The fourth-year medical students who’d gathered around cadaver No. 86886 made mistakes.
The first student, who’d volunteered to attempt a cricothyroidotomy — an incision just below the Adam’s apple — didn’t push the scalpel deep enough into the dead man’s neck. A second student couldn’t find the trachea. The lab’s guest lecturer, a trauma surgeon at John Peter Smith Hospital, adjusted her grip on the forceps. Another student slipped one hand instead of two into a freshly carved opening in the cadaver’s chest.
In the anatomy lab at The University of North Texas Health Science Center at Fort Worth, medical students interact with what some consider their very first patients: dead people who, more often than not, chose to donate their bodies to science through the school’s Willed Body Program. They provide the repetition that leads to confidence for students who will one day treat living patients.
But about one in four cadavers belong to those the county calls “unclaimed”: people whose families couldn’t afford or chose not to provide funeral services, or those whose next of kin couldn’t be found. Not only has the program saved Tarrant County hundreds of thousands of dollars in its first three years alone, it’s provided a more diverse donor pool from which students can learn.
The ends may not justify the means, according to Eli Shupe, an assistant professor of bioethics at the University of Texas at Arlington. The donation of unclaimed bodies, she argues, raises ethical questions about consent — and whether it matters after death.
The county’s responsibility for people who die poor or alone
Claudia Yellott was 26, a single mom and working in insurance when she stumbled upon an ad for a part-time sales job at a funeral home nearby.
“I’d always heard about people having a calling or a passion — I did not have a passion for insurance,” she said. “But as I was at the funeral home, I found more and more I really had a passion for being there, being involved with the families.”
Yellott went to mortuary school at the Dallas Institute of Funeral Service and ended up directing UT Southwestern’s Willed Body Program for more than a decade until she joined the Health Science Center in 2017.
Her transition preceded major developments at the school’s Center for Anatomical Sciences: the completion of a $2.6 million renovation of the anatomy lab in 2018 and, later that year, the securing of a contract with Tarrant County related to the latter’s responsibility over unclaimed bodies.
Texas law requires each county’s commissioners court to care for the bodies of people who can’t afford funeral arrangements. An attorney general opinion in 2000 noted the language allows the county to donate the body to a medical facility.
Before contracting with the Health Science Center, Tarrant County offered burials or cremations at no cost to the person’s family, according to Lisa Martin, director of the Tarrant County Department of Human Services. The expenses cost the county roughly half a million each year.
After the contract went into effect, those expenses plummeted. The county mostly stopped offering burials — the most costly option — though exceptions for unidentified bodies, veterans and people with certain religious beliefs remain.
Instead, the Health Science Center became the county’s funeral home: transporting bodies, filing death certificates, notifying Social Security and, ultimately, cremating the body whether it’s used for medical research or not.
In Yellott’s experience, more than 80% of Tarrant County families who connect with the Willed Body Program choose donation over cremation, which the Health Science Center provides at no cost.
The October 2018 Tarrant County Commissioners Court vote for the contract passed unanimously. Andy Nguyen, then the Precinct 2 commissioner, supported the motion with a caveat: He needed the Health Science Center to give families ample time to identify a relative who has died and ensure the bodies were treated with “respect and dignity.”
“I felt like, when those people passed away, they did not have anyone to speak on their behalf,” he told the Report.
He worried that people who worked with the bodies would, over time, “lose sight of life and death and the dignity of a human being.” After the Health Science Center staff assured Nguyen they would honor the bodies, he decided to support the contract.
Before the pandemic, the Health Science Center hosted an annual Legacy of Life ceremony to honor the lives of people whose bodies were donated toward medical research — roughly 1,500 each year. Families and friends of the dead light hundreds of floating candles, each dedicated to a specific person, to express gratitude for their contribution.
Rustin Reeves, the director of the Center for Anatomical Sciences, said he cherishes witnessing the camaraderie of families and students. Families will share boxes of photos, medals and other tokens they’ve kept to commemorate their loved one.
“And I mean, you’ll see these students out there just bawling,” he said.
‘Uncomfortably close to grave-robbing’
Eli Shupe was volunteering at a hospice in Arlington in late 2021 when she learned about the Health Science Center’s contract with Tarrant County. A chaplain with whom she made weekly rounds mentioned one patient wouldn’t survive much longer.
“After he died, he’d ‘go to the med school,’” Shupe said. “And I asked what that meant … that’s how I learned that this is what happens when you die with no assets.”
Shupe, a recent transplant to Texas, had earned a Ph.D. in philosophy and was well-steeped in the world of donation — in 2018, she donated one of her kidneys. She now teaches bioethics at UT-Arlington.
Her concerns with the program were both philosophical and practical. She mulled over consent, or lack thereof. People have a right to make decisions about their bodies while they’re alive, she said. “A deep philosophical question to ask is, ‘Does that right persist after we die?’”
For Shupe, the answer is yes. In December, she published a column in the Dallas Morning News critiquing the program. She didn’t want to solely offer criticism, so she signed up to, one day, donate her body to the Health Science Center’s program. The consent forms abounded.
“If they think it’s important for me to sign all of those consents, clearly, they think the fact that I’m making this unpressured, autonomous decision to give my body to them is important,” she said. “So, why do they not need those consents for someone who just happened to have nothing when they died?”
