There were four of us, two on either side of the naked body on the table. I was the only woman and I didn’t know any of the others. An acrid smell burned my nose and stung my eyes. Shivering in the cold basement room, I pulled on gloves and opened my tool box, revealing shiny metal instruments. The four of us looked at each other, trying to act as if we cut up bodies every day. “Who wants to start?” one of us asked. It was the first day of medical school anatomy class.
Unclaimed bodies donated to science replaced grave-robbing
Harold, Bert, Kyong, and I benefited from learning anatomy on a human cadaver at our Pennsylvania medical school. I know now the body that taught us so much was almost certainly donated through Pennsylvania’s non-profit Anatomical Board. The Anatomical Board was established in 1883 and is now known as Humanity Gifts Registry (HGR). Many other states — Virginia, Colorado, and Maryland among them — have similar Boards that accept donated human bodies for medical education purposes. Illinois just passed a law about unclaimed body donation to science in 2017.
Anatomical Boards came about largely in order to abolish the practice of robbing graves to obtain bodies for medical education. Those Boards were following the precedent set by England’s 1832 Anatomy Act which legalized donation of unclaimed bodies to medical schools. Unclaimed body donation to science replaced grave-robbing as the primary source of cadavers for medical study.
Pre-mortem donation of one’s own body for altruistic or financial reasons, sometimes called willed donation, is a more recent phenomenon. Pennsylvania’s HGR, for example, first began accepting such donations in the 1950s.
For-profit body donation companies
There’s a big market for bodies and part of bodies beyond medical schools and beyond the borders of the United States. It’s no surprise, therefore, that private enterprise offers an optional path for body donation. Emily Petsko’s 2019 article takes an in-depth look at MedCure, one of several for-profit “non-transplant tissue banks.” Sometimes referred to as body brokers, such organizations receive donated bodies, then dissect them and sell the parts. Heads and joints like knees and shoulders are often used for surgical training. The incentive for donors, besides a desire to contribute to scientific research, includes “no-cost cremation.”
Mary Roach’s book Stiff: The Curious Lives of Human Cadavers is an excellent investigation into the various ways non-profit and for-profit organizations use donated bodies.
How many unclaimed bodies are there?
When does a body become unclaimed? Most states have legal definitions. In most places, if someone dies with no next of kin and no one willing to make funeral arrangements, that body becomes legally unclaimed. The length of time varies, but ten days must pass in North Carolina, while in Pennsylvania it’s only 36 hours. After that, Pennsylvania law requires hospitals and nursing homes to call Humanity Gifts Registry. Usually there’s some leeway in that timeframe, however, as long as the body is refrigerated. If the unclaimed body doesn’t qualify for donation, HGR can provide an “unfit certificate.” That allows the institution to turn the body over to the Coroner or Medical Examiner (C/ME).
Coroners and medical examiners can report unclaimed persons to the National Missing and Unidentified Persons System (NamUs). Currently NamUs lists over 15,000 unclaimed bodies nationally, but most unclaimed persons are never reported to the database. In Pennsylvania, for example, only five of its 67 county C/MEs (inclusive of Philadelphia) currently list a total of 64 unclaimed persons in NamUs.
How many unclaimed bodies are donated to science?
How many of those tens of thousands of unclaimed bodies do hospitals/nursing homes or C/MEs donate to science? I couldn’t find any data to answer this question. There’s no accurate numerator (total unclaimed whole body donations) or denominator (total unclaimed bodies).
To get an estimate for my state, I spoke with Clariza Murray, Manager and Outreach Specialist at HGR. The answer surprised me.
Humanity Gifts Registry accepted an average of 641 bodies a year (range 412-751) from 2018 – 2022. But during that five-year period, counties donated only 60 unclaimed bodies. In other words, on average less than 2% of the bodies donated to HGR were unclaimed. The vast majority are pre-registered willed donors. These numbers do not include unclaimed bodies donated to for-profit organizations like ScienceCare or MedCure.
The number of donated unclaimed bodies in Pennsylvania is probably low for several reasons. One is that many hospitals/nursing homes and county C/MEs simply don’t follow the law about reporting unclaimed bodies to HGR. Second, the unclaimed at a coroner’s office often have medical and social histories that disqualify them as donors. For example, certain infectious diseases, severe overweight or underweight, prior autopsy, or decomposition will make a body ineligible. Disqualifying social histories may include incarceration and intravenous drug use. Finally, the receiving organization simply may not have enough body storage space.
As Murray explained to me, body storage was at a premium during COVID-19 surges. HGR had to refuse many unclaimed body donations because medical school morgues had to store victims of COVID-19. Any space available to HGR was prioritized for pre-registered willed donors.
One county coroner’s experience with unclaimed body donation to science
Chester County, a suburban Pennsylvania county of 525,000 people, received 15-30 unclaimed bodies every year from 2018-2021. That puts it somewhere between the Philadelphia ME Office (hundreds cremated every year) and sparsely populated rural counties.
During the opioid epidemic, the number of unclaimed bodies in Chester County hovered between 16-18 per year. But when COVID-19 arrived, the number of unclaimed bodies increased to 30-31 per year. County management, concerned about budget, asked me “why so many county cremations?”
As Coroner, I had to become more diligent about reminding medical institutions of Pennsylvania’s unclaimed body law.
When a hospital or nursing home called us to request pick up of an unclaimed body, our first question became “Have you called HGR?”
If HGR could not accept the body donation, we at the Coroner’s Office took the body into our care. In some cases, Science Care, a for-profit organization with less stringent requirements than HGR, was able to accept the donation. Only if neither institution accepted the unclaimed body donation to science, did we proceed with cremation at the expense of county taxpayers.
Is unclaimed body donation to science ethical?
Should only those bodies donated voluntarily with full written consent of their “owners” before death be used in medical education and research? In other words, should we put an end to unclaimed body donation to science? That is the practice in some countries, like Canada. But in the U.S., disposition of unclaimed bodies is a state-by-state and sometimes county-by-county affair.
In her April 2023 essay, Vanessa Ortiz, a student at St. Mary’s University of San Antonio, Texas, argues that unclaimed body donation to science is unethical. She cites “lack of consent, the socioeconomic discrimination behind it, and the lack of respect and dignity given to the individual in many cases.”
Maybe that was true in the past. This Smithsonian article on graverobbing in 19th century Baltimore tells a grisly tale. Unscrupulous persons obtained bodies — often black, often poor — illegally before the board came into being. But there are valid counter-arguments supporting donation of unclaimed bodies to science.
As far as lack of consent, next of kin relinquishing rights to a body sign a form which advises of possible donation. As for socioeconomic discrimination, yes, most but not all people whose bodies become unclaimed are poor. But at least in Pennsylvania they are not usually people of color. Fifty (78%) of the Pennsylvania unclaimed in NamUs are white. And as far as respect and dignity, body donation organizations often hold celebrations of remembrance and inter ashes in established cemeteries after cremation.
I will never know the background of the unknown man whose body taught my anatomy group so much. He might have been a wealthy altruist or he might have been a pauper. Regardless of who he was or what he did in life, in death he made a valuable contribution to society.