Taking the key from a hook beside the door, the professor unlocks each of three freezers standing in a row along the wall of the lab. “We don’t have any heads,” says Cari Whyne brusquely. The freezers hold bins labelled with the names of graduate students using these bone samples. It also holds some vacuum-packed specimens, a femur on a shelf and a cardboard box labelled “spines.”
The bones were donated to the University of Toronto’s medical school, anatomy division, by people who decided to leave their body to the university to help with education and research. In this laboratory, they’re being used by Dr. Whyne, an associate professor in U of T’s department of surgery, for research on bone strength.
“You test bridges to see how strong they’re going to be,” explains Dr. Whyne, who trained in bioengineering and proudly wears the iron ring given to Canadian engineering graduates. “You test bones to see how strong they’re going to be.”
Pride of place in her small lab in the basement of Sunnybrook Hospital belongs to the Servohydraulic Materials Testing Machine. It can compress, stretch and twist bone, to test strength and assess the interface between bone and metal implants. The researchers work on computer models in the offices next door, but they use real bones to verify those models. Their musculoskeletal research could lead to new implants and could help patients with fractures or bone cancer. It has already produced a new method to stabilize the spine. But for any of that to happen, people must agree to give her their bones.
Researchers are interested in all body types for donation: male or female, of any race or religion. If you are thinking of donating your body after you die, typically you’re probably getting on in years (donors are often in their 70s and older). You might have received a terminal diagnosis, or you might simply be planning ahead. It’s possible you were in and out of hospital a few times and are grateful for the care you received. You might be a practical person who views the body as a shell and who likes the idea that your death might benefit others.
When you’re motivated enough, you make a call to someone like Heather Thornton, the coordinator of U of T’s donor program. She uses tact to answer questions from someone just told they have six months to live and humour to respond to a donor who jokes that they always wanted to go to university.
“Part of the gift is the intention, the willingness to give,” she says. “People call me, and they’ve had an operation or an illness, and it occurs to them that their doctor was trained on an anonymous donor, and they want to help. The main thing I hear is, ‘I want to give back.’”
The phone rings at her desk in the medical sciences building and she has to take the call. (“Sorry, that’s the transport service.”) She discusses with the person on the line whether the donor program can accept the body of a patient infected with a disease similar to tuberculosis. “It’s very rare that we have to turn somebody away,” she explains afterwards. It can happen with people who died from infectious diseases, with bodies that are too large or heavy, or with bodies that are difficult to embalm because of recent surgery or organ removal.
Some people may have signed up as organ donors when they were young, but choose to donate their whole body when they get older, believing that their organs will no longer be as useful for transplants as when they were younger. (Ontario’s Trillium Gift of Life Foundation disagrees, arguing that donating organs lets you save lives directly and that every age group can do so – an 89-year-old Ontario woman donated her lungs.)
Across the country, there are perhaps 1,000 people a year who leave their bodies to universities and colleges. The recipient programs include medical schools from Newfoundland to British Columbia as well as Humber College’s funeral services diploma program, the Canadian Memorial Chiropractic College and Brandon University’s undergraduate dissection course for pre-med students.
The body donation program at U of T receives 125 to 140 donations every year. Besides being used in research like Dr. Whyne’s, the bodies help surgical residents to upgrade their skills and Toronto Emergency Medical Services workers to practise emergency procedures. The majority of bodies, however, help with teaching basic anatomy to students studying to be doctors, dentists, physical therapists and, sometimes, medical illustrators, anthropologists or bioengineers.
It’s debatable whether there’s a shortage of bodies donated to science, but the medical schools could always use more. Michael Wiley, chair of U of T’s anatomy division, says additional donors would allow him to fill more requests for cadavers for medical education, for example, in training surgical residents. At times, the department can’t meet all the requests it gets. “From conversations I’ve had with my colleagues,” he adds, “my understanding is that the situation is similar at several of the other Ontario schools of anatomy.”
In a lecture hall in U of T’s medical sciences building, Judi Laprade is lecturing animatedly to some 300 students of gross anatomy. They follow her overhead slides and scribble notes. “Some of you have already gotten to the sole of the foot,” says Dr. Laprade, an assistant professor in the anatomy division and a physiotherapist by training. “You may have started to take the skin off. Anyone noticed how tough it is? Try to go in from the sides, not always from the top or bottom.”
Dissecting feet can be difficult because of the fascia, but other body parts can be emotionally difficult: the first cut of the year, the head, the hands and the genitalia. Small groups of eight students share one male and one female cadaver. Despite the time commitment for busy students (10 to 12 hours a week in the lab), professors and students alike endorse the value of learning anatomy through dissection rather than learning only from textbooks and 3D simulations. They say that to understand the body as a system, it helps immeasurably to know by touch the difference between a nerve and a vein. “It’s a different thing,” says Dr. Wiley, “to learn from a picture and to learn by running your hands along a nerve.”
