhouse to avoid burial costs.3

Embodiment
The medical profession has traditionally held the 'Cartesian dualism' approach of the mind and body as two distinct entities; 'the ghost in the machine' based on the philosophy of Descartes. This approach to the body enabled physician detachment in dealing with cadavers and human tissues.

At the extreme of this is the utilitarian view that as society has so much to gain from the dead body, 'presumed' consent should be assumed and that the body is a 'republic'.4

The retained organs scandal at Alder Hey Children's Hospital, Liverpool, demonstrated how distant the attitudes of pathologists were from those of the general public and led to a reform of the Human Tissue Act.

The modern philosophy of embodiment challenges this traditional approach and how the dead body is perceived.1 Some medical schools no longer teach anatomy by dissection, others vehemently protest its value.5

Media impact
A TV programme, The One Show, discussing body donation and exploring one individual's motivation, led to a four- fold increase in enquiries to the Human Tissue Authority.6

Conversely, Gunther von Hagens' exhibition of plastinated bodies, Body Worlds, has caused controversy, some viewing them as degrading, others as educational and artistic.

Health professionals
In 1992, a study of 765 donors in New Zealand found that only five were doctors, while 25 per cent were healthcare professionals (for example, nannies, carers, nurses) and 11 per cent, teachers.7

A smaller and more recent study of 200 donors found no doctors, but several other health professionals.8

  • Dr Miller is a GP trainer in west London

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Ensure you have the appropriate forms in the surgery and hold a practice meeting to discuss the practicalities of requests for body donation as well as the ethical and legal issues.
  • Ensure that fellow GPs are aware that consent should be fully informed and specific, and consider mental state assessment to exclude depression. Be aware that financial problems can be a motivation.
  • Use a significant event or structured reflective template (appraisal toolkit) to reflect on the impact of this request on you. Do you have a donor card? Have you considered body donation?

References
1. Campbell A. The Body In Bioethics. Routledge-Cavendish, 2009.

2. Bolt S, Venbrux E, Elsinga R et al. Motivation for body donation to science: more than an altruistic act. Ann Anat 2010; 192: 70-4.

3. Hurren E. Patients' rights: from Alder Hey to the Nuremberg Code www.historyandpolicy.org/papers/policy-paper-03.html

4. Giordano S. Is the body a republic? J Med Ethics 2005; 31: 470-5.

5. Campbell A, Mclean S, Gutridge K et al. Human tissue legislation: listening to the professionals. J Med Ethics 2008; 34: 104-8.

6. http://news.bbc.co.uk/1/hi/health/8428190.stm

7. Fennell S, Jones G. The bequest of human bodies for dissection: a case study in the Otago Medical School. NZ Med J 1992; 105: 472-4.

8. McClea K, Stringer M. The profile of body donors at the Otago School of Medical Sciences - has it changed? NZ Med J 2010; 123: 9.

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