Willed Body Program Release Of Liability (Page 2 of 2) in pdf

UT Southwestern Medical Center

Alzheimer’s Disease Center

Alzheimer’s and Related Diseases Research Clinic

Brain Autopsy and Donation Program Instructions

____________________________________________________________________________________________________________________

Attention families: Candidates for brain autopsy/donation must have been a regular patient of

the Alzheimer’s and Related Diseases Research Clinic at UT Southwestern.

_____________________________________________________________________________________________________________________

Important Steps for a family member to follow at the time of death:

Step 1:

If the donor dies in a nursing home or hospital: Call your funeral home and tell them that

someone from the UT Southwestern Willed Body Program will contact them to make

arrangements to remove the brain.

If the donor dies at home: If the patient is under the care of hospice call the hospice to

report the death and they will help make arrangements. If a patient is not under the care of

hospice you will first need to call 911 and the patient’s primary care physician.

Step 2:

Call the UT Southwestern Neuropathology Office: (214) 648‐2148, seven (7) days a week,

24 hours a day, and state that you are calling regarding an Alzheimer’s Research Clinic

autopsy and state that your family member was seen in the Alzheimer’s Research Clinic. A

person from the research clinic will call you back to help facilitate the process. You will

need to give them information about the funeral home (location, phone number) and

location of the donor.

Step 3:

The family will need to obtain and sign a form (the Willed Body Program Release of

Liability form) giving written permission for the brain removal by the Willed Body Program.

You can obtain this form ahead of time from research clinic staff or by going on the UTSW

website at

take you to the Alzheimer’s Disease Center website where the forms are available on the

left side of the page. The form can also be faxed or emailed to you at the time of death.

This form must be signed and available to the Willed Body Personnel in order for the

procedure to be completed.

All costs related to the autopsy will be paid by the research clinic.

A diagnostic report will be issued based on the autopsy and the family will be contacted

regarding the results.

Thank you for your participation in this very important program.

If you have questions, please call us at (214) 648‐9376.

Willed Body Program Release Of Liability Page 2