An increasing number of unclaimed dead bodies went to help train medical students in Texas between 2017 and 2021, new research reveals.
Investigators did not expect to see such an increase, said lead author Eli Shupe, PhD, assistant professor in the Department of Philosophy and Humanities at the University of Texas at Arlington (UTA).
The numbers jumped from 64 unclaimed bodies to 446 bodies annually over those 5 years. "People are usually under the impression that this is something that either doesn't happen anymore or it's on the decline as more people step up to be willed body donors," said Shupe, who is also co-director of the Medical Humanities and Bioethics Program at UTA.
The study findings were published online on August 24 in JAMA as a research letter. Researchers said that the number of unclaimed bodies — those not claimed by next of kin for burial or cremation — has dropped significantly across the United States since the middle of the 20th century.
Some people don't want to discuss the practice because it is controversial, said Matthew DeCamp, MD, PhD. "But 'sweeping it under the rug' means we miss the opportunity for dialogues about respect, consent, social justice, and so on — as well as the opportunity to change policy." DeCamp is associate professor at the Center for Bioethics and Humanities and Division of General Internal Medicine, University of Colorado Anschutz Medical Campus.
The study included all medical schools in Texas, and researchers say it's likely happening elsewhere in the United States and abroad. The practice is legal in most counties and states. One exception is New York, which passed a law in 2016 that does not allow unclaimed bodies to go to medical schools without prior written consent from the deceased.
"Although limited to one state, these findings suggest that use of unclaimed bodies may be both more common than we thought and increasing," added DeCamp, who was not affiliated with the current study.
Even doctors can be split on the value to medical training vs the rights of the dead. "I know that medical professionals are divided on the role of dissection and anatomy learning and its necessity," Shupe said. She predicted working with cadavers in medical schools will probably continue for the foreseeable future.
The Marginalized and the Vulnerable
So who are the unclaimed? They can include those who are unhoused and those who do not leave enough money to cover cost of burial or cremation. In some cases, they don't have a next of kin or their next of kin is unwilling or unable to pay for their burial or cremation.
"Predominantly, these are going to be people who are poor or members of marginalized or vulnerable populations," Shupe said. She estimated that about 80% of the people who die in poverty in her region, the Dallas-Fort Worth area, are Black or Hispanic individuals.
"It is alarming that we are going in the wrong direction when it comes to the increasing utility of unclaimed bodies," said Joy Balta, PhD, associate professor of anatomy and Founding Director of Anatomy Learning Institute at Point Loma Nazarene University in San Diego, when asked to comment on the study. The hope is to rely solely on donated human bodies to ensure that donors have provided informed consent for their use in education, research, and clinical training, he added.
"These unclaimed bodies did not provide any consent, [which] raises ethical questions," Balta said.
Key Findings
In Texas in 2021, 43% of the cadavers in 14 medical schools studied came from unclaimed bodies. A total 14% of schools reported that they accepted unclaimed bodies, 28% possibly accepted them because they were transferred from institutions that use them, and the remaining 57% do not accept unclaimed bodies.
The total number and proportion of unclaimed bodies going to medical education in the study increased during the study. The 14% in 2021 was a jump from 2% in 2017, for example.
The 14 medical schools studied included both public and private institutions. The investigators also looked at data from the Texas State Anatomical Board, which tracks how cadavers are attainted and distributed in the state, including how many began as unclaimed bodies.
Legal in Most Jurisdictions
Shupe first learned about what can happen to unclaimed bodies as a hospice volunteer. She was accompanying the hospice chaplain one day who said, "Poor Mr. Smith [not his real name] doesn't have long, and then he's off to the medical school." Shupe asked what the chaplain meant because she was unaware of the practice.
"I stumbled on this by chance, and it ended up being a really fruitful research area," she added.
The Bigger Picture
Greater awareness is needed and there is not a lot of research out there, Shupe said. One exception is a 2018 study of medical schools nationwide that found 12.4% reported possible use of unclaimed bodies, Shupe said.
DeCamp, an author of that previous research, said: "Knowing this practice continues is the most important thing for doctors and medical students to know."
It remains unclear whether the COVID pandemic or the opioid epidemic contributed to the rise of unclaimed bodies going to medical training. That is a question for future study, Shupe said.
Most Bodies Willingly Donated
The majority of cadavers that go to medical training in the United States are 'full body donors,' people or relatives who agree to voluntarily send a body to medical schools. "We are fortunate to have a lot of people who are willing to become whole body donors," Shupe said.
Greater awareness about how donated cadavers could make a difference to further increase willful donations, she added. "Honoring those gifts by allowing them to help train the next generation of doctors is a wonderful thing."
A May 2023 study from Balta and colleagues on body donation programs in the United States, "found that the number of whole-body donations have decreased in some states and the numbers are not enough to meet the needs for education, research and clinical training," Balta said. This could explain the increasing use of unclaimed bodies.
"Some medical schools have explicit educational interventions on this topic, and formally recognize the unclaimed at anatomical gift ceremonies," DeCamp said. "More should."
Research support was provided by the UTA. Shupe, Balta, and DeCamp report no relevant financial relationships.
Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology and critical care. Follow Damian on Twitter: @MedReporter.
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