MARYLAND
Department of Health
Larry Hogan, Governor
·
Boyd
K.
Rutherford, II Governor
·
Robert R. Neall, Secretary
STATE ANATOMY BOARD
Maryland’s Anatomical Body Donation Program
This letter is responding to
your personal interest in the State’s Body Donation Program and making an
anatomical gift for the use of your body after death as a Maryland resident. Your interest in this program is
greatly appreciated. The donation is a caring and selfless act that supports the advancement of medical
education, clinical, surgical, trauma and allied health training programs and research study in Maryland and
even beyond our State borders. The State Anatomy Board through the participation and donation by
individual citizens provides an opportunity to advance medical and health sciences objectives throughout
Maryland that positively improves the public’s health and well-being.
Donation of your body at death is an alternative means of body disposition to burial and cremation and
would come without cost to the family or estate. The information required to be completed on the form is
needed to complete the Certificate of Death. Once the pre-death donation is received by the Board, it will
remain active unless cancelled by the donor. The donor, by properly executing the anatomical gift, grants
the Anatomy Board the legal and exclusive right to the custody, control and study use of the donated body
following death. A donor may also be an organ-tissue donor and there is no conflict with either donation.
The authority for organ-tissue donation, autopsy or post-mortem examination rests with the Board. When a
Maryland donor dies in-state, the expenses related to transportation, preparation, cremation and state
disposition is borne by the Board’s State Appropriation. Following the study use and cremation of the
body, the donor cremated remains can be released to the named individual on the donor form for private
disposition.
Upon receiving the donor body following death, the board has a duty and responsibility to the donor, the
family, friends and the institutions and programs served to use the gifted body to serve the greatest good, it’s
the legacy of health and hope the donor left behind for those that follow. Maryland is fortunate to have an
overwhelming and much needed citizen support that advances the objectives of medical-dental education:
all fields of clinical-surgical residency practice: emergency medicine, paramedical, trauma and military medical
training; and significant research studies that impairs health. Many people for many years will ultimately
benefit from this unselfish and benevolent gift.
Along with this letter, enclosed is additional information to read and review. If you desire to make an
anatomical gift and proceed with donation, please complete the enclosed form. Two witnesses are required to
sign at the time the form is completed. The original signature copy is to be returned to the Board address
listed below. A copy of your form and donor identification card will be mailed to you after review and
approval. Please allow 30 days for processing.
Respectfully,
Juan L. Ortega, Director
655 W. Baltimore Street, BRB Bldg. ∙ Room B-026 ∙ Baltimore, MD 21201
Phone: 410-547- 1222 ∙ Fax: 41-706-8107
In State toll Free 1-800-879-2728 ∙ TT 1-800-735-2258
Web Site: health.marland.gov/anatomy
655 W. Baltimore Street, BRB Bldg. ∙ Room B-026 ∙ Baltimore, MD 21201
Phone: 410-547- 1222 ∙ Fax: 41-706-8107
In State toll Free 1-800-879-2728 ∙ TT 1-800-735-2258
Web Site: health.maryland.gov/anatomy
Maryland State Anatomy Board Donor Packet
Please review ALL the information and the Donor Consent section provided before proceeding with
completing attached form to fully understand the FULL body donation to our program.
I or
the person requesting donor form is a Maryland resident.
The person requesting registration can make a legal informed decision about their end of
life plan.
The person requesting registration understands that the request is about a FULL body
donor program only.
If you cannot check yes to all THREE questions, please contact the SAB office during business hours
for alterative or options for your circumstances. Please see NOTE below.
All forms will be evaluated for accuracy and completeness before accepting. Incomplete forms will
be returned to requestor and may delay registration in program. No FAX or email copies will be
accepted. ALL COMPLETED DONOR FORMS MUST BE MAILED with original signature copy ONLY
accepted for registration. Form not received and accepted before death shall result in rejection of
donation. An acknowledgement letter and a donor card will be mailed once form has been
accepted.
Please read all attached paperwork to understand the requirements of our SAB program.
NOTE:
• If you are not a Maryland resident and wish to donate your body for scientific purposes,
please go to https://anatbd.acb.med.ufl.edu/usprograms
to locate a medical school near
your residence. You must contact that program and follow their requirements.
• Person registering must be able to make legal informed decision about their end of life
plans without intimidation or coercion. No next of kin, guardian, POA, etc. shall make the
decision for another person’s end of life plan.
