Working with cadavers in an anatomy lab is often a humbling and monumental moment in a doctor’s career. Students spend hours toiling over dead bodies with gratitude and reverence for the donation that allows them to practice and learn about human anatomy in their journey to become healers. Only, sometimes, these cadavers are not truly donated — and the dead person never consented to have their body dismembered.
When a dead person’s next of kin cannot be located or their family cannot afford a funeral, the responsibility of what to do with the remains falls to the state or county. In these cases, unclaimed bodies are sometimes sent to and accepted by medical schools, but several experts in the field object to the practice, raising ethical concerns that these people never consented to being dissected in life.
Writing in the New England Journal of Medicine in 2020, one medical student shared her experience finding out that her first patient was in fact an unclaimed body after she had already sliced into him with a scalpel.
“I still grapple with the guilt of having dissected a man who may have wanted to rest in peace,” she wrote.
There is no central database to count how many unclaimed dead bodies are reported each year nationally, and practices vary depending on the state or county in question. Some states — including Hawaii, Minnesota, Vermont, Rhode Island, and New York — have prohibited the use of unclaimed bodies in medical education. But schools in other states continue to use them. In Texas, the proportion of unclaimed bodies accepted by medical schools increased from 2% to 14% between 2017 and 2021, according to a 2023 study in JAMA.
Eli Shupe, a medical ethicist at the University of Texas at Arlington and the author of the paper, said she was shocked to learn about this practice.
“The use of somebody's body, even after their death, without their consent is in tension with many of our commonly accepted norms of best ethical practices in medicine,” Shupe told Salon in a phone interview.
Many in the field are concerned that medical institutions who are using unclaimed bodies are violating the deceased's fundamental right to consent. Furthermore, without being able to identify any of their relatives, there is no way for those doing the dissecting to know if the person came from a religious background or had spiritual beliefs that directly contradicted or prohibited body donation, said Joy Y. Balta, chair of the Human Body Donation Committee at the American Association for Anatomy (AAA).
“Body donation is a noble, selfless gift, and an individual themselves makes that decision,” Balta told Salon in a phone interview. “It's not something that someone else enforces on them.”
In addition to the ethical concerns that affect the unclaimed individuals directly, this practice also harms families, Shupe said, citing a recent NBC investigation that found unclaimed bodies were not only sent to the North Texas Health Science Center without a family’s consent but sold to various other institutions for training purposes. Some families were still looking for their deceased relatives when the outlet contacted them for the story.
“In some cases, the deceased have next of kin who weren't located, either because they were very hard to find, or because whoever was responsible for finding them did a poor job or was negligent,” Shupe said. “Sometimes relatives emerge later and they learn that a loved one's remains have been donated without their knowledge, and this can and has caused really serious emotional distress.”
Many programs have curbed the practice in recent years. In 2007, for example, Oregon stopped taking unclaimed bodies after a dead man’s sister and friends — who were not notified of his death and never consented to donating his body to the institution — tracked down his body at Oregon Health Sciences University. In Texas, the county subject to the NBC investigation changed its policy to provide burial or cremation for unclaimed bodies. The North Texas Health Science Center told Salon in an email that it has stopped using unclaimed bodies in its programs.
Still, other data suggests the practice continues to occur in various institutions across the country. In a 2018 study published in the journal of Anatomical Sciences Education, 12% of 146 medical schools who responded to a survey said they used unclaimed bodies in medical education, with many of the people who ran the programs reporting that they were neutral on the question of whether it was important to tell students about the origins of the body, said study author Dr. Matthew DeCamp, a general internist at John Hopkins University.
“We certainly observed in our research the full spectrum,” DeCamp told Salon in a phone interview. “Everything from institutions who knew they were using unclaimed bodies and decided not to tell students at all, to institutions that used it as a learning opportunity to help students develop what we would call their professional identity formation and ... learn about social justice and inequalities in our country.”
