While confronting our passing is never going to be easy, a surprising number of people are willing to look beyond the fear and sorrow - and see the gift they can bestow. Story by Lerae Rowney.

While death is an inevitable part of life - the last great unknown - in the main it is considered taboo, often regarded as bad luck to raise as a topic of discussion, even in hushed, reverent and regretful tones. Like the pink elephant in the corner of the room, we all know it's there, but we avoid eye contact with it, or asking anyone else if they can see it.

Death often forces both the living and dying to confront myriad issues including pain, loss, grief, faith, spirituality, regrets, and yes, even finances. But while most of us still shy away from the subject because of the fear it instils in us, there are many others who are prepared to confront their mortality, at least in this earthly cycle of life. These are the donors - those who want to help others directly through organ donation, or humanity in general through donating their whole body to science. Surely, they would argue, this is the ultimate gift we can offer humankind.

The most common reasons cited for wanting to donate one's body (whether erroneous or not) are:

• Being of benefit to science through education and research - the humanist approach
• Creating a positive (education) out of a negative (death)
• Being against vivisection or testing of laboratory animals
• Being proactive in death as you may be in life, or just to be "different"
• Environmental concerns regarding burial and cremation
• Not wanting the "fuss" of a "normal" or "typical" funeral, whether to spare family from difficult decisions or unnecessary grief or even, pragmatically, that it saves you or your family the cost of burial or cremation.

A word of warning: if you thought you could donate whatever organs and tissues that could be useful for transplant and then "leave the rest to science", think again. You can be an organ donor or a body donor, but not both. Surprised? So was I.

Most of Australia's states and territories have at least one body donation (or bequest) program, and all are operated by the medical faculties within universities. Several more universities without such medical programs are licensed to receive cadavers for the teaching of anatomy and human biology to health professionals.

So how do you register here in Australia, and what happens after your death? What are you actually consenting to? What rights does your family have? And will your body even be deemed suitable? The following is a general guide only, as each state and territory has its own Anatomy Act (more on this later), and each donation program differs slightly.

Practicalities versus Realities
All body bequest programs in Australia share a few commonalities. Your body:

1. Must be whole - with no organs or tissue removed (except, in most circumstances, the corneas) for donation, or amputation. "Routine" organ removal (eg tonsils, appendix, gall bladder) is fine
2. Must not have undergone autopsy or embalming
3. Must not have had a recent operation
4. Must not be obese or emaciated
5. Must not have been significantly altered by medical conditions or procedures In addition, you will be rejected if you have certain communicable diseases including Creutzfeld Jacob Disease (Mad Cow), widespread cancer, jaundice or dementia, or have any conditions that would prevent effective embalming. Clearly, as very few young people die of natural causes and are therefore autopsied to find the cause of death, almost without exception, accepted bodies are those of elderly people.

The reason an autopsied cadaver cannot be accepted is that during autopsy, the main blood vessels are severed, preventing the embalming fluid from accessing all body tissues. This fluid - which is mainly formaldehyde to "fix" the body tissues and prevent decomposition, and phenol as a mould retardant - is normally gravity fed into a major artery, allowing it to flow through the entire circulatory system and into the tissues.

By contrast, plastination, replaces the natural body fluids with polymer (either rubber or epoxy resin). Invented by German anatomist Gunter von Hagens, plastination has many health and educational benefits. The specimens are safer and easier to handle as they are completely dry and there are no chemical fumes, and gloves need not be worn. More detail can be seen and felt as specimens can be freely touched and handled.

You may be familiar with von Hagens' travelling exhibition, Body Worlds - The Anatomical Exhibition of Real Human Bodies, which graphically and controversially displays partially and fully dissected human bodies.

The time limit for body collection/delivery to a university varies. Generally, it is between 24 and 72 hours after death. Participating universities pay for collection in the metropolitan area, though this may be deemed a 40km radius in some programs and up to 100km in others.

So does the university have carte blanche over your physical remains, or can you stipulate what can and can't be done? While consent is usually generalised as "dissection and retention for teaching purposes", most programs allow you to specify some restrictions. Your anonymity is assured, along with respect and dignity, by all programs.

All human tissue, even that not used, is labelled and preserved or frozen so eventually all of the donor can be buried or cremated (that's the donor's choice) together - except any percentage that may, by law, be kept indefinitely unless you stipulate otherwise.

Following your death, your family and friends can still hold a memorial service for you just like a "normal" funeral, simply minus your body. Most bequest programs offer a regular donor memorial service (some yearly, others every two or three years). Generally, except in the case of a few universities offering a choice of two programs, your remains are not returned to your family. They need to realise, and so do you, that when you are accepted by a program, it effectively is the end of any physical contact by those you love with your remains.

