From: The Director 69 (6) : 22,24,28, 1997 Jun.

Embalming the Anatomical Donor

By Cydney Griffith & Stephen Smith

Many of us have embalmed individuals who were organ and tissue donors, but seldom are we asked to embalm someone who has donated their entire body to science. The need for anatomical donation is increasing due to the proliferation of medical study and research. Just as the funeral profession has become more involved in organ donation and tissue harvesting, at some point we may be asked to embalm an anatomical donor.

Most individuals who desire to donate their body to science make their wishes known to their family, and many even contact the medical school or anatomical gift program of their choice. As funeral directors, we are called upon to make prearrangements for these individuals, as well as contacting the donor facility regarding paperwork and other requirements. Furthermore, it is important that we ask what specific embalming procedures need to be used that might be different from those applied for a visitation and funeral service.

Unlike "traditional" embalming techniques, embalming for science is quite different. The main differences include positioning the body, selection of embalming chemicals and injection and drainage methods.

Proper positioning of the body for placement in the casket is something we all learned in mortuary school. The primary goal is to create a natural, comfortable appearance of the deceased. For anatomical study, the body is place in a supine (lying down) anatomical position. This means the legs are placed together with the feet parallel and facing forward. The arms are placed close to the sides with the palms facing forward. While it is possible to modify positioning during the embalming process (i.e. to facilitate fluid distribution), the body should be placed in the supine anatomical position at the conclusion of the embalming process. Positioning devices can also be used under the head, shoulders, buttocks and feet to reduce contact with the embalming table and to facilitate fluid distribution.

Fluid distribution and diffusion are of particular importance when embalming. Not only will the donor body be kept for a longer period of time (possibly one to two years), but also many facilities do not refrigerate the body once anatomical dissection and study has begun. For this reason, the proper choice of embalming chemicals is very important. In addition, since the body will be dissected, there is always the potential for formaldehyde exposure to the students and other personnel. Many medical facilities also dictate the type and strength of embalming chemicals that may be used. Therefore, it becomes vital to reach a delicate balance between adequate disinfection and preservation of the human remains and protecting the health and safety of the students and staff.

Another consideration is that of refrigerating an anatomical donor prior to embalming. Due to delays with the completion of paperwork and arrangements with the family, the post mortem interval may be lengthy. In many instances, the donor is refrigerated for a longer period of time than normal. As with any embalming, refrigeration may cause complications with the overall embalming operation. Antemortem and postmortem emboli commonly are resulting challenges. Injection and drainage methods are also different for an anatomical donor situation.

To increase disinfection and preservation, it is often necessary to choose more than one injection site, even if there appears to be adequate distribution from single point injection. It is not uncommon to utilize six injection sites to ensure sufficient fluid distribution in the upper and lower extremities, as well as in the hands and feet. And unlike traditional injection/drainage procedures, most medical facilities discourage drainage of any type. Distention of the tissues is desired, since it tends to give the body an appearance that more closely resembles its antemortem condition. This is true with the internal organs, which maintain a "normal" size, contour and proportion. However,this can cause problems with hypostasis, particularly in the head and face, and may lead to rapid decomposition of the brain. It is required that the viscera remain intact. Cavity aspiration and cavity fluid injection are not completed. Needless to say, this often leads to an extensive amount of purge during the embalming process.

Donor preparation

As with any embalming procedure, the body and clothing are thoroughly treated with a topical disinfectant. After the clothing and any personal items are removed, the entire body and all orifices are further cleaned and disinfected. This provides an opportunity to relieve rigor mortis and to conduct the preembalming analysis of the condition of the body (including the presence of any scars, incisions or decubiti). The body is then placed in the supine anatomical position, as previously outlined, using positioning devices as supports.

Unless specific instructions from the medical facility prohibit feature setting, the mouth and eyes are then closed. The type of mouth closure is determined by presonal preference. Eye caps are usually used for convenience, but also because they retain, a more natural contour of the eye over a longer period of time and prevent further dehydration.

