Joe Smolenski: Well Gwendolyn, thank you for joining us. And this has been an episode that I’ve been looking forward to. It matches really well with one of the other episode guests that we had last week, related to tissue and organ donation.

And so for the families that we’re serving, I just think to get information out to make better decisions, these two items really work well together. But before we even get there, can you tell me more about yourself? What led you into working with Duke and specifically getting into the anatomical gifts program?

Gwendolyn Keith: Thank you. Thank you, Joe, for having me here on this show, but, I can start out by saying my background. I am a therapeutic coach and counselor. I work with people going through loss, transitions and assist people moving on in their life. And so, it’s not necessarily a field specifically with body donation that I ever expected to go into, but my family has a deep background in, in medicine and in education. And a number of my family members have chosen to donate theeir bodies, and I’ve assisted with those donations. Including grandparents, a sister who went through a bone marrow STEM cell transplant that didn’t work.

So I’ve been intimately involved in people’s decisions and also the process of donation. And in my professional work, working with grief is, is a tremendous journey. And I think you, in, in any kind of bereavement and funeral business, understand that, and people would really like to have meaning associated with their deaths, you know, but what can be meaningful?

So, I was actually recruited for the job and felt really honored because it’s, it’s a very sensitive decision for families.

Joe Smolenski: Do you meet with the families?

Gwendolyn Keith: So I, I do, I meet with families. I also work, I work primarily over the phone because a lot of our, the process happens in the moment and we have to make very quick decisions  But yes, I do. I meet. Except for during this time time right now. Yes, I oftentimes meet with families in the hospital. I meet with families prior. I meet with a lot of the donors. So I’ve met, I work with people who are considering the donation and they want to know, “Well, how do I do it? And what does it mean for me to do this and what’s going to happen?”

So that’s a lot of my role.

Joe Smolenski: And what did you do prior to working with the anatomical gifts program?

Gwendolyn Keith: I am a therapeutic life coach. So while I’m not a licensed counselor, I work with people in how they want to create their lives, how they want to move on from difficulties loss of a child, loss of a loved one, divorce, grief, terminal illnesses, different things.

Joe Smolenski: I understand. I mean, a lot of people need just some guidance, you know, they don’t know where to turn. I think that’s valuable. So it, it definitely ties into what, what you’re doing and, and what we’re doing here.

My first question here to start is, what are the reasons that people donate their body?

Gwendolyn Keith: Well, there are many reasons.  As I mentioned prior, people want to have meaning in their death as well as in their life. And so for some people, just because they want their body not just to be buried in the ground or they, they would like there to be some use of their body that they’ve left. And a lot of people that we work with have had a significant illness or condition that they’d also like people to learn more about so that other people may be able to benefit from that knowledge. There are other families sometimes that they know that their family member would want something more meaningful to happen, but the family member themselves didn’t make the arrangements prior.

And so we do work with families who said, “You know, my mom always wanted to, you know, help somebody who was suffering with this, and we just think that this is something she would want to do.” So we, we primarily work with people who have actually made that decision themselves, but we also work with families who, somebody who has healthcare power of attorney who says, “Well, my mother gave me this. She said I could decide what to do, and our family has decided that this is something that she would feel good about.” So there are all sorts of reasons.

Joe Smolenski: And you mentioned that donating their body is benefiting the school and some research and study, can you explain how it benefits the school?

Gwendolyn Keith: No, absolutely. So in the history of medicine, doctors have needed some way to learn about the human body. We ask for people to make that choice themselves, because there’s no other way to learn anatomy that is so in depth and so intimate. It’s hands on learning.

The other one thing that students get to learn is how disease presents itself.

So otherwise, you can’t really see that and read that in a book until you’ve seen how a cancer does affect the body and affect the organs. And until you’ve seen how disease like scleroderma or Parkinson’s or other, other diseases, how they affect the body and what that looks like, how that presents, how it develops over time, how it affects different organs, and so this is an opportunity for students to see that,  just really be able to go into it where as it would be too invasive for, for somebody who is alive with that. The other opportunities for learning are to experiment with different techniques of trying to correct a problem. And so trying new surgical techniques, trying new orthopedic techniques, trying new different ways to help people have better lives and create less pain, more comfort, more opportunities to correct things that have developed over time or were genetic.

So that’s a big reason. And there is some research that happens, but post-mortem research is a little different.  So there, there are all sorts of things that happen that are deep learning for both professionals at the beginning of their careers and also our skilled surgeons and internists and et cetera.

We have all sorts of levels of courses

Joe Smolenski: Can the donors themselves specify how they want their body to be used?

