University of Utah Body Donor Program
Student Donor Use and Disclosure Form
The University of Utah Body Donor Program is committed to honoring the life of each donor and
the donor’s family. This gift should be treated with the utmost respect and dignity. It is
important that each individual appreciate the opportunity afforded them and strictly observe
the policies outlined in this disclosure. These policies have been created to promote respect for
the donor and the success for your learning.
Please read the following statements and initial in the respective boxes to signify your
compliance and comprehension of the policies.
I understand that my access to human anatomical material is a privilege, and all donations
have been made by consenting individuals and/or families in support of education, research,
and the training of medical professionals.
I understand that it is my responsibility to comply with the established policies of the Body
Donor Program and additional laboratory policies outlined in the course syllabus or training
objectives and guidelines.
I understand the failure to comply with the established policies regarding human
anatomical materials may result in the disciplinary actions on the part of the program and
educational institution as they determine appropriate and may impact my ability to fulfill the
requirements of the institution, course, and lab.
I verify that to the best of my knowledge; I do not know of any whole-body donor who has
died in the past two years. If a donor is known, please leave box empty and fill in donor’s name:
Print Donor Name: _______________________________________
I have read and understand the Body Donation Program laboratory policies on the reverse
side of this page and that compliance with all policies is mandatory.
Please see reverse side
Revised 05/08/2023.
University of Utah Body Donor Program Laboratory Policies
1. No cell phones and/or cameras allowed in the laboratory. Videotaping or photographing the
human anatomical material is strictly prohibited without prior consent from the Director of the
Body Donor Program, including but not limited to any images which will be published,
distributed, or shared in any public forum. Any photos used in anatomy coursework are not to be
shared or disseminated by learners.
2. Disrespectful language, improper handling, or any other behavior deemed inappropriate
regarding the donor or dissection process will not be allowed or tolerated. Both conversational
and written language relating to the donor and donor dissection by a learner must be respectful
and discrete. Any information about the donor’s demographical or medical history is for course
use only and learners are not at liberty to disclose this information.
3. Learners shall track all human anatomical material by keeping the donor’s ID tag with the donor.
If this tag should become dissociated from the donor, the Lab staff should be notified
immediately. All tissue removed from the donor during dissection must be retained, identified
with the donor’s ID number, and accounted for. An approved receptacle is provided by lab staff,
for the storage of any removed or dissected donor tissue. There should be NO co-mingling of
tissue from different donors under any circumstances. Any dissected tissues on the dissection
table, floor or other areas should be collected and placed in the appropriate receptacle.
4. It is expected of the learner to maintain integrity of the donor material when in use, including
the use of wetting solution to prevent desiccation, draping the donor or donor parts with the
shroud when not actively in use and ensuring the donor is stored appropriately in donor bag and
the receptacle fully closed.
5. Anatomical materials must NOT be removed from the anatomy laboratory and/or facility.
6. Unauthorized access to the lab or course content is not permitted. There is a, NO VISITOR policy.
If a learner or visitor is not part of the program, they are not permitted to view the donors, be
within the dissection laboratory space, or view course content.
7. The use of the Internet in general, and social media outlets, including but not limited to
Facebook, Instagram, or Twitter, by learners as a venue for discussing any personal aspect of the
donor or donor dissection is strictly prohibited.
8. Proper attire must be always worn during anatomical learning activities as your lab instructor
deems necessary.
9. It is expected that all learners are familiar and abide by their institution’s Student Handbook.
10. Non-compliance with the above policies my result in a learner being immediately removed from
the lab and referred for further disciplinary actions as deemed appropriate by the institution.
This disclosure form must be signed, dated, and returned to the course director before access to the lab
or donors is granted.
Benson Thomas
Print Name:
Signature:
Revised 08/08/2023.
Date: