Donating your body to science is one final, lasting gift. It plays a critical role in teaching trainee doctors, improves the quality of medical care and helps save the lives of millions
AS far as Maurice Bryan is concerned, once he's dead, he's dead. So the idea of donating his body to medical science struck him as nothing more than a perfectly practical way of helping the medical profession. He certainly doesn't have any qualms about the prospect of callow anatomy students poring over his internal organs.
"You're dead -- what's the difference?" says the 79-year-old, who today is one of 1,200 names on Trinity College Dublin's list of body donors. "You have to be a little cold and brutal about it."
Cold and brutal maybe, but more than a touch philanthropic at the same time. Having been the grateful recipient of three hip replacements, Maurice had first-hand experience of how medical advances had improved his own quality of life and he wanted others to have the same opportunities.
"Surgeons are incredible people, but they have to have somewhere to learn their trade. They've got to get inside the body and practice. I was a blood donor, and then an organ donor, but once you're past the age of 70 they don't want your organs, so it seemed like a logical extension of that."
And it is. But while thousands of us are more than happy to tick the boxes of an organ-donation card, the numbers signing up for body donation are far smaller.
In the UK, a shortage of donors has proved a major headache for medical schools trying to teach their students human anatomy. The situation here is not so bad however: while UCD admits that increased class sizes means it has a shortage of cadavers to work with, Trinity's list is so long that the college has had to temporarily halt donor applications, pending a review later on this year.
Prospective donors must contact the medical schools at UCD, Trinity, UCG, UCC and the Royal College of Surgeons directly and each college manages its own donor programme. The direct link between donor and medical school -- in the UK body donation is run through a centralised office -- is crucial to the success of Irish programmes, believes Philomena McAteer, joint chief technical officer at Trinity's school of anatomy.
From her office, tucked away behind the cricket pitch at the end of the campus, Philomena and her colleagues, Siobhan Ward, Mary Lynch and Claire Murphy, oversee the smooth running of the college's programme.
The school itself is on consecrated ground, and a beautifully bound Book of Remembrance, containing the names of those who have donated their bodies to the school over the past 50 years, takes pride of place.
Over tea and biscuits in the small, high-ceilinged room, piled high with files and photos, there's a cosiness to the set-up that belies the fact that just the previous day the women were embalming the latest arrival at the medical department.
The four personally oversee the care of the bodies from the moment they arrive in the building -- usually direct from a nursing home, hospice or from a private home -- until they are eventually released for burial or cremation, two or even three years later. They're even responsible for slowly introducing the first-year students to the idea of anatomy.
"We explain to them it is a very special privilege to be working with the remains," says Philomena.
"First, we show them a part of the body -- it might appear waxy because of being in cold storage -- the appearance of the body is not like a live body. Then, we look at the bone structure, before we eventually start dissections."
Most students are awe-struck the first time they see a real body, says John Bannigan, professor of anatomy at UCD.
"There are lots of pale faces and a bit of trepidation. But after a few days, people overcome this. In 30 years, I only knew one student who had to leave the course because they couldn't overcome their revulsion at dissection."
Prof Bannigan's queasy student wasn't alone: Charles Darwin dropped out of medical school for exactly the same reason. But for those who stick it out, dissections become a regular feature of student life.
It isn't just trainee doctors who benefit from having real bodies to work on. Qualified surgeons facing difficult medical procedures often practise on a cadaver to make absolutely certain that they know how the operation should go.
One surgeon, recalls Philomena, had the task of removing a cancerous tumour from the prostate of a young male patient. Anxious that the complex procedure should be completed without rendering the patient infertile, the surgeon visited Trinity's anatomy department every day for a week, practising on the cadavers, perfecting the technique.
"The thing is, we're all different," says Prof Bannigan. "So if you get a textbook or a model to learn from, you're just seeing one set of structures. But there is an awful lot of variation between one individual and another -- blood vessels and nerves take different courses and branches, and so on.
"Working on a cadaver, you get a 3-D idea of what things are like. You can touch them, whereas with a model the sense of touch is pretty uniform.
"We find, for some reason that is hard to define, it gives the students more of a sense of respect of the human body, a sense of mortality and of what death means."
Once Trinity has finished with the body, everything is returned to it. At that stage, the bodies are either cremated or buried in the university plot at Glasnevin Cemetery or, alternatively, wherever the family wish.
The college will bear the costs of the Glasnevin interment, but if the family opt for another location, Trinity pays the transport costs, but not those of opening up the grave.
Recent speculation that hard-hit consumers looking for a cost-effective way of planning their exit has clogged up the donor list is way off the mark, says Philomena. For a start, prospective donors are told that they must make alternative arrangements in the event of the body not being accepted by the medical school. This can happen for a number of reasons: for instance if a person is obese or emaciated, or has died from a particularly infectious disease.
"Most people say that the reason they decide to donate is that they wanted to give something back to society. And to say otherwise is to make light of someone else's donation and offend them," says Philomena.
While their motives might be similar, donors come from all walks of life, she adds. "We have gardeners, builders, waiters, pilots, doctors, nurses, so you can't say it's elitist in that sense. It is simply an altruistic thing."
"There is quite a number of doctors, but very large numbers of clergy, of both denominations," says Prof Bannigan. "I think it's because they are people whose life's work has been the care of others or duty to others and they'd like to continue to be of use. We have quite a number of army officers, for instance -- people who have a strong sense of duty."
Typically, the actual decision to fill out the form happens, says Prof Bannigan, when a person is in their 60s, coming up to retirement age and getting their affairs in order.
For Maurice, it was the death of a much-loved aunt, Iris Bardon, that led him to Trinity's doors.
"She died nearly nine years ago. She was a huge charity worker and a great believer in helping people out. So it didn't surprise anyone that she had decided to donate her body."
Impressed by the way Trinity had handled the whole donation process and by a beautiful memorial service held afterwards, within a month of Iris's death, both Maurice and his wife Bernadette (68) had added their names to Trinity's list.
Do people ever get cold feet?
"Once in a blue moon, someone will change their minds," says Prof Bannigan. "But they can do that at any stage -- a simple note to us is all that's needed."
Maurice Bryan is not changing his. He's too pragmatic for cold feet. "My wife and I went into this, not as a result of some deep philosophical discussion, but we simply decided that we would do it. We don't want medals for it. We don't think it's that big a thing.
"If more people could learn to think of it as a practical, day-to-day thing, there would be more donors. It's the sensible thing to do."