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Searching for Good Practice Recommendations on Body Donation across Diverse Cultures



Good practice recommendations for the donation of human bodies and tissues for anatomical examination have been produced by the International Federation of Associations of Anatomists (IFAA). Against the background of these recommendations, the ethical values underlying them are outlined. These are the centrality of informed consent, their non-commercial nature, and the respect due to all associated with donations including family members. The latter is exemplified in part by the institution of thanksgiving services and commemorations. A number of issues in the recommendations are discussed, including the movement of bodies across national borders, donor anonymity, taking images of bodies and body parts, and the length of time for which bodies can be kept. Outstanding questions in connection with body donation include the availability of bodies for research as well as teaching, allowing TV cameras into the dissecting room, and the display of archival material in anatomy museums. Future prospects include whether IFAA could be formulating a position on the public exhibition of plastinated human material, and in what ways IFAA could assist countries currently dependent upon the use of unclaimed bodies. This article is protected by copyright. All rights reserved.
Searching for Good Practice Recommendations on Body Donation across
Diverse Cultures
Department of Anatomy, University of Otago, New Zealand
Running title: Good practice recommendations
Correspondence to: D Gareth Jones, Department of Anatomy, University of Otago,
PO Box 913, Dunedin 9054, New Zealand. Email:
Good practice recommendations for the donation of human bodies and tissues for
anatomical examination have been produced by the International Federation of
Associations of Anatomists (IFAA). Against the background of these
recommendations, the ethical values underlying them are outlined. These are the
centrality of informed consent, their non-commercial nature, and the respect due to all
associated with donations including family members. The latter is exemplified in part
by the institution of thanksgiving services and commemorations. A number of issues
in the recommendations are discussed, including the movement of bodies across
national borders, donor anonymity, taking images of bodies and body parts, and the
length of time for which bodies can be kept. Outstanding questions in connection with
body donation include the availability of bodies for research as well as teaching,
allowing TV cameras into the dissecting room, and the display of archival material in
anatomy museums. Future prospects include whether IFAA could be formulating a
position on the public exhibition of plastinated human material, and in what ways
IFAA could assist countries currently dependent upon the use of unclaimed bodies.
Key words: IFAA good practice recommendations; body donation; ethical
values; donor anonymity; uses of donated bodies
A number of papers in this issue have made reference to the IFAA (International
Federation of Associations of Anatomists) ‘Recommendations of good practice for the
donation and study of human bodies and tissues for anatomical examination’. These
were produced by me in consultation with others at the request of the executive
committee of the IFAA and appeared first in Plexus, the newsletter of the IFAA, in
August 2014 (IFAA, 2014). They were produced in order to outline what are regarded
as good practice guidelines. They are reproduced here in full.
The study of human cadavers is essential for teaching, advanced training and
research in medical and anatomical sciences. Institutions1 rely on the
donation of bodies by the general public, and are immensely grateful to
donors. However, it is imperative that institutions follow procedures of the
highest ethical standards in order to give donors full confidence in their
decision to donate. Transparency regarding the use of human material and
institutional procedures increases public trust and in turn increases public
support of body donation.
1. Informed consent from donors must be obtained in writing before any
bequest can be accepted.2 Consent forms should take into account the
a. Donors must be entirely free in their decision to donate, this excludes
donation by minors and prisoners condemned to death.
b. Although not essential, good practice is encouraged by having the next
of kin also sign the form.
c. Whether the donor consents to their medical records being accessed.
1 The term “institution” is intended to refer throughout to a university, medical school
or anatomy department as appropriate.
2 This excludes the use of unclaimed bodies.
2. There should be no commercialisation in relation to bequests of
human remains for anatomical education and research. This applies to the
bequest process itself, where the decision to donate should be free from
financial considerations, and also to the uses to which the remains are put
following bequest. If bodies, body parts, or plastinated specimens are to be
supplied to other institutions for educational or research purposes this may
not yield commercial gain. However, charging for real costs incurred,
including the cost of maintaining a body donation program and preparation
and transport costs, is considered appropriate. Payment for human material
per se is not acceptable.
