01.12.2007

The Ultimate Gift

While death is an inevitable part of life - the lastgreat unknown - in the main it is considered taboo,often regarded as bad luck to raise as a topic of discussion,even in hushed, reverent and regretful tones. Like thepink elephant in the corner of the room, we all knowit's there, but we avoid eye contact with it, or askinganyone else if they can see it.

Death often forces both the living and dying to confrontmyriad issues including pain, loss, grief, faith, spirituality,regrets, and yes, even finances. But while most of usstill shy away from the subject because of the fearit instils in us, there are many others who are preparedto confront their mortality, at least in this earthlycycle of life. These are the donors - those who wantto help others directly through organ donation, or humanityin general through donating their whole body to science.Surely, they would argue, this is the ultimate giftwe can offer humankind.

The most common reasons cited for wanting to donateone's body (whether erroneous or not) are:

Being of benefit to science through education andresearch - the humanist approachCreating a positive (education) out of a negative(death)Being against vivisection or testing of laboratoryanimalsBeing proactive in death as you may be in life,or just to be "different"Environmental concerns regarding burial and cremationNot wanting the "fuss" of a "normal"or "typical" funeral, whether to spare familyfrom difficult decisions or unnecessary grief or even,pragmatically, that it saves you or your family thecost of burial or cremation.

A word of warning: if you thought you could donatewhatever organs and tissues that could be useful fortransplant and then "leave the rest to science",think again. You can be an organ donor or a body donor,but not both. Surprised? So was I.

Most of Australia's states and territories have atleast one body donation (or bequest) program, and allare operated by the medical faculties within universities.Several more universities without such medical programsare licensed to receive cadavers for the teaching ofanatomy and human biology to health professionals.

So how do you register here in Australia, and whathappens after your death? What are you actually consentingto? What rights does your family have? And will yourbody even be deemed suitable? The following is a generalguide only, as each state and territory has its ownAnatomy Act (more on this later), and each donationprogram differs slightly.

Practicalities versus Realities
All body bequest programs in Australia share a few commonalities.Your body:

Must be whole - with no organs or tissue removed(except, in most circumstances, the corneas) for donation,or amputation. "Routine" organ removal (egtonsils, appendix, gall bladder) is fineMust not have undergone autopsy or embalmingMust not have had a recent operationMust not be obese or emaciatedMust not have been significantly altered by medicalconditions or procedures In addition, you will berejected if you have certain communicable diseasesincluding Creutzfeld Jacob Disease (Mad Cow), widespreadcancer, jaundice or dementia, or have any conditionsthat would prevent effective embalming. Clearly, asvery few young people die of natural causes and aretherefore autopsied to find the cause of death, almostwithout exception, accepted bodies are those of elderlypeople.

The reason an autopsied cadaver cannot be acceptedis that during autopsy, the main blood vessels are severed,preventing the embalming fluid from accessing all bodytissues. This fluid - which is mainly formaldehyde to"fix" the body tissues and prevent decomposition,and phenol as a mould retardant - is normally gravityfed into a major artery, allowing it to flow throughthe entire circulatory system and into the tissues.

By contrast, plastination, replaces the natural bodyfluids with polymer (either rubber or epoxy resin).Invented by German anatomist Gunter von Hagens, plastinationhas many health and educational benefits. The specimensare safer and easier to handle as they are completelydry and there are no chemical fumes, and gloves neednot be worn. More detail can be seen and felt as specimenscan be freely touched and handled.

You may be familiar with von Hagens' travelling exhibition,Body Worlds - The Anatomical Exhibition of Real HumanBodies, which graphically and controversially displayspartially and fully dissected human bodies.

The time limit for body collection/delivery to a universityvaries. Generally, it is between 24 and 72 hours afterdeath. Participating universities pay for collectionin the metropolitan area, though this may be deemeda 40km radius in some programs and up to 100km in others.

So does the university have carte blanche over yourphysical remains, or can you stipulate what can andcan't be done? While consent is usually generalisedas "dissection and retention for teaching purposes",most programs allow you to specify some restrictions.Your anonymity is assured, along with respect and dignity,by all programs.

All human tissue, even that not used, is labelled andpreserved or frozen so eventually all of the donor canbe buried or cremated (that's the donor's choice) together- except any percentage that may, by law, be kept indefinitelyunless you stipulate otherwise.

Following your death, your family and friends can stillhold a memorial service for you just like a "normal"funeral, simply minus your body. Most bequest programsoffer a regular donor memorial service (some yearly,others every two or three years). Generally, exceptin the case of a few universities offering a choiceof two programs, your remains are not returned to yourfamily. They need to realise, and so do you, that whenyou are accepted by a program, it effectively is theend of any physical contact by those you love with yourremains.

Your next of kin will, of course, be notified of yourburial or cremation in due course, but this will notbe for several years. The university pays for a simpleburial or cremation, and some programs will allow donorashes to be released to the family.

