Non-transplant Anatomical Donation Organizations, or NADOs, recover human tissue donations which are not intended for transplant into a living patient. Most NADOs operate a whole-body donor program, where they receive whole-body donations and prepare non-transplant tissues for distribution, both in the US and worldwide, for a wide range of applications, including research, training, and education.
The American Association of Tissue Banks (AATB) is a voluntary, professional, scientific, and educational organization, that maintains an accreditation program for NADOs. While there exists many NADOs in the United States, only a small number are accredited. This accreditation helps to ensure that their organizations are implementing the highest standards available in order to best honor the donor’s gift.
No, organ or tissue donation is the process of giving an organ or tissues for the purpose of transplantation into a living recipient to save and enhance lives. Whole-body donation provides tissue for research, education, and training, which aids healthcare in many ways.
Every whole-body donation has the ability to impact an immeasurable number of lives through advancements in surgical technology as well as educating and training the medical professionals of tomorrow. Just a few areas of research and education that benefit from non-transplant donations include:
- Anatomy and Physiology Student Education and Labs
- Alzheimer’s, Dementia, and Parkinson’s Research
- Cranio-Maxillofacial Surgical Technology
- Dental Surgery Training & Device Development
- Drug Therapy
- Emergency First Responder Training
- Medical Resident Training
- Minimally-Invasive Surgical Technology
- Musculoskeletal Enhancements
- Orthopedic Device Technology
- Pain Management
- Robotic Cardiac and Thoracic Surgical Training
- Sports Medicine Surgeon and Physician Technique Development
- Transplantation Surgery Training and Technique Development
NADOs are regulated by state law with regard to consent (how a NADO gets permission from the donor or the donor’s legal authorizing party), acquisition (how the NADO handles the transportation and legal bylaws of getting the deceased to their facility) , distribution (how the non-transplant human tissues are allocated for education, training and research), and final disposition (how the donor’s cremated remains are handled to protect their dignity). However, NADOs that desire a higher level of scrutiny from an outside organization, and in turn, increased transparency and public trust, can voluntarily seek accreditation from the American Association of Tissue Banks (AATB), the premier standard-setting organization for NADOs. Prior to 2011, NADOs were accredited using parts of the Standards for Tissue Banking. In 2011, AATB published the 1st edition of AATB Standards for Non-Transplant Anatomical Donation, which is specific to NADOs.
Refer to AATB’s accreditation process for more information (https://www.aatb.org/accreditation/process).
Persons wishing to be whole-body donors can either register in advance with a program, or a legally authorized person can donate the body of a loved one after their death. Accredited NADOs need to obtain informed consent from the donor or their authorizing party as well as gather necessary information such as demographics and medical history before accepting a donor and transferring the donor from the place of death.
Once a donor is received by an accredited NADO, the NADO must assess the donor’s medical history, physical presentation, and results of serology testing, in order to screen for the presence of relevant communicable diseases or agents of disease. These processes also ensure that a donor will be best applied to research, education, and/or training needs.
NADOs can often accept donors who may otherwise be ineligible to donate for transplantation. NADOs often have no upper age limit restriction and can accept donors who have or have had cancer or other diseases not acceptable for certain transplant donations. NADOs also have a less restrictive time window to recover and prepare non-transplant tissues while transplant tissues have a rather narrow window for suitable recovery. A NADO’s acceptance criteria are largely dependent on the individual institution’s practices, but the most common reasons a donor may not be accepted are due to the presence of infectious diseases such as HIV/AIDS, Hepatitis B, Hepatitis C, or prion diseases such as Creutzfeldt-Jakob Disease (CJD). It is best to contact a NADO directly to determine its specific acceptance criteria.
Only certain types of facilities are authorized to use donated human tissue. Before a NADO can transfer the tissue, accredited NADOs are required to obtain written requests from tissue users that outline the exact planned uses for the specimens, a description of the facility where specimens will be utilized, and how the specimens will be disposed or returned to the NADO facility. Each request must be carefully reviewed by a responsible NADO representative for compliance with AATB Standards as well as the NADO’s institutional requirements, policies, and procedures.
To protect the privacy of the donor and the organizations that are utilizing non-transplant specimens, in virtually all cases it will not be possible to get specific details about which specific tissues were recovered or which organizations received the donor tissue. However, most Accredited NADOs offer letters back to a donor’s designee(s) which outline how their loved one aided research, training, and education.
Most Accredited NADOs cover all costs associated with the donation, including transfer of the donor from the place of death to the NADO facility, filing of the death certificate, performing final disposition (e.g. cremation), and providing at least a suitable temporary urn to house cremated remains (if requested to be returned to designee(s). It is best to contact the NADO directly to inquire about its practice.
Accredited NADOs return at least a portion of the donor’s remains in the form of cremated remains, to the donor’s designee(s) or legal authorizing party. The time between donor acceptance and the return of cremated remains is largely dependent on a NADO’s own policies and whether a portion of the donor or the entirety of the donor’s remains is returned. It is best to contact the NADO directly to determine its practice regarding the return of cremated remains.
Due to time constraints on whole-body donations, a traditional funeral is not possible. However, there is nothing that prevents a donor’s loved ones from having a memorial service in honor of the donor, with or without cremated remains present. Burials, scatterings, and other ceremonies are often performed by the donor’s loved ones once they are in possession of the cremated remains.
Accredited NADOs fully support organ and tissue donation. Many accredited NADOs will accept a whole-body donation after organs and tissues have been recovered for transplantation needs. It is best to contact a NADO directly to inquire about its acceptance of donors after organs and tissues have been recovered.
It is important to note that a red heart designation on a driver’s license expresses a person’s wish to be an organ donor for transplant. This does not automatically enroll a person into a registry for eye and tissue donation for transplant, nor does it enroll a person into non-transplant donations, including those made with the donor’s whole body. The reverse is also true in that registering as a whole-body donor with a program does not automatically enroll a person into a transplant donor registry. It is best for a person to make their wishes known among their loved ones or even enroll in programs of their choice in advance of their death.
In order to sustain a mission of helping donors and their loved ones fulfill their wish to aid researchers, educators, and clinicians in advancing science and medicine, most often at no cost to the donor or her/his loved ones, NADOs must fund their operations by charging a fee for service to those who are requesting, and being provided, non-transplant gifts.
Some NADOs, such as those that operate within institutions such as universities, may be funded by State grants or through tuition fees.
A NADO’s service area may vary between organizations, and it is best to contact a NADO to determine whether the organization can accept donors from a particular area.
There are many non-transplant donor programs (NADOs) available in many states, however there are only a small number of AATB-accredited NADOs operating in the United States. To view a current list of accredited NADOs, please visit https://www.aatb.org/accreditation/accredited-bank-search, and select the box, “Non-Transplant Anatomical Material (NAM)” under the “Accredited for Tissue” category and click the SEARCH button.