The road to best practices in body donation

Abstract

The American Association for Anatomy convened a task force to create a best practices and recommendations document for human body donation, addressing a critical need for standardized guidelines in this area. The task force included members with specialized expertise in procedural and ethical aspects of body donation programs. Their aim was to ensure that the process of body donation adheres to the highest ethical standards, protecting both the dignity of donors and the integrity of the programs that receive them. This document represents the first comprehensive guide to ethical best practices in working with body donors, offering clear and actionable recommendations for professionals in the field. In this viewpoint article, JYB, Chair of the Human Body Donation Committee, provides a summary of how these guidelines were developed, covering the various procedural and ethical considerations. The Q&A format of the article further explains the document's key areas and its impact on future practices.

The American Association for Anatomy was lacking a comprehensive document with best practice recommendations. The organization had a list of resources and a few policies—but no detailed guidelines. This may be the first of its kind—a comprehensive document that aligns best practices and recommendations for body donation.

The Human Body Donation Committee (HBDC) thought it would be helpful to create this because, in the United States, there's not much oversight—legal, federal, or state—in most places. It is really up to the body donation programs to do what they think is best for the donors. As anatomists and body donation program professionals, we have a responsibility to ensure we are promoting best practices and ethical ways of working with donors. Donors trust us with their bodies and expect us to act in their best interest after they pass.

The process to generate the best practice document took many years and was quite complicated. Initially, the American Association for Anatomy created a task force to respond to legislative bills and media requests. As the task force discovered a big gap between what guidelines were available versus what was needed, the task force advocated for many years to establish a committee. Once approved, one of our jobs was to create these best practices.

We spent a lot of time discussing and developing definitions and terms, which was challenging but necessary to ensure understanding and consistency. We then created a table of contents, which was first presented to the AAA Board, and then to the membership at the 2023 anatomy meeting, during which we requested and gathered feedback on what the AAA membership wanted to see included in the document.

Different teams of HBDC members drafted sections, shared among the whole committee and we held meetings to discuss. Once we had a comprehensive draft, we sent it to the Board for feedback, made changes based on their input, and then opened it for membership feedback again. This way, it wasn't just the task force's input but also the entire American Association for Anatomy.

After these rounds of feedback, our Internal Affairs Subcommittee made the final changes and brought them to the larger committee for approval. The AAA Board then gave their approval. Our last step was to go through the submission process with ASE where peer reviewers made impactful contributions to the document. All contributions are acknowledged in the document. To summarize, the process was lengthy and involved a large number of individuals and the entire membership of the American Association for Anatomy.

We aimed for this document to be as comprehensive as possible. The law, specifically the Uniform Anatomical Gift Act, generally allows a donation to be made and how to do so, but not much else. We therefore wanted to provide recommendations and best practices for the entire body donation process.

The document includes best practices for everything from setting up policies, financial modeling for the body donation program and establishing an oversight committee through to obtaining consent, working with donors, technical operations, and donor memorialization.

There's also a human element—staffing. We discuss the best ways to train individuals and ensure they are up-to-date on best practices. We address end users, whether they are academics, researchers, or clinicians, and outline the best ways to inform them about best practices that emphasize uses, conduct and terminology.

We also address the disposition of bodies, such as cremation, and how to bring the process full circle by acknowledging donors through services or memorials.

These are the key areas we covered, each with multiple sections and considerations for working with donors.

The best practices document starts with the ethical premise that donors are consenting individuals who are trusting us with the stewardship of their bodies. The document emphasizes that it is our responsibility to treat the donors with respect and honor, and to teach others to do the same. We also emphasize a transparent process and a contemporary view on how body donors contribute to education and research.

All the individuals who contributed to this document were either directors of body donation programs, faculty with donor program responsibilities, or researchers. For example, in the Balta Lab, there is a PhD student and three master's students whose research contributed to this document. The document is the result of both experience and research with many professionals sharing their expertise. It is based on evidence and is meant for everyone working with donors to consider.

From the perspective of an educator who is not running a human body donation program, it is our ethical responsibility to ask where the bodies come from and to be familiar with the consent they have given. It is important not just for those running body donation programs, but also for those utilizing donors to educate the next generation of healthcare workers.

We also include students in this as well, since it can be challenging for them to enter the lab. One of the main things we tell them to help process this experience of dealing with death for the first time is that they are not doing anything wrong. It is helpful for students to know that these individuals donated their bodies for them to learn. This knowledge helps students process their emotions and the triggering feelings they may have in the lab. So, it is very important for students, educators, and even donors to see that we are doing a lot to protect them after they pass.

Human body donation programs best practices and recommended standards: A task force report from the American Association for Anatomy

Joy Y. Balta: Conceptualization; writing – review and editing; writing – original draft. Thomas H. Champney: Writing – review and editing; writing – original draft. Christopher Ferrigno: Writing – original draft; writing – review and editing. Laura E. Johnson: Writing – original draft; writing – review and editing. Callum F. Ross: Writing – original draft; writing – review and editing. Brandi Schmitt: Writing – original draft; writing – review and editing. Heather F. Smith: Writing – original draft; writing – review and editing.