LIAONING, Northeast China — In the anatomy building at Dalian Medical University, there is a scroll from a body donor hanging on the wall. Inscribed with florid calligraphy, it reads: “I’d rather let students try something 20 times on me than see them make one mistake on a future patient.”

It’s a noble sentiment that the young medical students are grateful for, but one that isn’t common in China. 

As many Chinese believe in an afterlife, cultural norms dictate that a deceased person’s body should remain intact, and thus body donation is unpopular. But slowly, norms are changing, and laws are making it easier to donate one’s body to medical research.

In the city of Dalian, a total of 47 people voluntarily donated their bodies in 2016 so that university students could learn from them. Students respectfully call these donors their “silent teachers.”

Xu Fei is a professor in the medical university’s department of anatomy and has led the effort to bring in body donations since 2009. Over the years, he’s gotten to know the stories of many donors. He talks of elderly without family who are thankful for the care they’ve received at the university hospital and want to give something in return, and of those who want to help advance science, like a professor at Dalian University of Technology who was diagnosed with Parkinson’s disease and agreed to donate the entirety of her medical records, bodily tissues, and internal organs specifically for Parkinson’s research.

Over the years, he’s gotten to know the stories of many donors.

He talks of elderly without family who are thankful for the care they’ve received at the university hospital and want to give something in return, and of those who want to help advance science, like a professor at Dalian University of Technology who was diagnosed with Parkinson’s disease and agreed to donate the entirety of her medical records, bodily tissues, and internal organs specifically for Parkinson’s research.

“She went through so much pain and wanted to know exactly what it was that made her disease so hard to cure,” Cong Lin, the professor’s daughter, said. “She didn’t want other people to suffer the pain she suffered.”

Xu said that the donors come from all walks of life — and that their contributions are desperately needed.

China used to allow the organs from executed prisoners to be donated and their bodies given to medical research, which accounted for the bulk of medical universities’ supplies: An estimated 2,400 people were executed per year in 2013 and 2014, according to humanitarian nonprofit Dui Hua.

But using these bodies for medical research was later deemed unethical, and the practice was outlawed in 2015. Voluntary donations from citizens are now the only legal channel through which to obtain the bodies of the deceased. 

For every 1,000 medical students who study anatomy, Dalian Medical University needs a minimum of 70 bodies, Xu told The Paper, Sixth Tone’s sister publication. Universities short on bodies can only apply for assistance from other medical schools. But as almost all institutions face the same supply shortages, the amount of time each student can spend learning from these bodies is limited.

Increasingly, medical schools use computer models to teach anatomy, but many professionals argue that they fall short of real bodies. Xu worries that anatomy classes will be cut even further, leaving medical students without a solid foundation in the subject. “I wouldn’t dare to let them loose on patients,” he said. 

Sometimes, it’s not the lack of people willing to donate their bodies that poses the biggest obstacle, but rather their families’ objections.
Xu remembers the case of an elderly woman who wrote in her will that she wished to donate her body. After she died and was brought to the undertaker, her family made arrangements for her funeral. They kept changing the date they had set for Xu to come and collect the body. Eventually, they just had her body cremated. 

Body donors’ children often struggle the most with their parents’ decision.

The daughter of Dai Bingzhong, a chemical engineer who had studied in the former Soviet Union when he was young, said that she worried about the way friends and family would react to her father’s choice to donate his body, and how it would reflect on herself. 

After retiring, Dai published memoirs of his time abroad and donated Soviet gramophone records and household objects to a museum. “I donated my ideas; I donated my possessions; and finally, I will donate my body,” he wrote. “My life, while not spectacular, was not lived in vain.”

Dalian Medical University features a memorial hall built specifically to honor body and organ donors’ lives and achievements. One of the most prominent exhibits pays tribute to former Chinese leader Deng Xiaoping, who donated his corneas. His wife, Zhuo Lin, donated her entire body when she passed away in 2009.

The history of physicians dissecting cadavers to study human anatomy dates back to the third century B.C., but later, the practice became a cultural taboo for the Romans as well as the medieval Christians and Muslims. In 1032, Japan became the first country to allow certified schools to practice human dissection for the purpose of research.

During the Renaissance in Europe, dissection once again became vital to the study of medicine, and as the art of healing progressed over the centuries, body donations became more and more important for training doctors and surgeons.

But it wasn’t until 1968 that the U.K. drew up a national law on donating one’s body to medical science, with other countries soon following suit.

In the U.S., when residents apply for a driver’s license, they are asked whether they want to be listed as an organ donor; this policy has helped the nation amass 120 million registered organ donors out of a total population of roughly 320 million.

Whole body donations for science, however, are different. Most medical schools won’t accept bodies that have already had organs removed, and becoming a body donor is a more difficult process than signing up to donate organs. Although there are no official figures, experts estimate that fewer than 20,000 Americans donate their bodies each year.

In China, over 229,000 people are registered to become organ donors upon their death, according to the latest statistics from the Red Cross Society of China.

Official nationwide estimates for the number of people who have chosen to donate their bodies to science do not exist. Given the country’s strong cultural taboo and judging from the mere 47 bodies that Dalian — a city of more than 7 million — received last year, the number of body donors in China is likely much lower than that of the U.S.

One of the main reservations people have when it comes to organ donation involves preserving the dignity of one’s own body. But Xu insists that the bodies used at the medical university are treated with respect. 

On Tomb-Sweeping Day, when Chinese people visit the graves of their ancestors, Dalian Medical University students place flowers atop the refrigerators in the laboratory morgue. The memorial ceremony is not organized by the school but by the students themselves, who come to commemorate their silent teachers. This year, the school is also organizing a small memorial service.

Xu’s department has even started a student volunteer group that will visit public parks and squares to help raise awareness of body donation, as well as help to organize body donors’ funerals.

Last year, a number of donors whose bodies had been cremated were buried at sea — a service that the medical school covers. Some of the students attended the ceremony, as it was the last time they would pay respects to their silent teachers. 

Accompanied by the lilting sound of flutes, the boat sailed out to a designated burial area. “When Grandma was young, she always wanted to go to medical school,” a family member told one of the students, who then shared the message via social media app WeChat. “Unfortunately, she never got her wish, but it was her greatest honor to contribute something to medical science after she died,” the relative continued.

Together, family members of the deceased and volunteers from the university scattered the ashes amid the waves.

Others at the burial service also noted the way their family members had contributed to society even after death, and that they will always be remembered. Speaking about his father, one man said, “Every time I go to Dalian Medical University, I feel like our dad is still there.”

A Chinese version of this article first appeared in Sixth Tone’s sister publication, The Paper.

Contributions: Denise Hruby; translator: Matthew Walsh; editor: Denise Hruby.
(Header image: Medical students lay flowers to show respect for their ‘silent teachers’ at Shenzhen University, Guangdong province, March 26, 2012. Huo Jianbin/VCG)