Gwendolyn Keith: Well, not necessarily because it is all for education, but what we do try to do is – our donors are our silent teachers and each of our silent teachers have many gifts that they bring in their teaching.

So we do try to match our teachers with the best courses for them to teach. But, it’s not necessarily something that can be decided because there are many factors in looking and how one of our donors can teach.

Joe Smolenski: What, what are the restrictions, for somebody that does want to be a donor, what are the restrictions as far as maybe age, body size or any diseases before you say “Yes, we will accept you.”

Gwendolyn Keith: Yes. And that’s an excellent question because we can’t even – even though people have made their intention clear, we do have criteria because our donors do need to be safe in our labs and safe for our students.

So, one primary criteria is that there are no infectious diseases or no infectious blood diseases that are persistent after death. So things like hepatitis A, B, or C, which are persistent after death, HIV, right now, COVID-19. We look at also things like sepsis, which is blood poisoning, MRSA, staph infections, VRE, C. diff – things that can occur towards the end of life or at the end of life, that would be dangerous. So we do have to speak with medical professionals to make sure that our donors do not have those, those kinds of conditions. Other situations are, for example, we do need – size is an issue. It’s like being able to fit in an airplane.

We do have very small spaces and we have very small tables. So, unfortunately, we do have height restrictions. We look at height-weight ratios, but we also look at what specific courses are coming up. So sometimes we have a little bit of leeway in our criteria, but that really depends on if there’s an immediate course they would be able to teach.

Joe Smolenski: It sounds as if a donor can be refused after they’ve made the decision. So when they were alive, they wanted to be a donor, but now they’ve passed away.

Their conditions have changed and now they could be refused.

Gwendolyn Keith: That is correct. Yes. Unfortunately, that’s always heartbreaking –

Joe Smolenski: Yeah.

Gwendolyn Keith: For me. And I know –

Joe Smolenski: Oh, yeah.

Gwendolyn Keith: Family members as well.

Joe Smolenski: Yeah, and when families come to the funeral home and requests that they would like to take part in the anatomical gift program, one of the things we always tell them is have a plan B –

Gwendolyn Keith: Yes.

Joe Smolenski: Because though we expect that you will be accepted, there’s always that chance. And instead of having the family stressed out and not knowing what to do, we didn’t think of anything else. Well, we’ve got that in place and that’s something I think is quite important.

Gwendolyn Keith: Yes, and that’s one of the reasons why we ask people to choose a funeral home and choose, choose those things ahead of time, because that is so important.

And the, services of a funeral home extremely important in this time, both in holding our donors’ bodies while we can make those assessments, as well as having those opportunities for the plan B. And then the other thing is the services you provide in filing the death certificates and supporting the families through all of that and with the obituaries so, yes.

Joe Smolenski: Exactly. So the funeral home still plays a role even for the families are accepted, that we are there to also transport at the time, to help with any, possibly any services that might take place, or if the family needed death certificates, like you explained. So in those ways the funeral home is still assisting the donor family for some of the pieces that the program doesn’t take care of. And that’s an important aspect of this discussion is that just because the family’s donating the body to Duke, there still needs to be somebody that is going to, at least – at the very least – transport that body and file the death certificate, but things can actually progress further than that.

But at the very least those two items.

Gwendolyn Keith: Yes, absolutely. And that’s such an important-I can’t tell you how much that means to families as well, to have, have the support of a funeral home to take care of those pieces, especially when they’re grieving, and do it with such compassion as you do, so, yes.

Joe Smolenski: Yeah. And one of the situations that some people may not think about that we might encounter is a death occurring on a holiday or a weekend. And the anatomical gift program may not accept the body until the following day or whenever we can coordinate together, and so that body has to be placed somewhere, preferably. Now, if it’s like a week, like this week where it’s 90 something degrees, we need to store that body in certain conditions, a cool environment. You know, if the funeral home has refrigeration, which most do, that would have to be done without a question. Embalming is not done by the funeral home.

And you can tell them a little bit more on that, but you want the body basically stored by the funeral home and then received in the condition at death. Is that correct?

Gwendolyn Keith: Yes, that is correct. And that is essential, cold storage and yes, our program is not open on weekends and we can’t receive at night either.

So if a death occurs in the evening or at night or early morning, then there still is that necessity of cold storage. So yes, funeral homes play a very important role in that process.

Joe Smolenski: I was going to ask, Gwendolyn, if the heart on the driver’s license, does that have any relation to anatomical donation or is that only for tissue and organ donation?

