Texas medical schools are increasingly using unclaimed bodies in medical education, a practice largely thought to be dwindling because of ethical concerns.
In 2021, Texas medical schools accepted 446 unclaimed bodies, or bodies not taken by the family for burial or cremation, about 14% of all cadaver donations. Just four years prior, medical schools in the state accepted only 64 unclaimed bodies to use in training, or about 2% of cadaver donations for the year, according to new research out of the University of Texas at Arlington.
The research, published in the Journal of the American Medical Association, doesn’t address why the number of unclaimed bodies increased — it’s unknown whether factors including the COVID-19 pandemic or the opioid epidemic contributed. But the findings dredge up ethical questions over the use of human remains without consent, especially among marginalized communities.
“There’s a misperception that, as more people have stepped up to donate their bodies to science, this kind of procurement either no longer happens or is in continual decline, and our study shows that this is not the case in Texas,” said study author Eli Shupe, assistant professor of philosophy and humanities at UT Arlington.
“This raises important ethical questions, and these questions ought to be part of a public conversation,” Shupe said.
The University of North Texas Health Science Center at Fort Worth contracts with Dallas and Tarrant counties to accept unclaimed bodies to use in medical education. About 35-40% of the bodies they use are unclaimed, the university said.
Bodies can go unclaimed for myriad reasons. The deceased may be estranged or isolated from their family, or their family can’t afford a burial.
The history of using unclaimed bodies in medical training is long and, at times, uncouth. Procuring unclaimed bodies, often of the poor, was common practice as medical schools popped up across the country. Unable to keep up with the demand for more cadavers, some schools accepted bodies that had been robbed from their graves.
The Uniform Anatomical Gift Act of 1968 changed that trend by allowing any American to preemptively donate their body to science. The state of New York banned using unclaimed bodies as cadavers without consent in 2016.
But in most parts of the country, counties can still donate unclaimed bodies to medical institutions without consent from the deceased or their family.
“It raises questions about justice and fairness, because now the burden of providing medical education is falling disproportionately on vulnerable and marginalized members of society,” said Dr. Matthew DeCamp, associate professor in the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus.
An estimated 20,000 people or their families donate their bodies to research and medical education each year, although requirements for acceptance may differ by program. The Willed Body Program at UT Southwestern Medical Center lists a number of reasons why a body might not be accepted, including cases of contagious diseases such as HIV, tuberculosis or Ebola or cases of severe obesity or emaciation.
Cadavers studied early in a student’s medical school journey serve as more than just a tool for visualizing the human body and are often referred to as students’ first patients.
“Anatomy lab is often one of the most profound and important experiences a student can have, not just because of learning anatomy but also because of learning some of the fundamental values of the medical profession and respecting human dignity,” DeCamp said.
Universities increasingly use simulation technologies to mimic human bodies for medical training, but the tools don’t provide the same real-world experience to students, said Rustin Reeves, director of the Center for Anatomical Studies at UNTHSC.
The significance of cadaver donations is not lost on students, who host ceremonies to honor the lives of those who give their bodies to science. Families of the deceased can sometimes request to receive the ashes of their loved ones after the school has completed its studies; UT Southwestern, which does not accept unclaimed bodies for medical education, does quarterly burials at sea for families who don’t request the ashes back.
DeCamp said using unclaimed bodies can pose not only ethical issues but practical ones as well. Unclaimed bodies may not have complete medical histories, which makes learning from the body harder.
Just how many unclaimed bodies are used in medical education is difficult to pinpoint. Medical schools don’t always advertise that they engage in the practice. Studies of the matter are rare and largely rely on the goodwill of schools to share information.
DeCamp co-authored a 2019 study that surveyed 146 U.S. medical schools on the use of unclaimed bodies, of which only 89 responded. Eleven schools reported possible use of unclaimed bodies, although programs differed on whether they believed students should be informed of unclaimed body use.
Shupe took a different approach when looking at Texas’ medical schools. She and her co-authors obtained data on unclaimed body use at public schools through the Texas Public Information Act. The private schools in the study voluntarily gave their data.
Only two of the state’s 14 medical schools directly accepted unclaimed bodies, while another four schools received transferred cadavers from schools that used unclaimed bodies. The other eight schools had no possible use of unclaimed bodies, the study said.
UNTHSC is transparent about the fact that some bodies used in training are unclaimed. The school uses between 100 and 150 cadavers a year in medical training and also supplies hundreds more cadavers to other health programs in the state.
Without the ability to source unclaimed bodies, Reeves said, some of the state’s medical and health schools wouldn’t be able to use cadavers in their training.
“We have students choosing to come here because of the dissection,” Reeves said. “There are students who won’t go to schools within the state that don’t do dissection because they want that training.”
Counties can also benefit from donating unclaimed bodies to medical education. It’s expensive to partner with funeral homes and cemeteries to bury people who can’t afford the process on their own. UNTHSC gives a discount to counties to cremate unclaimed bodies that don’t meet standards for medical education.
Shupe said the practice of using unclaimed bodies needs additional research not to only fill gaps in available data but also to evaluate why the number of accepted unclaimed bodies increased in the Lone Star State.
“There haven’t been other comprehensive state-specific studies besides our own, so I think there’s a lot of opportunity for further research here. I’m hoping to do some comparative studies, because by no means is this just a Texas phenomenon,” Shupe said.