Injection site(s)

Once this has been completed, the site(s) for injection can be selected and prepared. Again, while it is often necessary to use multi-point injection, most cases will warrant the use of the right common carotid artery. The artery is advantageous because it is proximal to the heart as the center of circulation, it typically has less sclerosis than other vessels, and it is recommended when blood clotting is likely to be present. A restricted cervical injection is also helpful in reducing hypostasis to the head and face. The use of other injection sites will be determined during the embalming process, or as stipulated and/or directed by the medical facility.

Embalming solution

Preparation of the embalming solution is the next important step. Due to the special requirements of embalming the anatomical donor, it is recommended that the fluid mixture be prepared one gallon at a time. It is often useful to begin with 16 ounces of an anti-coagulant fluid containing no formaldehyde or other preserving agents. This preinjection will facilitate the removal of any coagula which may interfere with fluid distribution and diffusion. Injection begins by inserting the cannula in the right common carotid artery, directed towards the heart. Utilizing restricted cervical injection, a cannula is also inserted towards the head in both the right and left common carotid arteries. Depending on the postmortem interval, it may be necessary to inject an additional gallon of preinjection solution.

Drainage

While it has been mentioned that most medical facilities do not desire drainage, experience has proven that better results may be obtained using controlled restricted drainage. This can be accomplished using a jugular drain tube that allows closure of the vessel for fluid distribution and tissue distention. The jugular drain tube also will help with removing clots that may have formed and/or collected in the right atrium of the heart. Since most donors will require the injection of two gallons of anti-coagulant solution, drainage is used only during the second gallon injection.

The major arterial solution is then prepared for injection. It is now time to use a preserving chemical. In order to prevent possible formaldehyde exposure at the medical facility, it is recommenced that a formaldehyde-free embalming chemical be used. If that is not possible, then a 28 to 32 index fluid is suitable.

Again, the fluid is mixed a gallon at a time, using 16 ounces of embalming fluid per gallon of water. Embalming fluids that contain cosmetic dyes will be helpful to identify distribution complications. The rule of thumb for embalming dictates the use of one gallon of fluid for every 50 pounds of body weight. However, given the special considerations that have been discussed, most anatomical donors will be injected with a minimum of four to six total gallons of fluid (including the preinjection fluid).

Of course, this could cause extensive purge and distention of all tissues, but it is desirable to ensure adequate disinfection and preservation of the remains for a long period of time. If poor distribution is noted in any portion of the body, it is necessary to use other injection sites. Hypodermic injection of the arterial solution is often used as a supplemental method for treating areas such as the palms of the hands, fingers, soles of the feet, toes, thoracic and abdominal cavities.

Completion

After the completion of the injection process, all vessels should be ligated, incisions should be sealed and sutured, and the remains must be bathed and dried completely. Since moisture may increase microbial and fungal growth, it is important to dry the donor completely before placing in a refrigeration or storage unit.

Identification of donors is very important. The use of an identification bracelet will reduce the risk of problems at a later date. Again, you need to realize that a cadaver may be stored and dissected over an extended period of time. Each bracelet should list an appropriate identification number and at least the date of death. Placement of the bracelet is also an important factor. The bracelet needs to be out of the way of primary dissection, in an area that will not restrict fluid distribution, and in a location that is approved by the medical facility. Through experience, the right ankle area seems to be the ideal location.

A thorough embalming report should be completed and sent with all of the necessary paperwork and forms that are requested by the medical facility. Information on the identification bracelet should correspond with the paperwork. It is important to keep a photocopy of all documents for your records and funeral home files.

Embalming for the anatomical donor is unlike what many individuals learned in mortuary school. Conditions such as purge that normally would be avoided become necessary when consideration is given to the expansion of viscera for dissection purposes. With a few modifications to the normal procedures, the embalmer can provide a valuable service to the family and also contribute to the further advancement of medical science.

Cydney Griffith is an assistant professor and program director in the mortuary science and funeral service department of Southern Illinois University at Carbondale, Carbondale, IL.

Stephen Smith is a teaching assistant in the mortuary science and funeral service department of Southern Illinois University at Carbondale Carbondale, IL.

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Updated August 29, 2000 by Webmaster