• The SAB program is for FULL BODY only. If you are interested in organ donation, contact
The Living Legacy Foundation of Maryland https://www.thellf.org
or your area organ
procurement program to obtain information about organ donation. If you are an accepted
pre-registered donor to the MD Anatomy Board and an organ donor, the Board will work
with the organ procurement program to attempt to accommodate both requests.
SAB-Cover Sheet 20-E
Q: What is the purpose of the Anatomy Board
Donation Program?
A: To receive the body of a person who has
donated his or her remains to the Anatomy
Board for use in the advancement of
medical education and research.
Q: Is there a need for body donations?
A: Yes. Donors are needed to support programs
in medical education and research.
Q: How do I donate my body to the State
Anatomy Board?
A: By completing an Anatomy Board donor
form. You may use the website, email, write
or telephone the Board to request this form
and any additional information.
Q: Are there any charges to my estate or my
family for donation of my body?
A: No. All costs are paid by the State, including
transportation, embalming, and cremation.
Q: Can a donation to the Board be made after-
death by the family?
A: The Board typically does not accept
posthumous “after death” donation.
However, you may contact the Board to
discuss your case.
Q: What if I signed an Advance Directive
donating my body to science?
A: Advance directives for ‘donation to science’
are considered a general intent, not
donation to the State Anatomy Board. To
donate to the Board, you must complete a
donation form. You may go to our website,
email, write or telephone the Board to
request this form and any additional
information.
Q: Is there an age limit?
A: Yes, someone must be 18 years of age or
older to donate his or her body to the
Board.
Q: May I also donate to organ bank programs?
A: Yes. If you are registered with an organ bank
or the Driver's License Program, keep your
card with any other identification you carry.
Q: Suppose I die out of State?
A: If one of our donors dies in one of the states
surrounding Maryland, the family shall incur
the cost of transporting the body into
Maryland and the cost of filing the death
certificate and cremation certificate. The
body shall be transported to the nearest
funeral home inside the Maryland border. A
completed death certificate from the state
of death must accompany the donor. The
Board will not accept or make removal
without the accompanying death
certificate.
If a donor dies out of state and the distance
to transport is unreasonable, then the
closest Medical Teaching Facility should be
notified to see if they will accept donation.
In this case also contact the State Anatomy
Board's office.
Q: How may I cancel my donation?
A: Your donation may be cancelled at any time
by writing to the Anatomy Board.
Q: What about a death notice in the
newspaper?
A: The family may place an obituary notice, at
their own expense. The newspaper will
usually confirm the death with the State
Anatomy Board prior to publication.
Q: How is the State Anatomy Board notified of
my death?
A: Notification to the Board is made
immediately by the nursing home, hospital,
or doctor in attendance. If there is no
attending physician, the local police
department should be contacted
immediately. The Anatomy Board will
arrange to have the body moved to its
facility.
Q: What happens to the body when it is
received by the State Anatomy Board?
A: The body is prepared for use in a medical
program and held until it is released for
study.
Q: Who will use the body?
A: The body will be used to support research
and educational study programs at medical
institutions. The Board serves medical and
dental schools, resident teaching programs,
and other related health, education, and
research study programs.
Q: Is a funeral service held?
A: No. The Anatomy Board assumes immediate
custody of the body, so a funeral service
with the body present is not possible.
However, the family may elect to have a
memorial service at any time and the Board
holds an annual Memorial Service for all
donors.
Q: What happens after the body has been used
in a medical program?
A: The body is returned to the Anatomy Board
and cremated.
Q: How long is it from the time of removal by
the Anatomy Board until cremation?
A: In most cases, cremation will occur within a
year to a year and a half, depending on
when the body is released to and received
back from the medical program, but this
may be up to two years.
Q: What happens to the ashes of my cremated
body?
A: Following cremation, the ashes are interred
in a dedicated gravesite in Sykesville,
Maryland.
Q: Can the ashes be returned to the family for
burial or private disposition?
A: Yes. You may designate on your donation
form that the ashes are to be returned to
the family by listing the name, address and
telephone number of the person to receive
them. The ashes will be returned in an urn
suitable for burial or entombment.
Q: Can I donate financially?
A: Yes, we can accept willed bequests or you
can directly donate financially through
www.medschool.umaryland.edu/SABgiving
.
All funds go to support the State Anatomy
Board’s medical educational and biomedical
research missions.
STATE OF MARYLAND
Maryland Department of Health
The poet Robert Test states:
"The day will come when my body will lie upon a
white sheet tucked neatly under the four
comers of a mattress, located in a hospital busily
occupied with the living and the dying. At a
certain moment, a doctor will determine that
my brain has ceased to function and that, for all
intents and purposes, my life has stopped.
