Many people hesitate to think about planning for death, but as surely as taxes during life, people will have remains to be disposed of.
In the United States, recently, the rate of cremation has exceeded burial. According to the National Funeral Directors Association, in 2017, 50.2 percent choose cremation, while 43.5 percent opted for burial. The association projects that by 2035, the rate of cremation will reach about 79 percent of deaths. It is important that people make advance plans, since there is a discrepancy in the Pennsylvania statutes as to who has the right to decide what should happen.
Under an older law, unless there is a surviving spouse, the next of kin have sole authority on the disposition of a decedent’s remains. In practice, “next of kin” generally means all children, even those who might be estranged or unavailable (and no provision for “majority rule”). A more recent statute authorizes the health care agent to make arrangements. However, many funeral directors adhere to the older rule. Good estate planning would suggest that parents arrange for what they want in advance, so all children might join in while they can be conveniently located, instead of having to get them all to agree to something almost on an emergency basis following death.
The more important question for planning is whether folks want to donate organs and tissue for life saving transplants, or to offer their entire body for medical research. There are different rules for both.
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Every day, about 92 people in the United States receive organ transplants. However, more people die waiting to receive a transplant than are saved. According to the United Network for Organ Sharing, more than 114,000 need a life saving organ transplant, and roughly 20 percent of those (74,848) are on active waiting lists. In 2018, year to date, there have been 4,109 donors who have provided organs for 8,510 transplants. Over the past decade, the largest organs transplanted are kidneys, followed by hearts, lungs and pancreata. In Pennsylvania, right now, there are roughly 7,500 candidates seeking organ transplants. Organs must be transplanted very soon after the person has died. Unlike organs, it may be possible to donate tissue up to 48 hours after death.
Tissue transplants, including corneas, can be used to restore sight, heal burns, repair hearts, replace veins and mend damaged connection tissue and cartilage in recipients. The requirements for tissue donation are less strict than organ donation. Pennsylvania allows drivers to designate organ donation on their drivers licenses; most medical directives and/or living wills provide for this, and the spouse, next of kin or medical agent can also give permission. A traditional funeral with an open casket is generally possible after most donations. There is no cost to donors or their families for organ or tissue donation. There are no restrictions on signing up for organ donation, and according to the United States Department of Health and Human Services, the oldest donor to date was 93 years old. Most major religions support organ donation, although organ donation is a matter of personal choice.
Many clients are also considering donating their bodies to science. Humanity Gifts Registry is a Pennsylvania nonprofit that coordinates the distribution of donated bodies to all medical and dental schools here. According to Dr. Michelle D. Lazareths, professor at Penn State College of Medicine, there are only very limited circumstances in which a body is rejected for donation to a medical school. Typically, medical schools will use someone’s remains in their curricula, and upon the completion of studies, the remains are cremated. Usually the ashes are interred in public cemeteries in Philadelphia, Hershey or Pittsburgh, although arrangements can be made to have them returned to families. There is potentially an expense in donating a body, since the Humanity Gifts Registry will only pay up to $100 for transportation expenses. If the cost is higher, the decedent’s estate or family would need to pay the excess.
There are also private agencies who will accept while body donations, typically at no cost to the donor or the donor’s family. These agencies, many of which are accredited through the American Association of Tissue Banks, send needed tissues and other needed body parts for medical research purposes throughout the United States and to scientific facilities elsewhere. Science Care, an agency with a Pennsylvania location, reports that the average body contributes to up to six research and education projects such as cancer and Alzheimer’s research as well as training surgeons. The rest of the body is cremated and available for return in 3-5 weeks.
Advance planning — saying what should happen to your body after you’re gone — is a gift anyone can give to survivors.