Gwendolyn Keith: That’s a great question, and people ask me all the time. So no, that is, that does not have anything to do with the full body donation. That is, primarily, the indicator that that person wants to donate tissue or organs and so that’s really important. I think you mentioned it earlier, and what I tell people when they’re trying to make a decision is that to give life to somebody else through an organ donation or tissue donation, that’s an incredible gift. So I say, you know, you need to decide and say, “OK, I prioritize this organ donation or tissue donation. This is my first choice,” because we actually are not able to accept bodies that have made those donations just because, for our purposes, the body does need to be intact. But, there are times when organ and tissue donation is not viable and that can be because of age or because of a certain illness or condition that makes the organs not viable. And so I suggest that people say, “OK, well then I would like to make the full body donation my second choice.” And so it’s important to write that up in your healthcare documents and your will or however you want to present that to your family and legally make that decision. But, yes. That is correct. The heart on your license does not indicate full body donation.

And there’s also, it’s important to look at, if you are writing up a document with a health care power of attorney so that’s somebody else can make medical decisions for you when you’re unable to make those, part of that does include disposition of your body once you’ve passed and if you do want to leave the option for full body donation, if you are not an organ donor, you do need to make sure that your healthcare power of attorney documents do reflect that and other legal documents to reflect that, because you can say that you would like to be a body donor, but if your healthcare documents are contrary to that, we can’t accept.

Joe Smolenski: So in the situation where someone has registered as a donor, and we’re going to get into in a few minutes how to become a donor, but if somebody has preregistered to be a donor and the survivor of the POA, or the next of kin says “I don’t want this to happen,” how is that handled?

Gwendolyn Keith: Well, actually for Duke and in the state of North Carolina, if somebody has signed a donor card, a universal donor card is what they’re called, and we have specific donor cards for Duke and other universities have a donor cards, with your signature and two witness signatures, that actually is a legal document. If it is signed by you and to impartial witnesses, that is a legal document and that is actually takes priority over say if you had some family members saying, “Yes, we want to donate” and other families saying, “No, we don’t.” That document actually is the individual’s choice in decision. So we go by, if that is in place, we will go by that. Now, if there is significant resistance with other family members, it may then also make it so that we can’t accept a donation. We highly recommend that families discuss this with their family.

Joe Smolenski: Oh, asbolutely.

Gwendolyn Keith: But, that is a legal document, yeah.

Joe Smolenski: Okay.

And it’s, it’s considered a disposition. Is that correct?

Gwendolyn Keith: Body, yes.

Joe Smolenski: And by, by the state of North Carolina it itself is considered a disposition just like burial is or cremation, anatomical donation is another form. And once the school is complete with their research and study, is the body cremated or buried afterwards? Or how is that handled?

Gwendolyn Keith: That’s a, that’s a great question. We actually do cremate. We contract and have our silent teachers are cremated

Joe Smolenski: Is that the only option?

Gwendolyn Keith: Well, we have made some special arrangements with some families we have tried to, honor different religious beliefs, too. So there, there have been times when we have, the donors have had a burial after, yes.

Joe Smolenski: OK.

Gwendolyn Keith: But primarily because of logistics it’s best often to have it – we do the cremation

Joe Smolenski: And that’s, yeah. That’s all I’ve ever known is, with Duke ,or any other anatomical gift programs that cremation, I think every time 99 –  probably a hundred percent, for us, in my experience, has been cremation afterward. And then the family can have the cremated remains sent to their home or to the funeral home to receive them, and then it’s up to the family at that point to do what they would like to do. But –

Gwendolyn Keith: Yes.

Joe Smolenski: But it’s nice to know that in some, some instances that burial might be an option that that’s really good to know,

Gwendolyn Keith: And then we also, we do, as you said, we do, return ashes to the family. We either mail them or they can come pick them up.

Or we also have a scatter site at Duke forest.

Joe Smolenski: Is there any tax or financial benefit by donating our body? The donor? To the donor’s family?

Gwendolyn Keith: There, there’s no – no, there’s no financial benefit specifically. It can be lower cost than a full funeral, but there is no financial compensation, any way, for a body donation.

Joe Smolenski: And how soon after the donation is the body used by the school? So if the donor passed away, let’s say in the beginning of July, when might the body be used and what is it, what does that depend – on what type of a schedule or what’s your experience?

Gwendolyn Keith: Well, we say between two weeks and two years,

So it really depends when, when you pass and what, what classes are available for you to teach. We generally don’t keep our donors past a year. However, there are times for example, this year we may not be having as many courses and we definitely have not been having as many courses.

So it may be, we may be waiting longer, but  two years is the maximum. So that can be, that’s something to consider for families if they don’t want to have that waiting period. We usually can’t accelerate that timeline for people.

