The generosity of Arkansans is keeping the state's body-donation programs well-stocked with cadavers, leaders of those initiatives say.
While some anatomical gift programs -- such as one in South Dakota -- have recently run low on donors, that isn't the case in the Natural State.
At the University of Arkansas for Medical Sciences' anatomical gift program, around 5,000 people are registered to donate their bodies when they succumb to the inevitable.
Those donors' gifts meet the needs of medical and nursing education programs at the health sciences center, as well as training at Harding University, John Brown University, the University of Central Arkansas and Arkansas State University, program director Dr. Kevin Phelan said.
Cadaver shortages in other regions are linked to an expanding number of health care education programs, but in Arkansas new medical schools have precipitated interest in donating.
Even before the Arkansas Colleges of Health Education's first medical class matriculated in 2017, people who attended open houses around Fort Smith "were wanting to donate their bodies to science," said Dr. David McWhorter, the colleges' anatomy chair.
"It really was not my plan, to have an anatomical donation program ... [but] I felt a moral obligation to investigate the possibility," he said.
In Jonesboro, students at the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University now use cadavers from Oklahoma, but the school is fielding regular inquiries about whole-body donation.
Associate professor Dr. Dosha Cummins said officials have reviewed regulations for an anatomical gift program that is in the planning phases.
"It's not something that's done every day. So we're still in the learning process," she said.
For medical educators, cadavers -- still considered the gold standard for teaching anatomy -- make the abstract real for students. Virtual reality and 3-D imaging have improved, but there's no substitute for learning from the body, Phelan said.
In work with cadavers, students learn the relationship between skin to bone, organ to muscle, including quirks and physical differences donors might not have been aware of when they were alive.
"A lot of people only have one kidney -- you wouldn't know that," Phelan said.
The UAMS program collects about 100 donations per year, which are distributed to health care education programs around the state.
McWhorter wasn't sure exactly how many donors that program accepts annually, but he said the project has "grown by leaps and bounds," allowing students to study 21 cadavers each academic year.
Making an anatomical gift has some perks for donors. It can be economical, because cremation expenses (and sometimes transportation costs, depending on the program and circumstances of the death) are generally paid for by the donor bank.
But faculty members stress that its real value is for students.
"When they're physicians, then they can look at a patient and imagine what's beneath the skin in that part of the body," Phelan said, "which is hard to learn from a book."
LIFE IN THE LAB
Like living patients, donors come in all shapes and sizes -- skinny or a little overweight, petite or muscular -- in a variety that sometimes reveals disease processes.
For students, using human bodies as a teaching tool can be "an adjustment," Cummins said.
"A lot of students have not had this experience before, or if they have it's on a limited basis ... They're standing up in a really cold room for several hours a week, but they also have to adapt to the fact that they're working on a human being."
Students typically work in teams with the same donor throughout their anatomy course, which lasts for several weeks. On the first day of class, they meet their "patient," McWhorter said.
In Fort Smith, the semester's first anatomy classes start with cadavers that are still wrapped in a bag, and are lying belly-down on lab tables.
That's because structures reached through the back of the body are larger and easier to work with, according to McWhorter.
"It gives the students a chance to develop that skill set of dissection ... [and] it's a little less personal, by starting on the back region with the face down," he said.
"Every now and again we get some [students] that are upset by it, but the approach that we take by and large works 99.9% of the time."
One challenge of the lab involves maintaining the donors' condition as the weeks of an anatomy course wear on.
Preservation is on the lab manager's mind as donors arrive to Jonesboro from Oklahoma on a refrigerated truck, Cummins said. The cadavers are embalmed using more fluid than is typical to keep tissues intact.
At that program, donors stay on anatomy lab tables for the duration of a course. A manager checks to make sure fluids are draining correctly, and that the teaching area adheres to Occupational Safety and Health Administration standards.
"It's a very tightly controlled, regulated space. ... You know, there are a lot of chemicals in there. The students have to be protected, the faculty have to be protected," Cummins said.
In class, students usually aren't told the exact age of the donors, or much about them beyond the cause of death that's included on the death certificate.
Instead, they discover more as they work, piecing together clues such as a pacemaker scar.
Sophia Cherry, a 26-year-old medical student at the College of Osteopathic Medicine in Jonesboro, said work with cadavers helped her "connect the dots" within the body.
She said the experience was difficult at first, but it offered a "different perspective."
"Learning anatomy is hard on basically a 2-D sheet of paper, kind of like what we're given in textbooks and in lectures," she said.
The donor's gift of a body motivated her to learn, she said, even on days when she didn't feel like being at school.
"I didn't want to take that lightly. ... Whether they were alive or not, they were still my first patient."
WHO CAN DONATE?
Each program in Arkansas has restrictions on who can donate a body to science.
Generally the very tall are excluded, because they don't fit well on the tables used for dissection. So are people who were very obese, or who are emaciated by disease.
People with infectious diseases, blood-borne pathogens or very advanced cancer are ruled out, and the body should be intact. It's not possible to donate if one died in a traumatic accident or if one's body has significantly decomposed.
A person also cannot donate organs (other than the eyes and corneas) and donate the body as well. For people older than 18, age doesn't matter.
At UAMS, program coordinator Celia Mccaslin said staff members there tend to talk through these stipulations when someone asks about becoming a donor.
"I think that's the main concern for somebody that is a donor, is that it's not set in stone," she said.
"[Registering] is not a guarantee that when that time comes, that you're going to be accepted. So that can be something that they need to understand, and maybe make other arrangements."
UAMS staff members encourage people who wish to donate to pre-register for the program, hang on to a donor registrant card and give family members and friends a heads-up about one's wishes.
Sometimes, hospitals will inform programs about people who might be good donors but are not enrolled, Mccaslin said.
There are other options for people who might not qualify in the state, or who have a specific goal in donating their bodies.
Arkansas programs specifically support medical education, so people who would like their bodies to contribute to research on a specific disease, for example, can donate to Genesis in Memphis.
The facility supports clinical research and accepts donations from 18 states.
While donations in Arkansas have kept up at a good pace, it can be a challenge for programs to publicize themselves, faculty members say.
McWhorter said there's usually an uptick in interest when the program is mentioned in the media.
"We don't go out and actively solicit donations -- it's just not appropriate," he said. "It's kind of a word-of-mouth [thing]."
Metro on 07/05/2019
Print Headline: Med schools meet need for cadavers; state avoids shortages seen elsewhere