Dissecting the Benefits
Gary Whittaker, an anatomist and plastinator with 20years of experience, says the educational benefits ofbeing able to prepare and study human specimens areimmensely valuable.

Dissection and preservation of an embalmed cadavertakes several weeks, and usually months, to complete.While plastination takes far longer, both processesinvolve a great deal of care, skill and respect.

Plastination is gaining support in Australia, thoughWhittaker concedes the scope is far from ideal as theindustry here cannot process a whole body, and the timeand effort required is somewhat undermined by the shorttime limits imposed on universities for the retentionof human remains (usually between three and eight years)."Many students primarily learn their anatomy fromalready dissected material, which has been preparedby staff or experienced anatomists. Only a small numberof students have the opportunity to dissect, and onlystaff and students are allowed to view specimens andprocedures," says Whittaker. "Staff and studentstake a great deal of pride in their work. It's almostan art. It seems bizarre to call it that but good dissectionenhances students' learning. And it's no easy feat."

Neither is tiptoeing through the minefield of legal,moral and ethical issues, particularly regarding consent.Does Whittaker agree that consent forms could and shouldbe more specific? "Absolutely, because at the momentthe consent is specifically for having your body usedfor educational purposes, but does this extend to display,to being photographed, to being taken across your stateborders? It's a grey area. "Also, many people wantto be an organ donor and body donor, but this simplyisn't possible now."

Whittaker agrees current restrictive regulations createa Catch 22 scenario: yes, they protect specimens frombeing gawked at by Joe Public, yet being open and transparentwould encourage more donations and debunk urban mythsregarding what goes on behind laboratory doors. Andwith student numbers in anatomy courses increasing dramatically,obviously more specimens would be helpful.

He suggests public "open days" to demystifythe process, but realises this is a difficult area interms of current consent and privacy issues. At thevery least, Whittaker advocates tours of facilitiesfor registered donors. But with each state and territoryhaving its own Anatomy Act, any consensus or expansionof current laws seems unlikely.

A national Act and program, coordinated through Medicare(since we all have to be registered with Medicare, andit is this body that manages the Australian Donor Register)seems the logical way forward, yet our (until recently)Federal Health Minister Tony Abbott had not respondedto such calls from within the science and medical communities."Certainly a national Anatomy Act would benefitall concerned. Currently, each time a state or territorymodifies its Act, it becomes even more unique - notunifying the states at all," says Whittaker.

So Be Prepared
Study closely the programs offered in your state orterritory. Choose a body bequest program and register.Tell your family and friends, and your GP. Keep a signedcopy of your body donation agreement (consent form)with your will. All body bequest programs can only assessyour suitability after your death, so make a contingencyplan in case your body is deemed unsuitable, so thatyour loved ones know how and where you wish to be buriedor cremated. In other words, prepare for donation butplan your funeral, too. You may also wish to opt fororgan donation in the event your body is deemed unsuitable.Or, if your preference is organ donation, you may liketo register for body donation should you not be suitablefor organ or tissue retrieval. At the end of this life,may we all have lived well, made each day count, andthen died well - or, at least, well prepared.

The Gift of Life
According to Medicare Australia, the Federal Governmentdepartment that manages organ and tissue donation, morethan 30,000 Australians have been donor recipients inthe past 60 years. Organs that can be donated includethe heart, kidneys, lungs, liver and pancreas. Tissuessuitable for donation include eye (corneas), bone, skinand heart valves.

Please note that whereas previously, in order to registeras an organ donor, you simply had to tick the requisitebox on your driver's licence renewal form and "OrganDonor" would be printed on your new licence, donorsare now are required to fill in and sign the appropriateMedicare form in the back of the Australian Organ DonorRegister booklet (Sign on to save lives) and lodge itwith Medicare. You will then be issued with a DonorCard, which you should keep in your wallet or purse.For a copy of the booklet, pop into any Medicare centre,phone 1800 777 203, log onto www.medicareaustralia.gov.auor email aodr@midicareaustralia.gov.au

There are several specific organ and tissue donor programsoperating in Australia, but it is vital that you registeryour consent to be an organ and/or tissue donor on theAustralian Organ Donor Register as it is the only nationalregister.

While it's actually quite rare that our organs andtissues are viable for transplant, unless we die inan intensive care unit (as organs must be harvestedwhile the blood is still circulating), organs may stillbe suitable for medical research.

Anything but Green
Sadly, if you think donating your body is a green option,think again. Eventually, your remains will be buriedor cremated - with all the inherent problems includingchemicals from the embalming fluid and coffin veneerleaching into the soil and water table, or being releasedin toxic smoke from cremation ovens. You can read VanessaMurray's excellent article, "Pushing up Daisies"on the NOVA website for an overview of the terribleecological cost of "traditional" burials andcremations, and eco-friendly alternatives: See www.novamagazine.com.auand follow the link to articles (Past Issues 2006, 13.4).

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