3. There needs to be an urgent move towards the establishment of
guidelines regulating the transport of human bodies, or body parts, within and
between countries.
4. Specimens must be treated with respect at all times. This includes, but
is not limited to, storing and displaying human and non-human animal parts
5. The normal practice is to retain donor anonymity. Any exceptions to
this should be formally agreed to beforehand by the bequestee and, if
appropriate, the family.
6. Limits need to be placed on the extent to which images, or other
artefacts produced from donations are placed in the public domain, including
in social media, both to respect the privacy of the donor (and their surviving
relatives) and to prevent arousing morbid curiosity. No individual should be
identifiable in images.
7. A clear and rigorous legal framework should be established on a
national and/or state level. This legal framework should detail:
a. The procedures to be followed in accepting bequests of human remains
for anatomical examination, including who is responsible for human remains
after death.
b. The formal recognition of institutions which may accept bequests,
which in some jurisdictions may involve licensing.
c. The safe and secure storage of human remains within institutions.
d. The length of time such remains will be retained by the institution.
e. The procedures to be followed in disposing of remains once the
anatomical examination is complete and they are no longer required for
anatomical education and research.
8. Institutional procedures should be formally established by an
oversight committee, which shall review the body donation program at
regular intervals. Such procedures should include the following:
a. Copies of the bequest should be retained both by the donor and by the
institution for whom the bequest is intended.
b. Records should be kept for a minimum of twenty years from the date of
disposal to ensure that human material can be identified as originating from a
specific donor.
c. Good conservation procedures should be employed throughout the
entire period during which the human remains are retained to ensure that the
most effective use is made of any bequest received.
d. Efficient tracking procedures should ensure that the identity and
location of all body parts from an individual donor are known at all times.
e. Facilities where cadavers are used must be appropriate for the storage
of human remains and secured from entry by unauthorized personnel.
9. There needs to be transparency between the institution and potential
donors and their relatives at every stage, from the receipt of an initial enquiry
to the final disposal of the remains. The clear communication of information
should include but not necessarily be limited to the production of an
information leaflet (hard copy and/or digital), which could also help publicise
anatomical bequests and increase the supply of donors. This should set out the
a. The procedures relating to registering bequests, acceptance criteria,
the procedures to be followed after death (including under what
circumstances a bequest might be declined), and the procedures relating to
disposal of the human remains. Sufficient grounds for rejection could include,
but need not be limited to:
the physical condition of the body
the virological or microbiological status of the donor in life
the existence of other diseases (for example neurological pathology)
that might expose staff or students handling the body to unacceptable risks
body weight or height over a specified limit
the possible over-supply of donations at that institution at that time
place of death outside the designated area from which bodies are
b. The range of uses of donated bodies at that institution.
c. Possible costs, if any, that might be incurred by the bequestee’s family
in making a bequest, and the costs to be met by the institution accepting the
d. Whether the donor’s anonymity will be preserved and whether their
medical history accessed.
e. Whether the body or body parts might be supplied to another
f. The maximum length of time the body will be retained, including any
legally sanctioned possibility of indefinite retention of body parts. The
relatives of the donor should be given the option of being informed in due
course of the date when the remains will be disposed of.
g. Donors should be strongly encouraged to discuss their intentions with
their relatives to ensure that their relatives are familiar with their wishes and
that as far as possible those wishes will be carried out after death.
10. Special lectures/tutorials in ethics relating to the bequest of human
remains should be made available to all students studying anatomy. This is to
encourage the development of appropriate sensitivities in relation to the
conduct and respect that is expected of those handling human remains used
for purposes of anatomical education and research.
11. Institutions should be encouraged to hold Services of Thanksgiving or
Commemoration for those who have donated their bodies for medical
education and research, to which can be invited relatives of the deceased,
along with staff and students.
These Recommendations stand as an illustration of good practice; one could say ideal
practice. They were drawn up against a background of practice already in existence in
a number of countries in the West, and reflect what might be considered underlying
ethical values that should, and frequently do, motivate body donation. Their
underlying premise is that all bodies are donated, on the ground that the alternative,
use of unclaimed bodies, represents an ethically dubious practice that has on a number
of occasions in the past placed anatomists in untenable predicaments (Jones and
Whitaker, 2012). This, however, raises a legitimate query: if the use of unclaimed
bodies represents a dubious path ethically, where does this leave countries and
societies where bequests are rare or non-existent (regardless of the reason)? How are
anatomists to act in this situation? In an attempt to address issues of this nature, it is
important initially to re-visit the fundamental ethical values that underlie these
Ethical values
The one value of pivotal importance to these Recommendations and that suffuses
most of the papers in this special issue of Clinical Anatomy is that of informed
consent. Once anatomists take this as a bedrock value for the use of human remains,
the bodies routinely used in teaching and research will be those donated specifically
for these purposes. The use of unclaimed bodies will be viewed as ethically
It should be noted that this statement reflects an ethical rather than a legal position. In
many jurisdictions the use of unclaimed bodies remains legal, but this does not abjure
anatomists from arguing that a more appropriate ethical path is that of bequests.
Anatomists should never rest easy in the knowledge that they are acting legally,
regardless of the nature of the legal position. Ultimately, they are moral agents who
have to take responsibility for the work they are doing and the resources they are
A second strand within the Recommendations is that the donation of bodies is to
proceed within a non-commercial context. Human bodies and body parts are to be
donated altruistically. For-profit companies are not to be involved, since human
material is not to be sold (Champney, 2015). While charging for real costs raises no
ethical strictures, the distinction between real costs, payment and profit is a vexed
area. Expectations will vary enormously and negotiations between parties that are not
based on trust and honesty may degenerate into little more than a morass of
profiteering. This, in turn, is a recipe for public distrust of anatomists and the
anatomical profession, and distaste for what they are suspected to be involved in.
Without scrupulous oversight of all anatomical procedures, both administrative and
academic, anatomists could find themselves depicted as outlaws of respectable
society, as was the case in some instances in the early-mid nineteenth century
(Richardson, 2001; MacDonald, 2010). That would do a great disservice to the cause
of anatomy in both the dissecting room and the research laboratory, and would also
denigrate the efforts of most anatomists who function according to impeccable ethical
A third strand stemming from these values is that all involved in the donation contract
are to be treated with respect. This has implications for the way in which the families
of donors are brought into the negotiations from the earliest stages through to the
death of the donor and the burial or cremation of the remains and possibly return of
the ashes. The details will vary depending upon cultural requirements and legal
stipulations. What matters is that there is transparency so that families know what is
happening. This will include providing criteria for rejecting bodies, what bodies will
be used for, and the length of time body parts will be retained. There may also be
demanding situations where immediate family members disagree on the donation or
on return of the ashes. Care is required that the anatomy department and its
representatives are seen to be acting in accordance with the Human Tissue Act under
which they are operating, but also with due care for the feelings and grief of close
relatives even when the problem stems from family disharmony.
These concerns for the family of the loved one have led to the institution of
thanksgiving services and commemorations. While these take a myriad forms
reflecting vast divergences in culture, religious stance and worldview, they share
common ground in their desire to acknowledge the inestimable gift of the donations.
In doing this students and staff who have benefitted show their respect for this gift,
and join with those responsible for providing it the families and friends of the
donors as they reflect on the donors themselves. The wider community is also
involved, from the institution that assists financially in making the donation process
possible, to the surrounding society in providing a suitable legal context for the
donation of bodies for teaching and research. It is appropriate, therefore, that students
are instructed in the ethical reasoning behind donations, and the ways in which they
are to behave when dissecting and dealing with any human material. There should be
no question about students (and staff) behaving inappropriately in the dissecting room
if they have been inducted into seeing dissection as an ethical activity in which all are
responsible participants (Kahn and Gardin, 2015).