The use of unclaimed bodies in medical schools was legalized in the 1800s as an attempt to stop grave robbing, where so-called “resurrectionists” dug up dead bodies and sold them to schools. However, some have argued this simply created a new pathway for medical schools to continue using bodies from disenfranchised communities.
There is not much research on the demographics of the unclaimed, but one 2020 study looking at trends in Los Angeles County found that they were more likely to be poor, unemployed, male and Black. Yet people of color are less likely to consensually donate their bodies to medical schools. This could be in part because medical institutions have a long and fraught history of exploiting Black bodies to “advance” science, from the Tuskegee syphilis study to the doctor who was once known as the “Father of Gynecology” practicing experimental medical procedures on enslaved Black women.
“If we know that unclaimed bodies are from a majority of people of color, and we know that very few people of color donate their bodies or want to donate their bodies, this is more of a reason for us not to send unclaimed bodies, especially from people of color, to be dissected,” Balta told Salon in a phone interview.
Many institutions justify the use of unclaimed bodies by saying they are necessary to fill the need for cadavers in a shortage, according to a brief on this topic from the American Medical Association released in May.
However, while some localities have reported not having enough donors to meet the needs of their medical institutions, others have reported more than enough. For-profit body brokers even collect enough bodies to ship thousands of body parts internationally each year. This industry does require consent, though family members have reported not being aware of the extreme distances the deceased would travel or what their bodies would be put through. Some family members, for example, have reported donating their loved ones' bodies to these body brokers thinking they will be used by medical institutions and they are instead sent to the U.S. Army to test explosives.
“This is where the lack of oversight is an issue, because if there was an entity that oversees this, then there could be a bank of donors, and individuals could be sent from one county to the other, or from one state to the other, rather than having to go outside of those ethical practices,” Balta said.
Apart from the Uniform Anatomical Gift Act passed in 1968, federal legislation regulating what is done with unclaimed bodies is lacking, said Thomas Champney, an anatomy professor at the University of Miami Miller School of Medicine. In the states that do not regulate unclaimed bodies, it is simply up to the institution and the county to decide what to do with them.
“I really would like there to be some federal legislation that would say that all unclaimed individuals' data need to be uploaded into a national database, where families could search to find their loved ones,” Champney told Salon in a phone interview. “But at present, there's little regulation and really no laws.”
Other countries have more centralized mechanisms of regulating unclaimed individuals, Balta said. In the U.K., for example, the HM Inspector of Anatomy has the authority to shut down programs if they do not follow federal regulations for body donation.
The AAA created a task force to establish best practices in body donation in 2019, which Balta said should be published before the end of the year.
“We specifically say [in the guidelines] that body donation programs should not accept unclaimed or unidentified individuals into their programs as a matter of justice,” Balta said.
Even next-of-kin who do choose to donate their deceased loved ones to medical schools might not be doing it out of a desire to further science. One 2022 study found the process of signing up for body donation is highly variable across the country, with many places that receive donors not informing families of all that the process entails. Unfortunately for some families, it might be the only affordable option to handle their kin’s remains, said Lauren K. Bagian, a body donation researcher at the Georgetown University School of Medicine.
“They may just be donating, because, as part of the donation, most of the time institutions will cover the costs of embalming, funeral expenses, preparation of the death certificate, or transportation of the body, which can be thousands of dollars,” Bagian told Salon in a phone interview. “That’s another interesting ethical question: Are we accepting these donations from next of kin even though they might be financially motivated when we are not requiring proof that this is what the individual might have wanted?”
For the county or state handling the remains, it’s cheaper to donate the body to science, too. Each burial or cremation can cost thousands of dollars, and the new policy in a single Texas county, for example, will cost it $675,000 a year. That, Shupe said, is the price to pay for the county to support its constituents in death — as much as in life.
“These are unclaimed bodies, so it's easy for them to be overlooked and forgotten,” Shupe said. “It's nice to see that people are finally paying attention to what's been happening and asking whether or not they don't owe stronger obligations to these people in death.”