"When that happens, do not attempt to instill
artificial life into my body by the use of a
machine and don't call this my deathbed. Let it
be called the Bed of Life, and let my body be
taken from it to help others lead fuller lives.
"GIVE my sight to the man who has never seen a
sunrise, a baby's face of love in the eyes of a
woman. GIVE my heart to the person whose
own heart has caused nothing but endless days
of pain. GIVE my blood to the teenager who was
pulled from the wreckage of his car, so that he
may live to see his grandchildren play. GIVE my
kidneys to a person who depends upon a
machine to exist from week to week. TAKE my
bones, every muscle, every fiber and nerve in
my body and find a way to make a crippled child
walk. EXPLORE every comer of my brain. TAKE
my cells, if necessary, and let them grow so that,
someday, a speechless boy will shout at the
crack of a bat or a deaf girl will hear the sound
of rain against a window.
"BURN what is left of me and scatter the ashes to
the winds to help the flowers grow. If you must
bury something, let it be my faults, my
weaknesses and all my prejudice against my
fellow man. Give my sins to the devil. Give my
soul to God.
"If, by chance, you wish to remember me, do it with
a kind deed or word to someone who needs
you. If you do all I have asked, I will live forever."
QUESTIONS
&
ANSWERS
About the
State Anatomy Board
Body Donation
Program
For further information:
https://health.maryland.gov/anatomy/
State Anatomy Board
Bressler Research Building, Room B-026 655
West Baltimore Street
Baltimore, Maryland 21201-1559
410-547-1222 Day or Night
1-800-879-2728 In State Toll Free
410-706-8107 Fax
STATE ANATOMY BOARD OF MARYLAND
655 West Baltimore Street, BRB Rm. B-026, Baltimore, Maryland 21201-1559
Phone (410) 547-1222 or (800) 879-2728 - TDD for deaf (410) 383-7555
ANATOMICAL GIFT / BODY DONATION REGISTRATION FORM
Select: ☐ New Registration
☐ Updating Registration
The information
on this form is required for registration purposes and sections will ultimately be used for death certificate
details. This is a legal form designating your final wishes, please carefully complete the entire form. If an item is “unknown”
or “not applicable” then please write that in the space. Do not leave any blank responses. Incomplete forms cannot be
processed and will be returned for correcting. We recommend that you keep your registration current by updating any
major life changes (e.g. moving to a new address, legal change of name, change in your designated next-of-kin, etc.).
You must be a Maryland Resident to donate to the State Anatomy Board.
Donor’s Full Legal
Name_________________________/___________________________/_________________________
First Middle Last
Address (number and Street) __________________________________________________________________________
City _______________________ County ____________________ State _________________ Zip ___________________
Phone Number _____________________ Email Address (if applicable) ________________________________________
Date of Birth _______________ Social Security Number ______________________ Citizen of ____________________
Birthplace: City _________________________ State ___________ Country ___________________________________
Marital Status _____________________________
Sex__________________
Other
___________________________
Ethnicity/Race ______________________________________________
Other ________________________
Donor Name at Birth (e.g.
maiden name) ___________________________ Education ____________________________
Donor Fathers Name at Birth _______________________ Donor Mother’s Name at Birth__________________________
Usual Occupation (do not use ‘retired’) ____________________ US Veteran ☐ No ☐ Yes, Service Branch ____________
Your Wish for Disposition of Cremated Remains – Upon completion of our studies, your remains are individually
cremated. You must indicate your wish for final disposition of your cremated remains from the options listed below. We
encourage you to discuss your wishes with your family and next of kin as your wishes take precedent over other claims to
your ashes. To be eligible for the SAB burial at a veteran’s cemetery, you must attach a copy of your long form DD214
discharge papers and have been discharged from active duty in good standing (i.e. discharges other than dishonorable).
I hereby instruct that my cremated remains be:
☐ Buried at the State Anatomy Board of Maryland burial site.
☐ Buried at a veteran’s cemetery by the SAB.
☐ Given to next-of-kin (or designated) individual below.
You must fill out a next-of-kin (or designated) name and address for contact purposes. This section must be filled out
completely regardless of the choice you selected above for final disposition of your ashes.