Points requiring further deliberation
Body bequests have generally been thought of in terms of providing bodies for use in
the region where they were donated. While the ‘region’ may vary considerably, it has
usually been within the country in question or within the state. It is often assumed that
those donating their bodies wish to assist those with whom they have dealings. While
this may apply most obviously to the training of students, even research uses appear
to be on the part of researchers working locally. It may be objected that restrictions
along these lines are over interpreting donors’ motives, and are reading more into
them than can be justified. However, until this is shown to be the case, care needs to
be taken to ensure that bodies are not distributed more widely than provided for by the
consent of the donor and the expectations of family members. Care is also required to
check that legal stipulations are not breached, particularly where bodies are
transported across national borders.
The latter raises interesting ethical questions for anatomists and anatomy schools
where bodies from other countries are being used in the dissecting room. What is the
provenance of these bodies? How much is known about them, whether clinical
history, consent provided for the donation, and the donors’ expectations as to what
will be done to and with the bodies? These are not merely theoretical questions, but
are seminal to involving the students in ethical discussions as developing health
Donor anonymity has been central to dissecting room practice for many generations in
many countries. The Recommendations continue to advocate this practice, and yet no
rationale is provided. It is not accepted in some religious cultures where the family is
integral to the dissecting process, in that they hand over their deceased family member
whose relationship to the family is known and celebrated (Winkelmann and Gulder,
2004; Lin et al., 2009; Subasinghe and Jones, 2015). This has led to the concept of
cadavers as teachers, a concept that is spreading to other cultures, where the notion of
cadavers as first patients is gaining acceptance. In spite of these developments, there
has been no substantial debate on the merits or otherwise of these concepts, nor on
their ethical base. The breadth of informed consent would also have to be investigated
to assess how it would function in this new environment within pluralist and secular
A topic taken up in one of the papers in this collection is that of taking images of
cadavers and body parts (Cornwall et al., 2015). While Cornwall has opened up what
he views as a growing area of concern within the digital era, the Recommendations
simply decree their inappropriateness in general. It is evident from Cornwall’s paper
that the opportunities for taking and spreading images have increased exponentially
and in an uncontrolled manner over the last few years. This is a debate that has barely
begun, and the in-depth discussion that needs to be held will have to be informed by
serious ethical analysis of its features. Banning taking images will not, and should not,
satisfy anatomists, unless supported by clear reasoning, and informed by the views of
potential donors and their families. Ultimately, there is no way of separating the
taking of images of bodies and body parts from knowing how the bodies were
obtained in the first place. If the bodies were unclaimed, who is to object to taking and
promulgating images since there is no one to contend for their remaining interests or
those of their (unknown) families?
Even in well-regulated institutions there are frequently unclear aspects to the bequest
process. How long can bodies or body parts be kept? Legislations vary, with some
stipulating time limits and others being more openended. Regardless of the precise
guidelines, issues arise with plastinated specimens and museum pieces, which may be
intended to contribute to ongoing museum collections. Along with these issues there
is the question of the disposal of such remains, especially plastinated ones. These
raise questions around institutional procedures covering record keeping, conservation,
and tracking of body parts and even tissue sections. Once again, there may be
different ways of coping with these challenges, but the message of this special issue
of Clinical Anatomy has been that their resolution has ethical dimensions.
Outstanding questions
Discussions along the lines of this paper as well as of most of those in this issue raise
questions that have been little debated in the literature. While I have largely confined
my attention to the IFAA Good Practice Recommendations in this paper, a number of
them lend themselves to ongoing analysis. These were touched upon in the preceding
section. In additon to these, there are further issues that have featured to only a very
limited extent in the anatomy/ethics literature. I shall do no more than outline these
for future discussions.
First, should bodies bequeathed to Anatomy Departments be available for research as
well as teaching? If they are to be available for research, should additional consent be
required at the time the bequest is made? Assumptions are currently made that this is
the case, and the public appears to have a very broad view of what constitutes
‘research’ (Fennell and Jones, 1992), but clarity and transparency would be good
How much should those interested in bequeathing their bodies be told about what will
be done to their bodies in the Dissecting Room? In other words, should consent
involve a detailed run down of the dissecting room processes? Is this unnecessary?
Books and a film have specified what happens and there is no evidence that they have
done any damage to the donation ethos (Hafferty, 1991; Carter, 1997; Montross,
2007; Trotman, 2011).