Your next of kin will, of course, be notified of your burial or cremation in due course, but this will not be for several years. The university pays for a simple burial or cremation, and some programs will allow donor ashes to be released to the family.

Dissecting the Benefits
Gary Whittaker, an anatomist and plastinator with 20 years of experience, says the educational benefits of being able to prepare and study human specimens are immensely valuable.

Dissection and preservation of an embalmed cadaver takes several weeks, and usually months, to complete. While plastination takes far longer, both processes involve a great deal of care, skill and respect.

Plastination is gaining support in Australia, though Whittaker concedes the scope is far from ideal as the industry here cannot process a whole body, and the time and effort required is somewhat undermined by the short time limits imposed on universities for the retention of human remains (usually between three and eight years). "Many students primarily learn their anatomy from already dissected material, which has been prepared by staff or experienced anatomists. Only a small number of students have the opportunity to dissect, and only staff and students are allowed to view specimens and procedures," says Whittaker. "Staff and students take a great deal of pride in their work. It's almost an art. It seems bizarre to call it that but good dissection enhances students' learning. And it's no easy feat."

Neither is tiptoeing through the minefield of legal, moral and ethical issues, particularly regarding consent. Does Whittaker agree that consent forms could and should be more specific? "Absolutely, because at the moment the consent is specifically for having your body used for educational purposes, but does this extend to display, to being photographed, to being taken across your state borders? It's a grey area. "Also, many people want to be an organ donor and body donor, but this simply isn't possible now."

Whittaker agrees current restrictive regulations create a Catch 22 scenario: yes, they protect specimens from being gawked at by Joe Public, yet being open and transparent would encourage more donations and debunk urban myths regarding what goes on behind laboratory doors. And with student numbers in anatomy courses increasing dramatically, obviously more specimens would be helpful.

He suggests public "open days" to demystify the process, but realises this is a difficult area in terms of current consent and privacy issues. At the very least, Whittaker advocates tours of facilities for registered donors. But with each state and territory having its own Anatomy Act, any consensus or expansion of current laws seems unlikely.

A national Act and program, coordinated through Medicare (since we all have to be registered with Medicare, and it is this body that manages the Australian Donor Register) seems the logical way forward, yet our (until recently) Federal Health Minister Tony Abbott had not responded to such calls from within the science and medical communities. "Certainly a national Anatomy Act would benefit all concerned. Currently, each time a state or territory modifies its Act, it becomes even more unique - not unifying the states at all," says Whittaker.

So Be Prepared
Study closely the programs offered in your state or territory. Choose a body bequest program and register. Tell your family and friends, and your GP. Keep a signed copy of your body donation agreement (consent form) with your will. All body bequest programs can only assess your suitability after your death, so make a contingency plan in case your body is deemed unsuitable, so that your loved ones know how and where you wish to be buried or cremated. In other words, prepare for donation but plan your funeral, too. You may also wish to opt for organ donation in the event your body is deemed unsuitable. Or, if your preference is organ donation, you may like to register for body donation should you not be suitable for organ or tissue retrieval. At the end of this life, may we all have lived well, made each day count, and then died well - or, at least, well prepared.

The Gift of Life
According to Medicare Australia, the Federal Government department that manages organ and tissue donation, more than 30,000 Australians have been donor recipients in the past 60 years. Organs that can be donated include the heart, kidneys, lungs, liver and pancreas. Tissues suitable for donation include eye (corneas), bone, skin and heart valves.

Please note that whereas previously, in order to register as an organ donor, you simply had to tick the requisite box on your driver's licence renewal form and "Organ Donor" would be printed on your new licence, donors are now are required to fill in and sign the appropriate Medicare form in the back of the Australian Organ Donor Register booklet (Sign on to save lives) and lodge it with Medicare. You will then be issued with a Donor Card, which you should keep in your wallet or purse. For a copy of the booklet, pop into any Medicare centre, phone 1800 777 203, log onto www.medicareaustralia.gov.au or email aodr@midicareaustralia.gov.au

There are several specific organ and tissue donor programs operating in Australia, but it is vital that you register your consent to be an organ and/or tissue donor on the Australian Organ Donor Register as it is the only national register.

While it's actually quite rare that our organs and tissues are viable for transplant, unless we die in an intensive care unit (as organs must be harvested while the blood is still circulating), organs may still be suitable for medical research.

Anything but Green
Sadly, if you think donating your body is a green option, think again. Eventually, your remains will be buried or cremated - with all the inherent problems including chemicals from the embalming fluid and coffin veneer leaching into the soil and water table, or being released in toxic smoke from cremation ovens. You can read Vanessa Murray's excellent article, "Pushing up Daisies" on the NOVA website for an overview of the terrible ecological cost of "traditional" burials and cremations, and eco-friendly alternatives: See www.novamagazine.com.au and follow the link to articles (Past Issues 2006, 13.4).