Even students who are nervous about the first cut can get excited about what their cadaver can teach them. They marvel at the large and colourful heart. “It’s very cool to dissect,” says first-year medical student Emily McDonough. “It looks like the textbook, and it’s easy to find all the parts.”
For her, respect for the donors includes learning as much as she can: “I really do think back to what Professor Wiley said, that these people deserve to be fully studied. They wanted us to learn from them.”
As dissection progresses, the removed tissues and organs are kept in a container labelled with the cadaver’s number to avoid mixing up remains. Parts of the body remain covered until it’s time to work on that area. Some students apologize to the cadaver as they lean in. “I caught myself almost patting his arm at one point,” confides Natalia Burachynsky, who’s studying biomedical communications. “You’re smoothing the skin, it’s like you’re trying to make them comfortable.”
Students are told the age and cause of death, but not the name of their cadavers. Still, uncovering tattoos or nail polish can forge a connection. “The lady had the most brilliant shade of pink on her toes and fingers. It was quite elegant, actually. It was fresh,” reflects Jesse Kancir, in his first year at medical school. “I think she knew what was coming and she had enough time to get ready for it. It really brought her some dignity.”
These kinds of attitudes contrast sharply with the cases reported in 19th-century newspapers of body-snatchers stealing corpses from graves to supply universities in Ontario and Quebec. Medical students sometimes paid their fees by selling cadavers. These unsavoury activities gave way to provincial laws that turned over the bodies of the indigent dead to medical schools, and then to the modern practice of donor cards and signed consent forms.
The macabre past and polite present collide at J.C.B. Grant Museum in the medical sciences building at U of T. Most anatomical specimens in the collection date from the 1930s, but a few are more recent (that’s a separate box to tick on the consent form, allowing specimens to be retained).
Six graduate students from the biomedical communications program are here this morning to sketch organs and tissues that are more visible in jars than viewed on the dissection tables. This is part of the preparation for careers illustrating medical textbooks and producing 3D animations for public health campaigns, once they finish the master’s degree. One woman holds a pencil in the air to get the proportions correct as she shades the unusual shape of horseshoe kidneys in a jar. Another student excitedly flips to a blank page of her sketchbook to draw the relative size of the thoracic ducts on two of the bodies the students dissected, one tiny and one unusually large (“ten times the normal size”).
Like many of the students taking anatomy, these women are fascinated by what they’re learning, the abnormalities and the natural variations that are part of every human body. “We all want to see inside ourselves,” observes Cindy Lau. Other students agree: if only it were possible, the students would love a chance to dissect themselves.
After up to three years with the University of Toronto, helping to teach students and perform research, the remains are cremated. A person leaving their body to science can opt for a burial by their family, but if they don’t, they will end up in a wide and spacious plot at St. James’ Cemetery. The university has erected a red granite tombstone: “Here lie the remains of those who, in the interests of others, donated their bodies to health education and research.”
Every June, three non-denominational memorial services end at the grave, each attended by about 100 to 150 friends and family members. People light candles, and students from the departments that benefited play music and read statements of gratitude. The names of the deceased being buried are read out. In 2010, there were 145 names. For students and family alike, the service gives a sense of closure and a chance to thank the donors.
“I would thank them a lot, because it’s really helped us to learn,” says Mianyan Wang, a biomedical communications student. “It’s great that people are willing to donate so much of themselves.”
In November, the cemetery is peaceful with the sound of rustling branches, the grass blanketed in yellow leaves. The grave holds plastic flowers, a candle, a portrait of a woman – signs that people are visiting regularly and lovingly. Not everyone will choose this ending. But for some, this is their final gift.
There are alternatives to using cadavers in medical training. At the high end, surgeons try out new techniques and tools at the University of Toronto’s Surgical Skills Centre with high-tech manikins priced at around $175,000. They also use low-tech balloons and meat from butchers. Simulators like the Resusci Anne manikins have helped millions to learn cardio-pulmonary resuscitation in first-aid courses since they were introduced in 1960.
For universities, the cost of running a dissection program can be expensive. Some medical schools work with prosected or plastinated body parts. Students can learn from digital dissections that remove layer after layer with the click of a mouse, or watch an animation of how eye muscles move. Simulators also provide a chance to learn techniques where there’s a shortage of cadavers; some companies make infant and child models.
Many experts believe training with simulators and cadavers can be complementary to using the real thing. Paramedics spend hours inserting tubes in the throats of plastic dummies before trying a cricothyrotomy on a cadaver as part of their ongoing training. “The tactile feel of doing it on real skin is different,” says Rob Burgess, a senior director at Sunnybrook Hospital, adding that there are many variations in people’s throats.
Interested in donating your body to the U of T anatomy department? Find out more about the steps you need to take.