Should TV cameras be allowed into the Dissecting Room (with appropriate
stipulations). If not, why not? This has been done (Trotman, 2011) and the resulting
film was very favourably received. It is one means of breaking down the mystique of
the Dissecting Room (and perhaps of Anatomy), and once again one needs to enquire
whether there are convincing ethical reasons to keep it this way. This query is related
to the question of the public display of plastinated and dissected bodies, about which
there have been numerous responses (see Jones, 2015).
Should Anatomical museums continue to display specimens that were obtained many
years ago without consent? This introduces the matter of the use of archival material
(Jones et al., 2003). While there has been considerable debate on this matter,
especially in relation to indigenous skeletal remains, it has not featured prominently in
the anatomical literature.
In another paper in this special issue, I have asked the question whether plastinates
with all their various uses have improved the ethical standing of Anatomy, or have
they done it ethical damage (Jones, 2015)? While the major spotlight has been placed
on the public exhibitions of whole body plastinates, it is of more general applicability
across anatomy. This is because plastinated material a far more permanent character
than material prepared using more conventional fixation techniques.
IFAA Recommendations and the future
Against this background of some of the features of the IFAA Recommendations two
questions emerge:
Should the IFAA be formulating a definitive position regarding human exhibitions
such as Body Worlds?
Should the IFAA be considering the possibility of establishing guidelines to assist
countries currently dependent upon the use of unclaimed bodies arrive at appropriate
legislation regarding the treatment of human remains?
As attempts are made to address these questions, policy makers will be confronted
with the question of how much compromise to accept on practices that are thought to
be ethically substandard or unacceptable? What degree of pragmatism is in order on
the path to more acceptable policies? These are questions for ongoing discussions by
the IFAA and anatomy departments worldwide.
Carter AH. 1997. First Cut: A Season in the Human Anatomy Lab. New York:
Champney TH. 2015. The business of bodies: Ethical perspectives on for-profit body
donation companies. Clin Anat. this issue.
Cornwall J, Callahan D, Wee R. 2015. Ethical issues surrounding the use of images
from donated cadavers in the anatomical sciences. Clin Anat. this issue.
Fennell S, Jones DG. 1992. The bequest of human bodies for dissection: A case study
in the Otago Medical School. NZ Med J 105: 472-474.
Hafferty FW. 1991. Into the Valley: Death and the Socialization of Medical Students.
New Have: Yale University Press.
IFAA. 2014. Recommendations of good practice for the donation and study of human
bodies and tissues for anatomical examination. Plexus (Newsletter of the international
Federation of Associations of Anatomists). August 2014.
Jones DG. 2015. The public display of plastinates as a challenge to the integrity of
anatomy. Clin Anat. this issue.
Jones DG, Gear R, Galvin KA. 2003. Stored human tissue: An ethical perspective on
the fate of anonymous, archival material. J Med Ethics 29: 343-347.
Jones DG, Whitaker MI. 2012. Anatomy’s use of unclaimed bodies: Reasons against
continued dependence on an ethically dubious practice. Clin Anat 25: 246-254.
Kahn PA, Gardin TM. 2015. A student proposal for ethical guidelines in anatomical
education: ethical and policy considerations. Clin Anat. this issue.
King MR, Whitaker MI, Jones DG. 2014. I see dead people: Insights from the
humanisites into tehnatire of plastinated cadavers. J Med Humanit 35:361-376.
Lin SC, Hsu J, Fan VY. 2009. "Silent virtuous teachers": Anatomical dissection in
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MacDonald H. 2010. Possessing the Dead. Melbourne: Melbourne University Press.
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Subasinghe K, Jones DG. 2015. Human body donation programs in Sri Lanka: A
Buddhist perspective, Anatomical Sciences Education, online March, DOI
Trotman P. 2011. Donated to Science. Dunedin, New Zealand: PRN Films. Available
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... The International Federation of Anatomists (IFAA) recommends that obtaining human material for teaching should occur through body donation programs, replacing the use of unclaimed bodies for this purpose [9][10][11][12] . Moreover, among the good practices recommendations of this federation to guide the adequate operation of body donation programs (BDPs) for scientific purposes, is the use of a term of donation that contains the notarized signature, as a form of consent of the donor who registers it during one's lifetime 12 . ...
