Indiana University School of Medicine
Department of Anatomy & Cell Biology
Donor Report
200__-200__ (insert years here)
Dissection teams are to provide a report to the Course Director by the end of their gross
anatomy course that contains observations about the donor, discovered during the course
of dissection. Use the following form as a guide in preparing this report.
Limit your narrative descriptions to the space provided.
Consult your instructors with any questions.
Donor Number
Campus Location
Age
Sex
Cause of Death:
1
2
External Examination (Be specific in your narrative and diagram all findings)
□ General body habitués (e.g.,
normal, emaciated, obese)
□ Presence of tattoos,
piercings, nail painting
□ Evidence of surgical
procedures (e.g., presence
and location of scars,
catheters, pacemakers,
central venous lines, gastric
tubes, etc.)
□ Evidence of trauma or injury
(e.g., excessive bruising,
fractures)
□ Evidence of scoliosis,
kyphosis; malpositioned or
malformed limbs,
amputations, etc.
□ Pathological findings (e.g.,
skin lesions, palpable
masses, hernias, etc.)
Posterior View
Anterior View
□ Absence of structures (e.g.,
breast/mastectomy, testes)
Narrative:
3
Internal Examination
Serous (Body) Cavities (Describe all findings in the narrative)
□ Status of pleural cavities (e.g., evidence of pleural adhesions, pleural effusion material)
□ Status of pericardial sac (e.g., evidence of blood, excess fluid)
□ Status of peritoneal cavity (e.g., evidence of peritonitis, excess ascitic fluid, blood)
Narrative:
Status of Thorax (Thoracic Cage and Thoracic Organs)
Thoracic Cage
Heart and Great Vessels.
□ Absent or extra ribs
□ Fractures
□ Fluid
□ Other:
□ Normal heart and vessels
□ Cardiomegaly
□ Right ventricular hypertrophy
□ Coronary Bypass*
□ Septal defects (ventricular, atrial)
□ Other:
Lungs
*Specify which vessels are bypassed; number
and location of bypass grafts. (Was the left or
right great saphenous vein used?)
Evidence of:
Y
□ Normal left lung
□ Abnormal left lung (specify):
□ Normal right lung
□ Abnormal right lung (specify):
N
□ tobacco use
□ fibrosis
□ masses
□ emphysema
□ Other:
Trachea and Bronchial Tree
Mediastinal lymph nodes
Diaphragm
□ Normal
□ Abnormal (specify):
□ Normal
□ Abnormal (specify):
□ Normal
□ Abnormal
□ Herniated (specify type):
4
Lt/Rt
Narrative (Status of Thorax):
Status of Abdominal Organs
Liver
□ Normal
□ Abnormal (specify):
Gallbladder
Pancreas
Spleen
□ Normal
□ Absent
□ Presence of stones
□ Normal
□ Absent
□ Abnormal (specify):
□ Normal
□ Absent
□ Abnormal (specify):
(specify)
□ Abnormal (specify):
Gastrointestinal Tract
□ Normal
□ Mucosal Erosions
□ Ulcer
□ Diverticulosis
□ Palpable tumors/masses
□ Appendix present
□ Appendix absent
□ Embryological defect (specify):
□ Other (specify):
Adrenal Glands
Abdominal Aorta and Arterial Branches
□ Normal
□ Abnormal (specify):
□ Normal
□ Evidence of aneurysm (specific location and approximate size)
□ Atherosclerosis
□ Other (specify):
Narrative: (Status of Abdominal Organs)
5
Status of Urinary Organs
Kidneys
Ureters
Urinary Bladder
Urethra
□ Normal (lt. and rt.)
□ Polycystic kidney
□ Embryological defect
□ Normal (lt. and rt.)
□ Absent (lt. or rt)
□ Embryological defect
□ Normal
□ Absent
□ Other (specify):
□ Normal
□ Other (specify):
(specify)
□ Other (specify):
(specify)
□ Other (specify):
Narrative: (Status of Urinary Organs)
Status of Reproductive System
FEMALE
External Genitalia
Vagina
MALE
External Genitalia
Testes
□ Normal vulva
□ Other (specify):
□ Normal
□ Other (specify):
□ Normal
□ Circumcision
□ No circumcision
□ Normal scrotum
□ Other (specify):
□ Normal
□ Absent (lt. / rt.)
□ Epididymis
□ Other (specify):
Uterus
Ovaries
Prostate
Seminal Vesicles
□ Present
□ Normal
□ Absent
□ Other (specify):
□ Present (lt. / rt.)
□ Normal (lt. / rt.)
□ Absent (lt. /rt.)
□ Other (specify):
□ Present
□ Normal
□ Absent
□ Other (specify):
□ Present (lt. / rt.)
□ Normal (lt. / rt.)
□ Absent (lt. /rt.)
□ Other (specify):
Fallopian Tubes
□ Present (lf. / rt.)
□ Normal (lt. / rt.)
Ductus Deferens
□ Absent (lt. / rt.)
□ Other (specify):
□ Present (lf. / rt.)
□ Normal (lt. / rt.)
6
□ Absent (lt. / rt.)
□ Other (specify):
Narrative: (Status of Reproductive System)
Status of Head and Neck
Larynx
Trachea
Thyroid Glands
□ Present
□ Normal
□ Absent
□ Other (specify):
□ Present
□ Normal
□ Absent
□ Other (specify):
□ Present
□ Normal
□ Absent
□ Other (specify):
Head
□ Normal
□ Abnormal (specify):
□ Other (specify):
Narrative: (Status of Head and Neck)
7
Cervical Lymph Nodes
(Deep chain)
□ Present
□ Normal
□ Absent
□ Other (specify):
Status of Central Nervous System
□ Normal
□ Evidence of intracranial bleeding (e.g., epidural, subdural, subarachnoid hemorrhage)
□ Other (specify):
Narrative: (Status of Central Nervous System)
Skeletal
□ Fractures (specify location and type)
□ Implants (specify):
8
□ Other (specify):
Overall Narrative Summary:
Date:
Time:
Student Name:
Student Name:
Student Name:
Student Name:
Student Name:
Student Name:
9
Additional Body Diagram (if needed).
Posterior View
Anterior View
10