#59: Why Would Anyone donate their body to science?

💀Content note: this post talks about death and cadavers

I once attended parts of a human dissection at a medical school. I remember the atmosphere as a mixture of awed, youthful embarrassment and excited studiousness. I remember the small dabs of tiger balm that some students applied under their nose, to cover the persistent smell. I don’t recall anything about the anatomical structure of the dead person’s knee pit on study that day, though.

I remember wondering who the donor was, what his life had been like, and how he’d ended up here. Why did he decide to donate his body? I asked myself again after hearing about the shocking, demeaning conditions¹ in which the “temple” of French anatomy and medical science in Paris had mistreated thousands of donated bodies during decades.

People parts. Photo by v2osk on Unsplash

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First, a clarification: Body donation isn’t the same as organ donation. Organ donors give parts of their body to patients who need a transplant. Body donors give their whole body, usually to a local medical university where it will be used to teach anatomy, or to research surgery techniques.

Some countries, like India, allow medical schools to keep unclaimed bodies, but in many places, people must now register, voluntarily, on a database to state their wish to donate their body after their death². It is a rare decision; sociologist Julien Bernard calls it “the most marginal of funerary options (0.5% of deaths),” in a 2016 article about the motivations of donors in France.

In surveys and interviews with registered donors, researchers identify a range of reasons for bequeathing one’s body, but these are not necessarily clear-cut or easy to articulate publicly. “The decision to donate is a kind of identity-work, a deeply meaningful act which resonates with lives led and values held,” write scholars Maria Olejaz and Klaus Hoeyer, who published a study about Danish donors in 2016.

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Sophie Bolt and colleagues analysed motivations in a survey of registered donors at the University Medical Center of Groningen in the Netherlands, published in 2010:

The motivations most frequently mentioned in response to the open-ended question were to advance medical education (29.7%); to contribute to medical science (22.0%); to be useful (18.8%), and to help others (15.8%). Other respondents want to donate for the sake of their offspring, especially their grandchildren or, more generally, future generations (1.9%).

The researchers lumped the responses in the following three main categories:

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Let’s look at some common reasons.

Altruism

This is, predictably, the top reason mentioned by donors. People want to help, often help something vast and rather vague like “science”, “medicine”, “knowledge”, or “progress”, as Bernard writes.

In another paper published in 2011, Bolt et al. point out that this altruism isn’t pure, and that donors themselves can also benefit:

Their altruistic gift is in some degree motivated by self-interest, such as heightened self-esteem, showing kindness or enhancing personal reputation and status, and personal emotional reward. Besides, body donation makes it possible for people high on the continuum of conscientiousness to control the timing, duration, and aesthetics of their own death.

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Gratitude

That desire to help often comes with a feeling of gratitude or duty towards medicine. For example, the Danish study quotes 70-year-old Connie and 68-year-old Hans as saying:

Because I feel that I have received such good help from doctors for so many years so I feel I have something to give back in some way…

I feel like we owe the healthcare system, we owe it to science, we owe it to research to do what we can without it harming ourselves or our next of kin.

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Personality?

Bolt’s 2011 study says many body donors are described by their loved ones as having “broad interests and unconventional thinking”, but finds that donors don’t have extreme personality traits. (They are “similar to those of the average Dutch citizen”.)

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Money

According to different studies, money is the main reason stated by 6% (in England and New Zealand) and 8% (in the Netherlands) of body donors. But these figures are probably underestimated because “this motive is less easy to admit, including to oneself, than the altruistic argument,” Bernard writes.

Donating one’s body is usually cheaper than making traditional funerary arrangements, although it’s not necessarily free. For example, one grandson said on French public television³ in the wake of the Paris scandal, in 2020:

My grandmother made the ‘mistake’ of dying on a Saturday morning. Because the university is closed at the weekend, I had to pay for the transit in a funerary chamber until the following Monday. This cost 900€.

In Tours, a smaller French city, sociologist Nicolas Naïditch says body donation only cost 33% less than the cheapest cremation. In a 2016 article, he describes a “gentrification” of body donation: the number of donors who cancelled their registration between 1990 and 2013 increased along with the cost that the donors’ families had to pay out of their own pocket. And the family must also have the “necessary cultural capital to accept body donation, that is, the absence of ceremony and sepulture.” Naïditch concludes that “what used to be the place of the least privileged people is now invested by more privileged individuals.”

