Overview, Criteria and Procedure for Anatomical Body Donation

Duke University School of Medicine’s Anatomical Gifts Program is a WHOLE BODY donation program. We are deeply grateful for the generous donation people make for the purpose of educating our present and future medical professionals. Our students include, but are not limited to, medical students, physical therapy students, nurse anesthesiologists, physician assistant students, pathology students, practicing medical doctors, plastic reconstructive surgeons, orthopedic surgeons, oncologists, neurologists, ophthalmologists, evolutionary anthropologists, and more. 

Our purpose at The Anatomical Gifts Program is to serve medical education and support donor families through the donation process

We hold our donors with reverence, gratitude, and awe.  The deep learning that happens through the generosity of donors cannot be replicated.  Body donation offers learning through the diversity of human life experience.  Students witness first-hand how disease and health present themselves in the human body.   They gain knowledge and learn humility and appreciation for their first patients, which helps them with every patient they touch in their lifetimes of service.  Accomplished medical practitioners improve their care and discover, practice and improve procedures to better serve humanity.  

Body donation is a gift that keeps on giving.

Our process starts at the time of death.  There is no pre-registration. We provide Uniform Donor Cards for potential donors. The cards inform loved ones and doctors of the intent to donate to Duke School of Medicine and provide our contact information for your loved ones to contact us at the time of death. We HIGHLY recommend you have your intentions to donate written in any other legal health care documents, so we know that donation is your wish. 

We keep no records before death occurs.  We screen donors based on criteria and other conditions occurring prior to, and at the time of death.  Criteria is designed for the safety of the students, our staff and patients in Duke University Hospital. See Step 3

We can often accept a body if there is no Uniform Donor Card (signed by the donor and witnessed by two impartial witnesses); or no other valid legal instrument indicating an intent to make an anatomical gift.  However, only relatives with Next of Kin (NOK) status or persons with notarized, North Carolina Health Care Power of Attorney (HCPOA) documents or other documents recognized in North Carolina are able to donate a body. See Step 2

Our facility is open daytime, weekday hours to receive donor bodies.  We are closed weekends and holidays. We try to receive bodies within 3 days of the time of death.  We recommend you and your family choose a funeral home or transport service with cold storage in case the death occurs when our facility is closed.  This also gives us time to contact family and medical professionals to qualify the donor for acceptance and to process the required documents to release the body.  If we are unable to qualify the donor for our program, the family is able to consider alternatives.

We do not perform autopsies, nor do we produce medical reports.  In order to honor the privacy of our donors, we also do not disclose the courses or outcomes of studies.  
 
We normally keep donor bodies for two weeks to two years.  We do our best to match our donors with their best opportunity for teaching based on their medical situations and history.  We cannot anticipate the exact time we will complete with the studies.   

The expenses the family/estate will need to pay for:  Transportation of the donor body to our facility, possible cold storage prior to the donation, and the cost of filing death certificates. Funeral homes and mortuary transport services generally facilitate the death certificates. Payments for these services must be arranged directly from family or estate to the transport provider or funeral home (See Step 5).  If this cost is a hardship to the family please contact us, preferably prior to the death occurring, if possible.

We facilitate and cover the cost of cremation after course studies are complete. Our donors are cremated individually.  We contract with a local crematorium and who then returns the cremains to us in a standard box urn.  We, in turn, return it to the family.

At the end of the studies, when cremains are ready, we offer families the option to pick up or for the Program to mail back the cremains of your loved one.  We can also scatter your loved one’s cremains at a special location in the Duke Forest.  

Memorial Service. We hold an annual Memorial Service for donors’ families in the Spring or Summer of the year following the donors’ cremations.  The service is held at the Duke Chapel in Durham.  It is an opportunity for students, doctors and instructors to share what the donation has meant to education and medical science.  The students also hold their own private memorial service to honor our donors, their “silent teachers.”  


