Donating your body
Nathan Borgeaud tells the tale of body donation for medical study
Some of us find it fascinating, others are
not so keen, though most agree that
medical students never forget their
experience of the dissecting room. This
unique opportunity to explore the anatomy
of the human body leaves images that stick
in your memory and strange smells that stick
to your lab coat. So it is surprising that
so few of us know anything about the
processes involved in body donation.
The story begins while you are still
alive. If I wanted to donate my body I
would have to approach the London
Anatomy Office, based at the Charing
Cross Campus, Imperial College School
of Medicine. The office deals with
inquiries from people who are interested
in donating their bodies for anatomical
examination. Although donors are
usually elderly, anyone over 17 years old
can bequeath their body, so I am not too
young. However, there are restrictions
on who can donate. Louise Evans, who
deals with inquiries from potential
donors, said, "We get around 800 people
offering to donate each year. But not
everyone is suitable." Generalised malignant
disease, amputation of limbs, or
any major deformity means someone
may be inappropriate for anatomical
examination, the object of which is study
of the normal structure of the human
body. Where there is a risk of transmissible
disease donation is also refused.
More than half of the requests that
Louise deals with will have to be rejected
and with the London medical schools
alone requiring around 300 bodies each
year Louise's job is not easy. "Unfortunately
we're always in short supply of
donors," she said.
HERITAGE IMAGES/BRITISH LIBRARY
The preparation begins
If I am accepted I will be asked to complete
the donation process by signing
some legal forms, and with a bit of luck I
will not be visiting the London Anatomy
Office again for many years. One day, however,
the inevitable must occur. Assuming
that I die suddenly from a stroke or heart
attack (the most common cause of mortality
among donors) my body will be collected
from the hospital mortuary and transported
to the office's laboratory where preparation
begins.
The embalming fluid used in the process
is responsible for the strange smell so characteristic
of the dissecting room. It is a cocktail
of powerful chemicals designed to infuse,
preserve, and stabilise my body, preventing
any kind of decomposition. David Gunner,
senior chief medical laboratory officer, has
been working in the embalming laboratories
for almost 10 years and he devised the "two
stage" fixation process. "A mixture of
formaldehyde, industrial methylated spirits,
and water is used to fix the tissues. We place
catheters into the femoral or carotid arteries
and either pump the fluids in or use gravity
methods," he told me.
Large plastic tanks holding the embalming
mix are shelved close to the ceiling of
the laboratory. Fluid passes down an array
of tubes and into my body lying below, flowing
through arteries and capillaries where
blood once flowed during life. "This first
stage takes two to three days," said David.
"The body is then stored for up to three
weeks before the second stage is begun.
This involves pumping in a preservative
consisting of phenol, glycerine, and methylated
spirits." The fluids will penetrate most
of my body, though some organs need special
treatment. My brain will need to be preserved
and is reached by passing a catheter
up the nose and injecting through the
ethmoid sinus. Adequate protection of
workers from the industrial chemicals is
essential. Goggles, boots, aprons, and
respirators may be worn during the
embalming process and the laboratories
are fitted with a £500 000 air
extraction system.
Over 25 litres of fluids are used
A month later and the preparations are
finally complete. Over this time my body
will have had around 25 litres of fluids
pumped through its vessels. However,
the job of the London Anatomy Office
will not be over until my body is buried
or cremated. Dr Diana Watt, chairperson
of the London Committee of
Licensed Teachers of Anatomy, oversees
the whole process and ensures that the
final details are in order. "Every part of
the body is retained and is either cremated
by the medical school or
returned to the relatives if such as
request has been made. An interdenominational
service of thanksgiving is held
at Southwark Cathedral in May each
year for relatives and friends of those
who donated their bodies." The service
is always well attended by students and
teachers.
The medical school may keep my
body for up to three years. In this time it
will have been used to display everything
in perfect detail from the structure
of the brain ventricles to the complexities
of the brachial plexus. It will have
played an essential role in the teaching
of future doctors.
So now we have heard the whole
story, a story that could not be told if it were
not for the generous donations made by the
public. The choice of donation does not
seem too popular with my fellow colleagues,
most of us would prefer the road from death
to grave to be as short as possible. For the
small numbers who decide to donate, it has a
long detour.
Nathan Borgeaud, fourth year medical student, Imperial College School of Medicine, London
Email: n.borgeaud@ic.ac.uk
studentBMJ 2001;09:217-260 July ISSN 0966-6494