In Tarrant County, people who are Black or Hispanic are more likely to be living below the poverty line than their white counterparts. Drawing cadavers from impoverished communities “risks exacerbating distrust of the medical establishment,” she said.
Alternatives exist. In 2016, New York banned the use of unclaimed bodies as cadavers. The state’s medical schools said they would fill any gaps by expanding their programs for private donations. Closer to home, Bexar County provides a “simple, respectful and dignified service” for people who can’t afford them. Furthermore, some medical schools around the country have decided to avoid cadavers altogether in favor of virtual anatomy tools.
At a minimum, Shupe said, programs like the one at the Health Science Center can make informed decisions about what a person with no assets or next of kin likely would have wanted. For example, the majority of Americans now prefer cremation to burial. But, she said, a “vanishingly small number” of people choose to donate their whole bodies — so the more ethical path is to err on the side of caution.
“This is uncomfortably close to grave-robbing,” she said. “That’s how it seems to me. They just don’t go in the ground first.”
‘A very honorable means’
Before students could make the first incision, Dr. Rajesh R. Gandhi asked them, one by one, to press their fingers into the cadaver’s neck. Gandhi, a trauma surgeon with JPS Health Network, wanted “everybody to feel.”
For students, “calm comes with familiarity,” the professor of the class, Cara L. Fisher, told the Fort Worth Report. In this case, with the intricacies and variations in the human body.
Fourth-year medical student Ashley Brodrick volunteered to perform a tracheotomy on the cadaver — her first. Brodrick, who plans to be an OB/GYN one day, said the cadaver lab helps contextualize what she learns from class.
“Everything looks picture perfect in a textbook,” she said. “When you get inside the cadavers, it could be wildly different, or they could have some type of anomaly or something that you just weren’t expecting.”
Photo gallery
Photo gallery: Health Science Center medical students get hands-on experience in anatomy lab
“I think you get, after a certain amount of time, a certain comfort level.”
Virtual anatomy tools can’t adequately capture the variety in the human body, Fisher said.
“You also get to see pathology, so you get to see disease as it happened in a person’s body, or any surgical procedures that they may have had,” she said. “You can hold and feel an organ. So someone says, ‘Cirrhosis of the liver — it gets hard and bumpy.’ You can feel it and actually touch it.”
Discoveries students make in anatomy lab can help their career. Fourth-year medical student Russell Vo has been involved with the program’s anatomy lab throughout his schooling. In his first year, he and his classmates discovered an extra artery attached to the cadaver’s kidney.
Fisher, who has a Ph.D. in biomedical sciences, encouraged the students to research the anomaly, and they did. In 2019, they published a case study in the Journal of Anatomy and Physiological Studies. Vo is the lead author.
Not only do publications like these sharpen the students’ research skills, he said, they strengthen their application to residency programs. “Research always helps,” Vo said. “It provides us a means to show that, ‘Hey, we are really dedicated to this field.’ We’re doing research, we’re inquisitive, and we’re lifelong learners.”
Who learns from the cadavers?
The Center for Anatomical Sciences brings in students of all kinds: medical students from the Texas College of Osteopathic Medicine and the TCU School of Medicine; physician assistant students; physical therapy students; nursing students from TCU and Texas Wesleyan, to name a few. The center uses cadavers to train first-responders like emergency medical technicians and firefighters. And, it supplies cadavers to research groups on the Health Science Center’s campus.
Variety among cadavers — everything from organ anomalies to demographic differences — benefits not only students but others who utilize the school’s anatomy lab, said Reeves, who has a Ph.D. in anatomy and cell biology.
An “eye group” on campus is trying to understand why glaucoma, a group of diseases that cause blindness, disproportionately affects Black people. “But we just do not have African American eyes to be able to give them to do that type of research,” Yellott said.
For years, the majority of bodies donated to the Health Science Center were white. That’s changing, Yellott said. She’s seen more people in the Asian and Black communities donate in the past few years than ever before, though donations from the Latino community have remained low. In the interim, she said the unclaimed bodies from the county have helped provide students and researchers with a more diverse pool of cadavers.
The Willed Body Program is also planning to do more outreach in communities that traditionally do not donate, Reeves said. In May, the program will have an exhibit at the Senior Synergy Expo in Fort Worth. They’re also planning to recruit students from those communities to help spread the word via the Health Science Center’s mobile health clinics.
Students aren’t necessarily aware that the cadavers in the anatomy lab may be unclaimed. Vo, the student who helped discover a kidney anomaly, wasn’t. His concerns echoed Nguyen’s, the former commissioner: As long as the program diligently tried to contact next of kin, and as long as the program approached the bodies with respect, he was OK with it.
“It’s a very honorable means,” he said, “just because it goes to a good cause to foster the education of medical professionals as a whole.”
Reeves understands how people outside the program could have concerns about the unclaimed body policy. Still, he’s seen the value in the training, day in and day out, for years. Yellott agreed.
“These are life-saving things that (the students are) learning and doing,” she said. “Not just life-saving, but quality of life, to be able to restore that quality of life for others, to be able to get something like that out of a tragic loss — where nobody’s wanting to be involved — for me is a good thing.”
Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.
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