Gift of Body Donation Form

Gift of Body Donation Form
Thank you very much for expressing interest in donating your body to Washington University School of Medicine in
St. Louis. Attached is the form by which this can be done. This form must be completed in its entirety. You may
make additional copies of this information sheet and the donor form for your family member(s) (or other individuals
responsible for your remains). Because documents such as wills are not often read until after final disposition of the
body, you should inform your family member(s), relatives, physicians or attorney of this donation in order for the
responsible party to carry out your wishes. The following information is provided to assist you in your decision:
We require the information be: a) typed or printed legibly, b) signed by you in the presence of two (2)
witnesses, and c) signed by those two witnesses (who must be over the age of 18).
Your body must be brought to us unautopsied and unembalmed. You should have your Funeral Director call
the Department of Anatomy at 314-362-3597 or 1-855-502-7894 to arrange for the delivery of your body.
There is no fee to donate your body to Washington University. However, Funeral Directors and Transporters
charge for the services they provide. We recommend you inquire about these charges prior to authorizing
someone to transport your body.
It is helpful if you provide a brief medical history, which you prepare yourself, including any illnesses, broken
bones, surgeries (and, for women, number of children) and the approximate dates when these events
occurred. This information can be most useful in helping students understand the anatomy.
After your body has been received by Washington University School of Medicine, no further information will be made
available concerning the use or final disposition of your remains. Historically, bodies donated to Washington
University are cremated. The cremated remains are not returned to the family. They are scattered in a pastoral
setting on property owned by the University which can be visited by family and friends. Because of the diversity of
the individual donors, memorialization is left up to the families of each donor.
Not all registered donors are acceptable donors at the time of their death. Washington University reserves
the right to refuse a body after death. Reasons for such refusal include (but may not be limited to): A) Whether or
not an autopsy has been performed or organs have been donated – (organs, other than eyes, may not be removed
after your death for transplantation purposes). B) Communicable disease or infection, such as HIV-AIDS, Hepatitis B
& C, MRSA, or extensive damage to the body, C) Suicide and D) Obesity. You are advised to have an alternate plan
in the event your body cannot be accepted.
If, after reviewing these instructions, you wish to donate your body to the School of Medicine, please fill out the
donor form, make copies, and return the original “School Copy” of the form with original signatures to the
Department of Anatomy at the address below. If you have any questions, please do not hesitate to contact us at
314-362-3597 or 1-855-502-7894 (toll free).
Body Donor Program
Washington University School of Medicine
Department of Anatomy and Neurobiology
660 South Euclid Avenue, Campus Box 8108
St. Louis, Missouri 63110-1093
October 2013
Gift of Body To Washington University School of Medicine
Mr. 
Mrs. 
Ms. 
City, State, Zip:
Date of Birth:
Social Security Number:
Place of Birth:
Marital Status:
Single 
Widowed 
Married 
Divorced 
Member of the Armed Services:
Father's Name
Mother's Name
No 
I, (please print your name)
the undersigned, being a person of sound mind and eighteen (18) years of age or over, pursuant to the provisions of the Uniform
Anatomical Gift Act, hereby make a gift of my body immediately after my death, to Washington University School of Medicine, or with the
approval of the Chairman of the Department of Anatomy at Washington University School of Medicine, to any other accredited Medical or
Dental School, College or University, within or outside of the State of Missouri, for teaching and advancement of medical science. (This
includes anatomical study, teaching, or autopsy or any combination of these at the sole discretion of the Anatomy Department). I hereby
direct that my body, unautopsied and unembalmed, be delivered to said Department of Anatomy at Washington University in St. Louis,
after my death. This is my free act and deed and not my last will and testament and is not intended to revoke, change, alter or cancel or in
any other manner whatsoever, affect any will made by me during my lifetime, nor shall any will made by me be construed to revoke or
alter this gift unless expressly so stated therein. I understand that my body will NOT be returned for burial or cremation, nor any
information about the use or final disposition of the body will be provided once the body has been received by Washington University
School of Medicine. I further agree to hold Washington University harmless against any liability arising from the use or disposition of said
Washington University School of Medicine reserves the right to refuse admission to the Body Donor Program or to refuse any body at the
time of death. Possible reasons for refusal include, but are not limited to: communicable diseases such as AIDS, Hepatitis B & C, MRSA,
Extensive damage due to accident, Suicide, Extreme obesity, etc.
You should have alternate plans for burial or cremation in the event that your body cannot be accepted.
The undersigned being persons of more than eighteen (18) years of age acknowledge and certify to the fact that they both witnessed the
execution of the foregoing Gift of Body by the donor on the date first hereinabove written:
1. Witness Signature:
2. Witness Signature:
Return this form to:
Washington University School of Medicine, Dept. of Anatomy & Neurobiology, 660 South Euclid, Box 8108, St. Louis, MO 63110-1093
Any questions, contact the Body Donation Program at: Phone - 1-855-502-7894 (toll free) or Fax - (314) 362-3446
October 2013
Return this copy to Washington University
School's Copy