We do not facilitate brain or organ donation.  We will work with brain donors to other programs if the program is compatible with our criteria and timing, and arrangements are made prior to death.

We do not facilitate research projects in our labs. People who wish to donate their bodies for specific study of a disorder or disease need to find researchers working on that particular issue.  Most research projects have specific criteria, often have narrow windows of acceptance, and require enrollment prior to death. 


 

Process for Body Donation at Duke University

Prospective Donors 

Please read through this information packet to better understand the program, decide whether our program fits your objectives and take steps to prepare.  

Fill out our donor card and give an additional card to Next Of Kin, family members, HCPOA, and alert medical professionals to the donor’s desire.  Donor cards are not required but recommended.  You may also document your intent to donate your body as an “anatomical gift” in your will or any health care directive.  This is different than “organ donation.”  See https://www.donatelifenc.org/  or https://carolinadonorservices.org for organ donation.

There is no pre-registration for our program. We do not keep information on those who have donor cards. A donor card does not guarantee we can receive the donor body.  It is a legal statement of the individual’s choice to donate their body upon death.  It includes phone numbers for loved ones to call in the event of the potential donor’s death.  

Directions for what to do when someone is close to death or has died:

Step 1: Call our Program  

When a death occurs, or a death is imminent, and the donor or family have made a choice to make a whole body donation, then call: 919-681-5471, between 8:30am and 4:30pm Monday through Friday.   If the death occurs when we are closed, call our after-hour, emergency phone at 919-812-7430, between 4:30 p.m. and 8:30 a.m. Monday through Thursday.  We are closed weekends and holidays.  Please leave a message and we will return the call on the next business day.

Be prepared: We require faxed copies of the Donor Cards, HCPOA documents and copies of parts of a Will or other Health Care Directives so we can confirm intent to donate and that we are working with the appropriate agents of the donor.  We must make sure the people we work with have the legal right to donate you or your loved one’s body.  Please also have phone numbers available for primary care doctors, hospice and/or the hospital floor charge nurse number.

Who can donate a body when there is not a signed donor card?
 If there is no legal declaration in a person’s will or health care directive that specifically states that person wants to donate their body to Duke Anatomical Gifts, the individuals who wish to donate that person’s body will need to hold the status of: Legal Next of Kin or be named as agent with Health Care Power of Attorney (HCPOA) in a signed and notarized Health Care Power of Attorney (HCPOA) document.  

These documents must be faxed to us and reviewed.  If there is no objection in the individual’s legal documents and no family member is opposed, we can then start to screen the donor for medical criteria 

Step 2: Determining authority and qualified agents for donation

A Signed and Witnessed Donor Card is a legal document declaring the individual themselves planned and chose to donate.  However, you will need a representative to assist in your donation once you have died, to make appropriate decisions, help us reach your medical providers and arrange funeral transport.  Please advise them on your wishes for disposition of your cremains.

Qualified Agents if there is no signed donor card:

  1. Health Care Power Of Attorney (HCPOA), holds highest level of legal authority around decisions when you are not able to make them yourself. If you do not have the appropriate Next Of Kin willing to assist in your donation – or there is resistance to your choice to donate among family members, we recommend you appoint someone as your Health Care Power Of Attorney (HCPOA).   To plan ahead, advance health care directive documents are often available through with your health care provider, attorney, social worker, or the North Carolina Secretary of State. Some out-of-state documents may not be recognized in North Carolina. Please find a copy of HCPOA form for NC at this address: https://www.dukehealth.org/sites/default/files/health_care_power_of_atto...
     
  2. *Next Of Kin (NOK) Order of Authority, when there is no signed donor card, no objection, but no specification about an individual’s desire to donate, and no individual is appointed the agency of Health Care Power of Attorney, Next of Kin is determined order of priority in N.C. Gen. Stat. § 130A-412.11 as set forth below:
    1. Spouse of the decedent
    2. Adult Children (Step Children if they are legally adopted) of the decedent
    3. Parents of the decedent
    4. Adult Siblings of the decedent
    5. Adult Grandchildren of the decedent
    6. Grandparents of the decedent
    7.  Adults who exhibited special care and concern for the decedent;
    8. Persons who were active guardians of the person at the time of death;
    9. Any other person having the authority to dispose of the decedent’s body.