Joe Smolenski: I understand. And the sum of that timeline has to do with, how many recipients there have been, or donors I should say, to the school, if there’s a shortfall or an abundance at a certain time, is that part of that spectrum of time too?

Gwendolyn Keith: That, that can definitely play into it. Because we have so much learning going on at Duke, generally we – it’s more about matching the right teachers to the right courses.

Joe Smolenski: I see.  Can you explain the process, once the school is complete with the study of the body, what happens at that point? Is, is the family notified or is it then the cremation is scheduled and then the family is notified. How does that work?

Gwendolyn Keith: Generally, I notify families once our cremation is scheduled and I know more when I might be receiving the ashes

Joe Smolenski: And, does anatomical donation affect funeral services in any way that you know? From my experience, it’s simply that with, let’s say cremation since that’s nearly a hundred percent of the time that the school is performing the cremation after the study, that the only way it really is affecting is that if the family chooses to have a memorial service prior to getting those cremated remains, or they can simply wait until after it’s received, but it would just be that unknown time frame where we’re either waiting or deciding not to wait for the cremated remains.

But in that sense, that is really the only way it’s affecting services on our end.

Gwendolyn Keith: Sure. Well, there’s several, several ways. That’s right on your end. We do try to accommodate. There are, on occasion, families do want to have a service with the body, at the time of death . We ask for that, if that’s something they want, we have to work very carefully with the funeral home to manage a partial. And so, that’s something that is possible for families. It does need to happen very quickly because we do need to receive the body as, as soon as possible. But that is something, if the family is interested in that, then we encourage the funeral homes to call us, and then I would put you in touch with our specialists.

And in terms of services, oftentimes, people will have a service without the body. Oftentimes they have a Memorial service without the ashes or they wait and some have one before, you know, close to the time of death and then have another one when the ashes are returned.

So there’s all sorts of creative ways that can be accomplished with an anatomical donation.

Joe Smolenski: And, can you explain to people how they can become a donor? What do you suggest?

Gwendolyn Keith: Well, if people are interested in becoming a donor, I recommend they give me a call and I’m happy to talk with people about what that means, what they’d need to put in place to do it.

We can talk about criteria, anything. And I’m happy to speak with family members as well, if they have concerns about the process. But, I think the most important thing – people actually sometimes feel relieved talking about their own deaths. I suspect you, you experienced that all the time. Just knowing that they’re taking care of something for their families, as well as for themselves, making the arrangements ahead of time and really knowing what they need to do.

It’s very helpful. And we do, we, I also can send out packets with our donor cards and a process of what they can expect to be doing and what their family members need to be prepared for, ways that they can prepare.

Joe Smolenski: And your organization, Duke, they have a specific website for the anatomical gifts program and your contact information is there if I’m correct?

Gwendolyn Keith: Yes, that’s right.

Joe Smolenski: So the public can find you there. We will also list in the show notes, a way to get in touch with you as well. And my last question here before we depart is can survivors of the deceased make the decision to donate their loved one’s body after death if, the deceased was not pre-registered?

Gwendolyn Keith: Yes, that is possible with our program. And what that takes is, first, we have to make sure that we’re speaking with next of kin or somebody who legally can make it that decision. So If somebody has healthcare power of attorney, and in those healthcare power of attorney documents there’s nothing that says that the person does not want to make an anatomical donation, as long as that person does have legal right to do that. And we also have to be sure that all family members are on board with that decision.

Joe Smolenski: Right.

Gwendolyn Keith: So, if it’s going to cause major strife in the family, we choose not to accept. But we do need either the next of kin or somebody with healthcare power of attorney to sign some documents.

We also need to speak with other family members to make sure that everybody is in accord. And then again, the donor does need to meet our criteria as well.

Joe Smolenski: Awesome, Gwendolyn. Thank you very much. Much appreciated.

Gwendolyn Keith: Thank you so much.

Joe Smolenski: Actually, you gave me a lot of great information that I didn’t know about with this subject, so very useful, and I know our public will find it useful as well. Again, just thank you for joining us and helping everybody understand more about anatomical donation.

Gwendolyn Keith: No. And thank you for your service as a funeral director, because that is, it’s such an important part of our lives that we don’t think about all the time.

Joe Smolenski: Absolutely not and we’re trying to get more people interested! I don’t know how to do that.

Gwendolyn Keith: People are afraid of their own deaths. It’s so comforting. I’m sure as you, you know, when people have made decisions for themselves and feel more comfortable knowing what, what they can do. So thank you.

Joe Smolenski: Very welcome. Thanks, Gwendolyn.