Next-of-kin (or designated) Name________________________/________________________/_____________________
First Middle Last
Address (number and Street) __________________________________________________________________________
City _____________________ State
_____________ Zip ___________________ Relationship ______________________
Phone Number _______________________ Email Address (if applicable) ______________________________________
SAB Donor 20-E
MD
SAVE
EXIT
PRINT
Clear Form
SAB Donor 20-E
Donor Consent:
My signature below indicates that I am at least 18 years of age, that the information on this form is accurate and true to
the best of my knowledge, that I am aware I have had the opportunity to ask the SAB questions about donation, and;
a)
I understand and hereby instruct, in the presence of the following witnesses, that it is my desire to donate
my body after death to the SAB for the purposes of advancing medical education, scientific research, or any
such related activity as duly authorized by the SAB.
b)
I understand that upo
n my death, the SAB will be notified and arrange for the transport, preparation, and
care of my body or body part for study in Maryland or, at the SAB’s discretion, to qualified out-of-state
medical education or research programs.
c)
I understand that study programs may take between two (2) wee
ks and two (2) years (and, in rare
circumstances, longer) before my ashes are available for return or burial as per my wishes.
d)
I understand that organs, biopsies, or other tissues may be removed from my body for the purposes of
education, research, or related activities and pertinent personal health information (e.g. age, cause of
death, etx.,) may be released to programs studying my body.
e)
I understand that a copy of this signed statement will be retained on file with SAB and serve as a legal
document designating my final wishes regarding my body.
f)
I understand that I may change my donation at any time by completing an updated donor form, or rescind
my donation by completing the Rescindment of Donation form, and sending the form to the SAB offices.
g)
I understand that I may be both a living organ donor and a body donor, and further understand that this
form is only for the body donation program. I understand that if I wish to be a living organ donor, that I
must complete a separate registration with my preferred living organ donation program.
h)
I understand that although I am registering for the body donation program, that at the time o
f my death, I
must meet the conditions for acceptance in order for my body to be accepted (i.e. body weight no greater
than 400 pounds, no severe trauma or advanced decomposition, no autopsy performed, no organs removed
at time of death, absence of a highly infectious disease including, but not limited to, Creutzfeldt-Jakob,
Aspergillosis, Clostridium difficile, Hepatitis, HIV, or Tuberculosis).
i)
I understand that my body donation registration becomes effective as of the date that this form is received
at the SAB administrative office.
Donor’s Full L
egal Name_________________________/___________________________/_________________________
First Middle Last
Signature _____________________________________________________________ Date ________________________
Witnesses – Two witnesses are required for this form to be considered complete. The witnesses must be at least 18
years old and not affiliated with the SAB. Witness #1 can be any person you choose. Witness #2 must be a disinterested
witness, meaning someone other than your spouse, child, parent, sibling, grandchild, grandparent, or legal guardian.
We, the undersigned, hereby certify that we are at least 18 years old, are not affiliated with the SAB, and have witnessed
the signing of this document by the donor.
Witness #1 Witness #2
Name ____________________________________________ Name ___________________________________________
Address __________________________________________ Address __________________________________________
City/State/Zip______________________________________ City/State/Zip_____________________________________
Signature _________________________________________ Signature ________________________________________
Submission - PRINT one copy (preferred two sided) and return the original signed completed registration form to the
SAB by mail ONLY: State Anatomy Board, 655 West Baltimore Street, BRB Rm. B-026, Baltimore, Maryland 21201-1559.
Print or save a copy of the form for your records
RETURN TO PAGE 1
SAB 20-E
Below are choices to use when completing our Body Donation Registration Form
MARITAL STATUS CHOICES:
Never Married (DO NOT USE SINGLE)
Married
Married but Separated
Divorced
Widowed
ETHNICITY/RACE CHOICES:
White/Caucasian
Black/African American
American Indian/Alaska Native
Asian Indian
Asian - Specify
Filipino
Native Hawaiian
Other Pacific Islander- Specify
Hispanic (Cuban, Mexican, Puerto Rican)
Other Hispanic -Specify
Other-Specify
Unacceptable entries: Nonwhite, Mixed, Multiracial
EDUCATION SELCETION CHOICES:
8
th
grade or less
9
th
– 12
th,
no diploma
High school graduate or GED
Some college credit, but no degree
Associate degree (e.g. AA, AS)
Bachelors degree (e.g. BA, AB, BS)
Masters degree (e.g. MA, MS, MEng, MEd, MSW, MBA)
Doctorate degree (e.g. PhD, EdD, or Professional degree (e.g. MD, DDS, DVM, LLB, JD)
Unknown
US VETERAN BRANCH CHOICES:
Air Force
Army
Coast Guard
Marines
Navy
COMPLETED DONOR FORMS ORIGINAL SIGNATURE COPY SHOULD BE MAILED TO:
MD State Anatomy Board
655 W Baltimore Street
ROOM B-026
Baltimore, MD 21201
