The people who donated their bodies to Harvard Medical School, only to have their remains allegedly stolen and sold, took part in a system based on generosity and trust — but one with very little oversight.
Medical schools around the country rely on donated bodies for students to dissect in anatomy classes and in some cases for research. State and federal laws govern the process of gaining consent and how the bodies are obtained, handled, and disposed of. But in most places, no agency inspects to make sure proper processes are in place, and medical schools are left to self-police.
In a shocking case that raised questions about whether donors can trust such programs, federal prosecutors on Tuesday accused Cedric Lodge, the former manager of the Harvard Medical School morgue, of selling body parts that were supposed to be cremated.
Leaders of the anatomy labs at two other medical schools said they have systems that aim to prevent such a thing from happening.
Dartmouth’s Geisel School of Medicine has“multiple layers of oversight,” said James Reed, director of the school’s anatomy lab. Two staff members and a faculty member certify that the body is complete after it has been dissected, and the crematory staff does a final check.
Reed’s assistant director signs off anything he does, and vice versa. “Not having one person with the ability to make a decision helps us ensure that the donors and facility and program are secure,” and it’s harder for something amiss to go unnoticed, he said.
Robert Bouchie, laboratory manager and director of the anatomical gift program at Boston University’s Chobanian & Avedisian School of Medicine, said he serves as “guardian” of the donors’ bodies. They are kept in a secure locked laboratory, he said, and he embalms them himself.
“At the conclusion, we make sure everything is checked off,” he said, to make sure every part is accounted for.
But Bouchie and Reed both acknowledged that no outside authority is overseeing the process.
“There is no legal organization currently that is coming in doing inspections like you would see at a crematory or funeral home,” Reed said. “I would love for that to happen.”
Such oversight would provide reassurance to donors and their families, he said.
“Anytime there’s negative press surrounding body donation, it always grabs headlines because it is such a breach of trust,” Reed said.
The director of a body donation program in another state told a similar tale.
Dr. Christine Pink, assistant professor of pathology at the Homer Stryker MD School of Medicine at Western Michigan University, said her program has an elaborate chain-of-custody system that uses software and QR codes to keep track of everything and make sure all dissected materials can be reunited with the donor.
But Pink said the program is “basically self-policing,” and she’d welcome more oversight to reassure patients.
As Harvard faces a hit to its reputation, other medical schools were reluctant to comment. Tufts Medical School, the UMass Chan Medical School, and the Warren Alpert Medical School at Brown University all declined to answer questions about their anatomical gift programs.
The American Association of Tissue Banks has established standards for nontransplant anatomical donation organizations and will accredit those that seek its approval and meet its standards. But so far, only seven such organizations have been accredited, none in Massachusetts.
Asked how incidents such as the alleged crimes in the Harvard morgue could be prevented, the association said in an e-mailed statement that “criminal behavior cannot be entirely prevented.”
But the association has “standards relating to the traceability of the donations that would deter such activity.” Each accredited organization must be able to account for all anatomical items during every step of the donation, from the initial authorization to the final disposition. The agency reviews these records during the initial accreditation and re-accreditation inspection processes.
Exploring the intricacies of human anatomy by dissecting a cadaver is an essential part of medical education and most medical schools have anatomical gift programs. People register with these programs before death, and their next-of-kin sign off on transferring the body from the funeral home. The medical examiner visits to ensure that there is no reason to investigate the death.
At Geisel, with relatives’ permission, the students learn the donors’ first names and come to think of them as “team members.”
“Often we hear them talking to donors while in the classroom,” Reed said. “Many times when they get a higher grade than expected, they are thanking their donors.”
At BU, donors are asked to record such personal details as their favorite movies or vacation destinations, which are then shared with the students.
When the studies are complete, the bodies are reassembled and cremated. Many schools hold memorial services, inviting the donors’ relatives.
Bouchie said he sometimes hand delivers the remains to the relatives. During these visits, he will spend time with the family discussing how much students benefited from the gift and maybe looking at photos of the deceased.
Asked whether the Harvard allegations will discourage anatomical donations, the tissue banks association said such a response is “always a worry” and the reluctance to donate “can literally put lives at risk through the lack of available donations from which physicians and clinicians can learn, train, and perform research.”
“We hope that people will understand that this was criminal activity, and the vast majority of programs have many policies and procedures in place to prevent and quickly detect inappropriate behavior,” the association said.
Reed said he hasn’t heard from any donor families — some of whom have a multigenerational tradition of donating.
“All we can really do is kind of stand on our reputation and the ethical standards we hold ourselves to and the culture we’ve built at the medical school,” he said.
If prospective donors have doubts about BU’s program, Bouchie said, he believes his honesty and the program’s reputation will reassure them.
“When you call up and I speak to you, I’m telling you as honestly as I can you will be respected. You will be cared for as if you were a member of our own family,” he said.