Donor Information Packet

Transcription

1 Donor Information Packet Thank you for your interest in Cleveland Clinic s. Body donation is a unique opportunity to leave a legacy that will truly have an impact on the future of medicine. As you read through the enclosed materials, you will find helpful information to aid you in making such an important decision. We also encourage you to visit our website at clevelandclinic.org/bodydonation. Of particular interest is the video message from the program s director and stories about our donors. If you decide that body donation is right for you, you can pre register with the program by completing the enclosed two page registration form and returning it to us via one of the methods noted below. Mail: Cleveland Clinic BodyDonation@ccf.org Fax: After we receive the completed form, it will be processed and an acknowledgement letter and donor cards will be mailed. You can expect to receive the information within a few weeks but if the situation is time sensitive, please let us know and we will provide it immediately. If you have questions, contact the program s administrative office at or at BodyDonation@ccf.org. Office hours are Monday through Friday from 8 a.m. to 5 p.m. We greatly appreciate your consideration. Enclosures: Answers to FAQs Brochure Registration Form Body Mass Index (BMI) Table

2 Answers to FAQs About the Program How many bodies does the program receive annually? In 2014 we received 168 body donations, and 421 people preregistered with the program. How are bodies used? Bodies are used for various medical education purposes, the advancement of medical science and research for the development of medical products and techniques. Will you make sure my organs go to someone in need? No, we do not handle organ donation. To find out more about organ donation, contact your local organ procurement organization. LifeBanc serves Northeast Ohio and can be reached at Can a body be donated for the study of a specific disease? No, we do not conduct disease-specific studies nor can we accept a body that is designated for such studies. Can the family receive a report specifying how the body was used? No, we do not provide verbal or written reports following studies. Conditions for Acceptance If I have an autopsy, will you accept my body? If the coroner determines that an autopsy is needed for an investigation and you are pre-registered with this program, we can accept the body following the autopsy. If you are not pre-registered with the program, we cannot accept the body. If the autopsy is elective, we cannot accept the body, regardless of registration status. If I donate organs, will you accept my body? If you are pre-registered with this program, the donation of most organs is allowable. The only exclusions are long bones and skin, which must be intact. If you have not pre-registered with this program, we cannot accept the body. Can you accept a body if death was caused by an accident, homicide or suicide? These situations are determined on a case-by-case basis. When Death Occurs What should we do if death occurs at home? If hospice is involved, contact them following the instructions they gave you. They will come to the home to pronounce death and make the proper notifications, including the report to us. If hospice is not involved, call 911. Who contacts the to report the death? Someone who is authorized to contact us, such as a nurse or first responder, should do so. We will obtain the required information and make sure the body is acceptable for donation. If the family contacts us, we will advise them how to proceed. What is the telephone number to report a death? The authorized representative (see above) should call and tell the operator they re calling to report a death for the. The operator will connect them to the appropriate person. Someone from the program is available 24 hours a day, 7 days a week. Survivor Concerns How will the body get to Cleveland Clinic? If death occurs within 100 miles of Cleveland Clinic s main campus (9500 Euclid Ave., ), we will make the transportation arrangements and cover the associated costs. The body will be transported as soon as possible, usually within a few hours depending upon time of day, distance and weather conditions. If death occurs outside the 100-mile range, transportation arrangements and costs are the responsibility of the donor/donor family. You may wish to contact a local funeral home in advance to discuss transportation options. Is there a cost or financial obligation to the survivors with regard to body donation? Cleveland Clinic assumes all costs except when the death occurs outside the 100-mile range, as mentioned above. Do we need the services of a funeral director to handle any portion of the body donation? Only if death occurs outside the 100-mile range, as mentioned above. Can we have a funeral when the body is donated? A traditional funeral is not possible but many families do have a memorial service, without the body present. Can we view the body after it arrives at Cleveland Clinic? No, family and friends must say their final farewells before the body is transported to Cleveland Clinic. How do we get the death certificate? We process the death certificate and then send it to the certifying physician or coroner. Upon completion, it is filed with and obtainable from the health department in the city (or county) where death occurred. How do we place an obituary in the newspaper? To place an obituary, contact the newspaper directly. They will need to verify certain details before the ad is placed. They can contact us, and we will confirm the information for them. Can the obituary acknowledge that the body was donated to the program? Yes. Some suggested language: NAME donated his/her body to the Cleveland Clinic for the advancement of medical science. Does the program accept monetary donations? We appreciatively accept monetary donations in memory of our donors. The donations are deposited into an account that supports the annual memorial service. Please make checks payable to Cleveland Clinic Education Institute and include the donor s name on the subject line. The mailing address is: Cleveland Clinic How do we contact the program? You can contact the program s administrative office at or at BodyDonation@ccf.org. Office hours are Monday through Friday from 8 a.m. to 5 p.m.

