Organ and body donations
In Sweden, about eighty full-body donations are made annually to promote medical education and development. The recipients are the anatomical teaching departments at the universities of Umeå, Uppsala, Linköping and Gothenburg and at Karolinska Institutet (KI) in Stockholm. Sweden has a relatively low donation rate. If more people chose to become donors, it would contribute to better medical education, research and healthcare.
Despite major advances in terms of technical and digital development, there remains a large need for body donations to medical education and development. Sophisticated computer simulation and high-tech imaging technologies cannot replace the added value offered by teaching using donated bodies. These studies also provide us with important information and knowledge regarding differences between individuals, age groups and genders.
Different types of donations
In certain cases, an individual may be interested in two different types of donation; the donation of organs for life-saving transplants and body donation for medical teaching and development purposes. If so, the individual in question may be both registered as an organ donor and have entered into a body donor agreement.
In practice, it is not possible to first become an organ donor and then be taken care of as a whole-body donor. The basic attitude of the medical profession is, in cases where a life-saving transplant or a full-body donation would be possible, that a life-saving transplant takes precedence.
Anyone who is interested in both types of donations can therefore register in the organ donation register and also enter into a whole-body donation agreement. The circumstances of the passing then determine the type of donation that will be relevant.
At KI, most donated bodies are used in anatomy education for medical students and, to a somewhat lesser extent, for prospective dentists, physiotherapists and in some cases for other health professions. For many students, the anatomy courses at an early level of education are also their first encounter with a deceased person, which is linked to discussion, reflection and targeted educational moments on the ethics and professionalism of medical activities.
Another area of application can be anatomical training and improvement for specialists at advanced level, such as surgeons. In Sweden, this is not so common since the frequency of donation is rather low and thus not quite enough for this purpose. Even in research and development, whole-body donations can play an important role, for example in developing surgical methods and developing knowledge in areas where animal testing is insufficient.
At KI, however, donated bodies are currently only used in anatomical teaching in undergraduate education.
The vast majority of people in Sweden who are between 18 and 95 years, can donate their body to medical education and development, if they so wish. A donor agrees that the dead body is handled at the anatomical unit at the Department of Neuroscience at KI.
Before making a donation decision, it is important that a prospective donor has unreservedly concluded that they want to donate their body. This is often expressed as "I want to come in handy for medical science".
A prerequisite for a donation to be completed is that the body, after the donor's death, can be handled freely at the anatomical unit. This means, among other things, that there cannot be any reservation of religious or existential nature regarding the handling of the body. Some diseases, injuries, excessive weight, or other changes to the body can prevent the body from being suitable for donation or to be handled by the anatomy unit.
For many donors, the decision means a sense of purpose – being able to contribute to a better understanding of the human body for the benefit of future generations. This attitude must, of course, be addressed in a serious and ethically correct manner by the receiving unit/organisation and its actors. The donor has given great confidence to the medical faculty and an invaluable resource in the form of their donation, a decision that creates obligations on the part of the recipient of the donation.
Although it is an eminently personal decision to enter into a whole-body donation agreement, it is desirable that the donor's relatives or equivalent are informed of and understand what the decision means. Not least, this can prevent possible ambiguities about what the donation means or disagreements about how the body is handled.
A donation agreement is entered into by the donor with the receiving anatomical unit at the Department of Neuroscience, KI. Only the donor in person can enter into such an agreement on his own body. Relatives of the deceased cannot subsequently donate the body.
The agreement with the donor's signature is filled in and sent to the anatomical unit. It assesses whether the offer of whole-body donation can be received and whether the wishes and reservations expressed by the donor in the form are possible to fulfill. In this case, the agreement is signed by a donation administrator or unit manager. The donation agreement is archived at the anatomical unit and a copy is sent back to the donor along with a donor's card. Only then is the intended donation valid.
The donor should ensure that the copy of the agreement is kept in a known place for relatives and also that any medical authorities are made aware of the decision.
The agreement states, among other things, wishes for burial. It is important that the form is completed as carefully and clearly as possible and that the donor contacts the anatomy unit if something needs to be changed in the agreement.
The donor can discontinue the agreement at any time and without justification. The anatomy unit can be contacted by regular mail, e-mail or by phone. Please note that the anatomy unit can discontinue the agreement, should the body prove, for any reason, to be unsuitable for donation after death.
Donation agreement, in Swedish (pdf)
What happens after a donor has died?
The anatomy unit at KI should be contacted as soon as possible after the death, either by a relative or a healthcare official. A check is made to make sure the donation can still be completed. Among other things, this involves checking that the responsible doctor has been able to confirm cause of death without autopsy (an autopsy makes donation impossible), that the person does not carry or has died from an infectious disease or that the body is damaged in any other way.
If the donor is still deemed suitable, the body will be transported from the morgue to KI’s anatomy unit, where the body will be embalmed and then used in teaching. After about one to two years, the body is usually cremated – unless otherwise stated – and handed over to relatives for burial. Usually, however, a symbolic funeral ceremony has been held before, already a couple of weeks after the passing.
The donor’s identity is strictly protected throughout the donation process. Donation agreements is kept under high security and are only available to a few authorised individuals. Upon arrival to the anatomy unit, the standard ID bracelet on the deceased body is exchanged for neutral codes or serial numbers. All staff and students who come into contact with donors are under strict confidentiality, both in terms of all aspects that may identify an individual and observations made on the donors.
If the body is depicted, for example by being photographed, facial features, tattoos or other characteristics that can be linked to the donor's identity may not be included. The fact that the donor is anonymous in all respects when handling in the anatomical unit also means that it is not possible to obtain a record of findings and observations about the individual's medical condition.
A body donation is a non-profit act. There is no cash compensation during the donor's lifetime. A completed whole-body donation, on the other hand, means that the estate is lifted off certain costs.
The university’s financial commitments apply within Sweden and include:
- Transport costs for the deceased body from morgue to the anatomy unit and from the anatomy unit to the crematorium or burial ground in Sweden.
- Fees to the funeral contractor
- Costs for coffin and burial urn of basic model
- Costs of cremating and finally depositing ash/remains at a cemetery in Sweden
Relatives are free to add funds to, for example, have a coffin of a more lavish kind than the simplest, advertisements, flowers and officiant. Memorial services or similar are not paid for by KI. In the event that a donor has taken out funeral insurance, this should primarily cover the costs, while KI is responsible for the excess amount. Please note that KI does not administer burial, reduction of urn or scattering of ashes in a place other than a burial ground in Sweden. For more information about spreading ash elsewhere (for example at sea), contact the County Administrative Board (Länsstyrelsen).
Make a donation
Memorial and tribute donations
A donation in memory is a beautiful way to honour a friend or relative who has passed away. Karolinska Institutet has funds dedicated to several important medical areas.