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In England, Wales, and Northern Ireland, people can choose to donate their bodies post-mortem to Medical School Anatomy Units. The body donation (BD) process is facilitated by anatomy unit staff (AUS). However, little is known about the extent and nature of AUS work with families, including when a body cannot be accepted. To address this gap, this paper draws on data from an ethnographic study, including a survey of 15 anatomy units (AUs) in England and Northern Ireland, a case study of one AU, 20 semi-structured interviews with 31 AUS and document analysis. We reveal the number of bodies (878) that are refused across AUs and examine how AUS deal with refusals. We argue that activities around refusals constitutes ‘over and above’ work for AUS, as it goes beyond their expected role. We suggest that this is done out of a duty of care, and is related to the discomfort of refusing the BD gift. Attention is given to the ‘over and above’ work of the AUS which allows for an exploration of gift relationships and emotion management in a new arena. We conclude with recommendations to address the lack of recognition and training around AUS refusal work. [ABSTRACT FROM AUTHOR]