      If there is not an existing signed donor card, and anyone in the family exists with higher or equal authority, they must be involved in the decision and be willing to sign the documents. 

 

Step 3: Screening for medical criteria

We screen medical information to determine if the body qualifies. We cannot verify this information with the donor far ahead of the time of death, because infections and other conditions can present at the end of life. Our staff must verify the condition of the body at the time of death, or just prior to death by speaking with the medical professionals who worked with the donor up until the time of death.  

  1. The family and/or health care power of attorney need to alert the medical professionals –to give Duke Anatomical Gifts Program staff permission to speak with the medical professionals about the medical condition of the donor.
  2. Medical professionals may include: the charge nurse at the hospital, the family doctor, hospice nurses and or doctors or specialist physicians overseeing their medical care. 
  3. It is most helpful if we are provided with the most direct phone numbers to reach medical providers. 
  4. We do not have access to Duke medical charts.

 

Criteria

These guidelines are established for the safety of our staff, students, educators, and the body’s suitability for teaching.  Criteria may be amended due to specific medical courses and lab capacity.  We do assess each individual, close to, and at the time of death, taking into account many factors.

  1. We do our best to receive the body within 3 days of death. 
  2. Donors must be 18 or over.  There is no age limit over 18.
  3. General Height: Under 6’ 4” in height (although we often make exceptions based on any special studies/courses happening at the time) 
  4. General Weight – height and weight proportional: Women: generally between 100 and 180 pounds;  Men: generally between 100 and 200 pounds. 

    Exemptions to both height and weight may be made on a case-by-case basis, taking into account proportion, BMI and any specific studies/courses happening at the time.

  5. The body must be free of infections, blood diseases and contaminants including, but not limited to:

    • A history of Hepatitis A through E 

    • Active staph infections, including MRSA, VRSA, VRE

    • Creutzfeldt-Jakob, HIV, AIDS, Fungus Candida Auris 

    • Active tuberculosis, meningitis, encephalitis, Noro Virus, Corona Virus

      Please note, we will need verification that any donor is free of COVID-19 and may not be able to accept donors passing of “unknown respiratory” infections without clinical documentation that it is not COVID-19.

    • Clostridium Difficile (C. Diff)

    • Sepsis (blood poisoning)

    • Severe jaundice 

    • Open wounds, skin ulceration, large bed sores, unhealed deep incisions, gangrene (exceptions are possible, based on current condition of the wounds and/or current course needs)

    • Ascites or significant abdominal bloating/fluids

    • Recent (within 6 months)  radioactive implants 

  6. Other situations under which we cannot accept a body:

    • A body that was in medical isolation

    • Drowning, submergence in water at death

    • Severe burns, severe trauma

    • Significant invasive surgery

    • Significant edema in the head and facial area

    • The body must not have undergone any internal exploratory autopsy or tissue removal (biopsies) without prior coordination and approval of our team, and it must be performed in Duke University Hospital  Pathology Lab.

      • We can, in special circumstances, work with donors who are involved in other Duke research in pre-arranged cases, when doctors request to remove tissue, if performed in Duke University Hospital Pathology Lab, or through pre-approval in coordination with another pathology lab.

    • We are open to receiving bodies when brain donation is planned, if pre-arranged.  We do not harvest brains in our facility for research.   

      • As of January 2020, unless a patient is involved in a study through Duke University during their life and part of the study includes brain donation, Duke does not have an active brain bank.       

    • Post death amputations or donation of an organ after death (with the exception of eyes. For eye donation contact the North Carolina Eye Bank, Inc. (800) 553-9956.

