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Donating one's body to science

I'm working in the skilled nursing unit of a retirement community. A few residents have mentioned that they want to donate their body to science after they die. Can you tell me more about this practice? Can people donate their body to science if they also want to be an organ donor?-B.K., PA.

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Some people want to feel that they're making the world a better place, even in their death. Organs, tissues, or other specimens from donated bodies may be sent to researchers studying diseases or drugs, or bodies may be used for anatomical dissections for medical students or to teach advanced techniques to surgeons. People wishing to donate can preregister, or their legal next of kin or healthcare power of attorney can ask to make a donation at the time of their death.


If someone is an organ donor, those donations take precedence over a whole-body donation to science because an organ donation could save or improve a life. The exceptions are eye or cornea donations, which never preclude whole-body donation. After other organs are harvested for donation, the rest of the body can sometimes be donated to science. Having a disease doesn't usually rule out a donation unless it's an infectious disease such as HIV/AIDS or hepatitis B virus infection.


Donating one's body doesn't cost the donor anything, but it will save the family some expense. The organization handling the donation pays for the cost of transporting the body, cremating it after it's served its purpose, filing the death certificate, and returning the cremated remains or sometimes, scattering the cremains into the ocean. Generally the cremains are returned within 4 to 12 weeks.


Although universal or whole-body donation is generally legal, people who wish to leave their bodies to science should check the medical donation laws in their jurisdiction to be certain. Because it's illegal for anyone to sell a body, the donor and family can't receive a payment for the donation including payment for the memorial service, burial, or marker.


Sources: MEDCURE.; The Living Bank. Whole body donation.



Beyond the nurse's scope of practice?

As an RN, I'm required to enter many orders in the computer system for physicians. The system we use requires the person entering the order to associate it with a medical diagnosis. A single diagnosis can have many ICD-10 codes, and I don't believe that choosing one is within my scope of practice. If I'm placing this diagnosis in the patient's medical record, am I practicing medicine without a license?-G.G., VA.


The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a system used to classify and code all diagnoses, symptoms, and procedures recorded in conjunction with hospital care in the United States.1 The assessment and formulation of a medical diagnosis in the medical record must be made by an independent licensed provider (ILP), such as a physician or advanced practice nurse, and falls outside the scope of practice for an LPN or RN.


If an ILP has already made a diagnosis and you're merely associating a treatment or billable activity with that diagnosis or one of the diagnoses already entered for this visit/admission, you aren't "diagnosing" in the sense of practicing medicine. However, if you're entering a code for a new diagnosis that hasn't been made by an ILP, you may be practicing medicine, which is clearly outside your scope of practice.


The important takeaway is to have the ILP enter an admitting, working, or provisional diagnosis for coding purposes. This protective action will help you to avoid the dangers of practicing beyond the scope of your license. If the ILP isn't entering any diagnosis for coding purposes, discuss this with your unit manager.



1. TechTarget Network. ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification). [Context Link]



Dialing up the service

I teach community health nursing at a long-term-care (LTC) facility. Recently I phoned a physician's answering service at the request of a busy clinical nurse. My intent was to make a nonurgent request for the physician to call the family at his convenience to discuss the patient's condition now that the patient was back in the facility after a hospital stay. But the operator refused to take a message because the service "takes calls only from nurses employed by the LTC facility." I explained my role and that I was authorized and encouraged to make nonurgent calls for the staff. Again, the operator refused to take any message from me.


Is it acceptable for an operator to decide what messages to pass along to the physician?-J.M., IOWA


This situation requires a few actions. First, you need to inform the LTC facility that you couldn't pass along the message from the family, and request that a clinical nurse transmit the message. Get the name of a specific nurse if possible. Then inform the family that you couldn't pass along their message and why, and give them the name of the nurse who will follow through.


Consider asking to speak on the phone or meet directly with either the physician or the practice's office manager during business hours about the experience with the answering service. They may not realize this is even an issue. Give them the opportunity to explain their approach and go from there. If that's their stance, it's unreasonably cumbersome for no good reason. If they're sticking with it, you might tell them that you'll be sure to let staff, patients, and families know of their policies so that they can engage with them directly. Who knows how many calls that might generate to the physician!