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Religious beliefs, or lack thereof

Many donors explain that they’re not religious, and therefore don’t care about what happens to their body after death, or downright reject funerary rituals. (See for instance this Guardian article, and its comments section!)

Others, on the contrary, mention their religious beliefs as one key reason to donate. For example, the Danish study quotes an 80-year-old, “deeply religious” Christian donor:

You know, when I am dead, then I am in Heaven with the Lord and what happens with my body? If anyone can use it then I think it’s wonderful.

The authors add:

Others similarly imagined a body emptied of the soul or the person, without necessarily connecting it to a Christian outlook. In fact, the decision to donate was accommodated by several different cosmological and theological outlooks among our donors, including contemporary Norse religion, reincarnation and atheism.

In Thailand, a 2017 study says that Buddhist faith is “the most important factor in the high rate of donor registrations” at Khon Kaen university, in the country’s northeast—especially as the university holds important ceremonies to honour donors:

The initial ceremony, known as Wai Khru Yai at KKU, is to invest the donated bodies with the status of Great Teacher. […] Monks carry out the ceremony, where they will pray and sprinkle water as a blessing on the cadavers in their body bags, and on the students, staff and relatives. They will also formally advise students of the importance of care and respect for the Khru Yai, and the importance of the availability of the bodies for their learning of anatomy.

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Simplicity

Rituals to thank donors happen in other places, like the United Kingdom, where universities organise interdenominational services with staff and students.

In many other places, there is no such ceremony. (In Paris, before the recent reform, the university organised a collective cremation and families did not receive the ashes.) But this lack of public ritual can actually be another motivator for some donors, who see donation as one way to avoid burdening their loved ones with funeral arrangements —and/or with what they see as unnecessary pomp.

In France, two of Bernard’s study respondents said:

I only have a grand-daughter and she’s in Morocco with her husband. If something happened to me, I couldn’t make them come, just for that.

The meaning of the cemetery, of bringing flowers, in the end that’s only selfish sentimentalism.

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Real people

In that anatomy room, I felt like the dissection also acted as a rite of passage, or a sort of test, for the students who stepped into the smelly, complex reality of their chosen profession. But there was no explicit time and space to air and process those intricate emotions.

Oldelaz and Hoeyer advocate for bringing in more of the donors’ personal reality into the dissection lab. They say some anatomy programmes have taken steps to do so, for example by showing students pre-recorded interviews with donors, putting students in touch with donors’ relatives, or sharing the donors’ medical history.

an approach to seeing cadavers as whole persons or “real people” may take as a starting point students wondering about “who donors are and why they donate”. […] it might also be an opportunity to see donors as whole persons with a life history, and based on this students can be invited to discuss the doctor-patient relationship, and to reflect on issues of end-of-life care. […] The dissection lab thereby becomes a possible venue for teaching medical ethics in a very practical sense.

Centuries ago, anatomists procured cadavers by desecrating graves⁴ or using the bodies of executed criminals. Now, some institutions gradually make efforts to infuse dissection and donation with more dignity, respect, reverence even. Maybe that will, eventually, make whole body donation less of a strange choice.

1. Journalist Anne Jouan revealed the scandal in a 2019 article in weekly magazine L’Express, and its ramifications were covered widely since, for instance here in French and here in English.

2. Over the years, medical schools have become more parsimonious with donated bodies, be it out of necessity or ethical concern. Two medical doctors who studied in Paris in different decades told me they had 1 body for 2 students in the early 1970s, vs. 1 per 4 students in the mid-1980s, respectively. (They said they would not donate their body to science, although some studies say healthcare professionals tend to be overrepresented among body donors.)

More recently, newer digital tools and models (in 2D, 3D, or virtual reality) also allow doctors in training to learn about anatomical structures without cadavers. But universities say that human dissection remains an essential learning tool.

3. Last month, 2.5 years after the Paris scandal, the French government issued a decree to beef up ethical requirements and specify the practicalities of body donation. It says in particular that the institution that receives the body cannot ask the family for any payment, will now pay for the body’s transport, and will organise a yearly (optional) ceremony in memory of the donors.

4. In the U.S. in the 19th century, those “submitted to the anatomists’ knife at the University were largely the bodies of recently deceased African Americans (both enslaved and free) who were grave-robbed for the school by hired professionals — known as resurrectionists — in Baltimore, Alexandria, Norfolk, Richmond, and elsewhere.”