3 Annual Memorial Service A memorial service is held annually at Cleveland Clinic s main campus to honor the individuals whose bodies were received by the program during that year. The service usually takes place in May, and an invitation is mailed to each donor s representative about a month in advance. During the service, we celebrate together those who lived their lives with a spirit of generosity and service to others. We offer words of gratitude and remembrance, with the hope that as we celebrate these special people, their legacy will live on. Team Richard L. Drake, PhD Director, Director of Anatomy, Cleveland Clinic Lerner College of Medicine Jennifer M. McBride, PhD Associate Director, Director of Histology, Cleveland Clinic Lerner College of Medicine Lisa Gucwa Administrative Coordinator, Body Donation Program I want to express my sincere gratitude to you and your loved ones. Your loved ones gave us a priceless gift. They gave themselves. They gave themselves to help others by helping us. Through their donation they became our tutors. Sarah, Lerner College Class of 2015 Through selfless generosity, knowledge grows Questions? Please call or us at BodyDonation@ccf.org. Lake View Cemetery's Community Mausoleum clevelandclinic.org/bodydonation Education Institute

4 Why Donate Your Body People have a variety of reasons for wanting to donate their body to medical science. Many people do so because they value education. Often they are educators themselves. They appreciate the education they received when they were younger, and their commitment to paying it forward becomes their legacy. Simplify the Process by Pre-registering By pre-registering with the program, you are taking a practical approach to help ensure that your wishes will be met. You also simplify the process for your survivors. Simply complete the enclosed registration form and return it to us. Upon receipt, we will mail you an acknowledgement letter and donor cards. We will remember your generosity for years to come. Thank you for the gift to our training. Briana, Lerner College Class of 2018 Thank you for the incredible and selfless generosity that you and your loved ones have demonstrated though their donations. These gifts mean so much to us. Rachel, Lerner College Class of 2016 Others donate their bodies to medicine because they value medical care they personally received. For many, it was a treatment that worked, confirmation that medicine is evolving and that we re helping more people now than ever before. For others, it was a treatment that failed, a signal that we need to learn more, work harder. In either case, the value is in the medical breakthroughs that result when education, research and innovative thinking converge. And some are repaying a gift they received years before, having learned their way around the human body through the generosity of another. We cannot thank you and your loved ones enough for your tremendous contribution to our education. Andrew, Lerner College Class of 2017 Through your generosity and sacrifice, we have all been made better physicians. Your gift will benefit our patients for a lifetime. Thank you so much. Jason, Lerner College Class of 2016 Thank you for your lasting contribution to the next generation of physicians. Their gifts will not be forgotten. Rebecca, Lerner College Class of 2018 The human body is marvelous and, yes, mysterious. We may never learn everything there is to know about our bodies or how to treat every ailment that plagues us, but by advancing medical science and through the selfless generosity of donors, knowledge grows. If you pre-register with the program and later change your mind, just contact us. We will update our records to reflect that you have withdrawn from the program and then mail you a letter stating the same. They gave the last thing that they had to give. They paid it forward and so will we. Thank you. Jordan, Lerner College Class of 2017 General Conditions for Acceptance The minimum age for body donation is 18; there is no upper age limit. Prospective donors should pre-register with the program, as mentioned above. However, if someone dies without having pre-registered with the program, it is possible for the next of kin to donate the body. We cannot accept a body when there is: severe trauma (advanced decomposition, serious injury, septic shock) presence of an infectious disease such as hepatitis, HIV/AIDS, Creutzfeldt-Jakob disease, methicillin-resistant Staphylococcus aureus (MRSA) or clostridium difficile (C. diff) extreme obesity (BMI above 39) Other considerations: death must occur within the state of Ohio some limitations exist with regard to autopsy and organ donation (see answers to FAQs) some limitations exist with regard to cause of death (see answers to FAQs) During Our Studies The program maintains a securely locked anatomy laboratory. Bodies are treated with the utmost care and are always handled in a respectful and dignified manner. Studies could take anywhere between several weeks and 18 months. Upon completion, the remains are individually cremated. Cremated Remains When the ashes are ready for final disposition, we mail a notification letter to the donor s representative asking them to contact us regarding their wishes. The cremated remains can either be given to the family or interred in the program s niche at the historic Lake View Cemetery, an option we are pleased to offer, free of charge. The niche is located in the cemetery s Community Mausoleum, and the inscription reads Cleveland Clinic. A memorial stone, located at the mausoleum entrance, acknowledges our donors as well. Following interment, the burial record is accessible on the cemetery s website, and visitors have the option of sharing additional information, memories and photos. The cemetery itself is open to the public every day of the year.