    • In special circumstances a pre-embalmed body can only be accepted, if the funeral home staff has consulted with our lab staff prior to any embalming, if the family chooses to hold a funeral prior to donation.  This requires our team to work closely with the funeral home. 

Step 4: Signing and faxing “Release of Body” form if there is no donor card  

Once the donor’s body has been accepted, if there is no existing donor card, we will fax a release form that must be signed by the Next of Kin or Health Care Power of Attorney and two witnesses.  The form must be FAXED back to us in order to legitimize the donation and for us to approve transport to our facility.  We also need the original, signed copies mailed back to us or sent with body in the care of the transport service. 

This is the legal contract, giving us permission to hold the donor for use in our program until cremation. It also gives the family a choice for where to send the cremated remains, or instructions for us to scatter them at Duke Forest in Durham, North Carolina.

Often hospitals, hospices, nursing homes, funeral homes and banks will assist you to receive and send faxes for body donation. UPS Stores, FedEx Stores and office supply stores like Office Max and Office Depot have fax machines.

Step 5:  Arranging transportation to our facility

Family/Estate is responsible to arrange and pay transport to our facility at Duke University Campus in Durham, NC by a funeral home, mortuary service or mortuary transport service*.  We recommend a service with cold storage in case the death occurs over a night or weekend when our facility is closed. 

  1. We recommend researching a transport service of your choice ahead of time if you are planning your donation. Different funeral homes and mortuary transport services provide different services at a wide range of costs.  It is helpful to provide the phone numbers of your chosen service to family members in your planning documents.  We will coordinate with the service you choose to help them get the body to our facility.  Our program will do our best to help you find a transport option if you have not found one on your own, but we cannot guarantee the best option for your situation. 
    *Please note: if it is a financial hardship to the family/estate to pay for funeral transport if we accept a donation, please let us know as soon as possible in the process, we may have resources to assist your family.
  2. In the case that we are unable to accept a donor’s body due to certain medical conditions, weight, timing or other factors, we recommend having an alternative plan, which may involve cremation or burial.
  3. If a donor lives or dies far from North Carolina, we recommend finding an alternative program in your community.  If the donor feels strongly about donating to Duke University, please find a funeral home that can to fly or transport the body within 3 days of death. 

Step 6: Preparation of the death certificate

We require that licensed funeral or mortuary professionals file the paperwork for death certificates.  We must have a copy (we do not require a certified copy) for our files and cremation. Funeral/Mortuary professionals generally charge a fee, and can help you get certified.  The funeral home/mortuary service can fax it to us.  Your family/estate may need certified copies to close bank, credit card and retirement accounts, and settle estates, real estate, life insurance, online accounts, and other legal matters.  You can arrange to pay for copies with the funeral service or get them online or from the Register of Deeds from the county where the death occurred.

Step 7: We provide cremation services after the studies are finished  

 

Step 8: Returning the cremains

At the time of donation you can choose how to receive your loved one’s cremains. We mail a letter several weeks ahead of time advising you the study is complete, and we follow up with a call to make sure you are still at the address on file.  Then we mail the cremains to the designated family member or internment site or we arrange at time for you to pick up them up at Duke Campus.  We also can scatter the cremains for you in a special scatter site at Duke Forest.

Final step: Memorial service and expression of gratitude

 We hold an annual memorial service in the Spring/Summer of the year of the donor’s cremation for the family members.  It is an opportunity for our students and educators to let the families know what impact the donors have on their education and their appreciation for the generous donation. You will receive an invitation in the mail and we ask you to RSVP.  

Our students hold their own, private memorial service, as they are deeply touched by the generosity and depth of what they learn and their connection to their “silent teachers.”

Thank you very much for considering whole body donation to Duke University School of Medicine’s Anatomical Gift Program. 

Please contact us with any questions and check back with us every two years to be sure nothing has changed.

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