5 Registration Form The information on this form is required for registration purposes and will ultimately be used for the death certificate. Please carefully complete the entire form. If an item is unknown or unobtainable, write that in the space; do not leave blank entries. Please keep your registration current by updating any information that changes. Select Type: New Registration Registration Update Donor s Full Legal Name Address City Number and Street Apartment/Unit or Village/Township State Zip County In City Limits? Yes No Phone Number Address (if applicable) Date of Birth / / Sex Male Female Social Security Number Month Day Year Birthplace City and State or Foreign Country Race (White, Black or African American, American Indian, etc.) Hispanic Origin? Yes No If yes, specify origin Marital Status Never married Married Married but separated Divorced Widowed Spouse s Name (if applicable) (prior to first marriage) Education 8 th grade or less 9 th 12 th, no diploma High School Graduate or GED College, but no degree Associate degree Bachelor s degree Master s degree Doctorate/Professional degree Occupation Business/Industry Type (prior to retirement) Ever Serve in the US Armed Forces? Yes No If yes, specify details Branch Air Force Army Coast Guard Department of Defense Marine Corps Navy Other Entry Date / / Separation/Discharge Date / / Month Day Year Month Day Year Separation/Discharge Type Honorable General Other Than Honorable Bad Conduct Dishonorable Father s Name Mother s Name (prior to first marriage) Next of Kin s Name Relationship Address City Number and Street Apartment/Unit or Village/Township State Zip County Phone Page 1 of 2

6 Disposition of Cremated Remains Upon completion of our studies, which could take anywhere between several weeks and 18 months, the remains are individually cremated. Please specify below your wishes regarding final disposition of the cremated remains. Placed in program s niche at Lake View Cemetery Assumed by next of kin Next of kin should decide when that time comes Health Information This item is optional and not required for registration. If you so wish, you may provide a brief overview of your health history. Donor s Consent I hereby instruct, in the presence of the following witnesses, that it is my desire to donate my body after death to Cleveland Clinic for teaching purposes, scientific research, or for such purposes as the authorized representatives of Cleveland Clinic shall, in their sole discretion, deem advisable. I understand that this form is not used for organ donation purposes and that a copy of this signed statement will be placed on file with Cleveland Clinic. My signature below indicates that the information on this form is accurate and true to the best of my knowledge. Donor s Printed Legal Name Signature Date Witnesses Two witnesses are required; they must be 18 years or older and not affiliated with Cleveland Clinic. Witness #1 can be any person you choose. Witness #2 must be a disinterested witness, meaning someone other than spouse, domestic partner, child, parent, sibling, grandchild, grandparent, or guardian of the individual who makes, amends, revokes, or refuses to make an anatomical gift; or another adult who exhibits special care and concern for the individual. We, the undersigned, have witnessed the signing of this document by the donor. Witness #1 Witness #2 Name Address City/State/Zip Signature Name Address City/State/Zip Signature Return the completed registration form to Cleveland Clinic by mail, or fax. Upon receipt, the form will be processed and the acknowledgement letter/donor cards will be mailed. If you have questions, contact the program s administrative office at BodyDonation@ccf.org or at Mail Cleveland Clinic BodyDonation@ccf.org Fax Do not write in the section below, for office use only. Date Received Date Processed THIS IS A LEGAL DOCUMENT UNDER THE UNIFORM ANATOMICAL GIFT ACT OR SIMILAR LAWS Page 2 of 2 Rev. 10/2016

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