... BDPs organized in different HEIs, distributed in the Northeast (6), Midwest (4), North (1), South (11), and Southeast (17) regions. ...
... Then, generally, all terms of donation were appraised by the Institutional Legal Department. Although donation for scientific purposes is provided for in federal legislation18 , the BDP registration as a university extension activity can guarantee users (internal and external academic community) not only compliance with institutional protocols, but also the transparency of the process, ensuring that good practices be followed when carrying out the BDP activities, in accordance with national and international recommendations10,11 . An opinion fromthe Research Ethics Committee (REC) is not required for the creation of the BDP and the respective associated extension actions. ...
Full-text available
Introduction: International recommendations reinforce the practice of voluntary donation for providing bodies for the training of health professionals, replacing the system of unclaimed bodies in medical courses (MC). Experience report: This work gathered information on Brazilian body donation programs (BDP), analyzed gaps and difficulties to the effectiveness of body donation, and proposed strategies to expand the information offered on the registration of participants in BDP and the effectiveness of the donation. Discussion: In Brazil, there are 39 BDP - six in the Northeast, four in the Midwest, one in the North, 11 in the South, and 17 in the Southeast - and two committees for body donation. Documents may be easily available through registration during life as a participant in the BDP, but it does not guarantee donation. In general, Brazilian’s institutions receive the donated body along with the documentation. When the death occurs in the same city of the institution, it is possible to have the transfer of the body provided by partnerships with funeral services and the city hall. There is no fee to be paid or received either for registration during life or for donation after death. Conclusion: Although the legislation has regulated the donation of body in life since 2002, it is necessary to implement campaigns to inform about the donation, in addition to mechanisms that can promote speed in the deadlines for obtaining documentation for the purpose of donating body for scientific purposes, the exemption of notary fees and the possibility of transporting the body donated with no fees by funeral home of municipal governments. The MC support through the registration of the PDC as an extension activity collaborates to ensure ethical aspects related to the participation of donors in the living program, with regard to the treatment with respect and dignity of donors and their families.
... Considering the extent by which body donors are being sent worldwide to meet the demand over the globe and the moral and ethical implications of such trade (Champney et al. 2019), it is important that requests for human material be placed or redirected to local body donation programs. Despite the broad regulation spectrum across countries and jurisdictions, moral and ethical considerations should always prevail (Jones 2016). Moreover, resources and support should be invested in helping countries and jurisdictions in need to build their own body donation programs instead of relying on international programs promoting commercialization of bodies. ...
... Many institutions struggle to maintain their body donation programs, as some might view the use of body donors as an outdated tool that is expiring and becoming redundant. The science community shares some of the responsibility of these views as little to no research has been dedicated to improving and revolutionize the gift that is left by body donors (Jones 2016). As a community, we owe it to our donors to dedicate resources that will help bridge the gap between the traditional ways of working with body donors and the modern-day needs as discussed in the tips above. ...
Full-text available
Human body donors selflessly decided to make the ultimate gift to donate their bodies to education. Being on the receiving end, the health sciences education community owes it to the donors to ensure that they are being treated with utmost respect by promoting and developing high ethical standards and maximizing the benefits from this gift. Working with human body donors for research purposes has increased over the years, while regulations associated with these processes did not change. This article draws upon current literature and author’s experiences to offer practical tips for health educators and everyone working with body donors to achieve these goals. We offer 10 practical tips that help in starting the conversation about the best ways to work with body donors to maximize their contribution to health sciences education.
... Post-mortem donation to science (PDS) is a sensitive topic for many people, especially in strongly religious countries [16]. PDS is favored by i) a comprehensive legislation with opt-in and opt-out systems [16][17][18][19]; ii) a donor registry, as exists in Mexico for post-mortem organ donation (POD) [20]; iii) economic benefits or other benefits to society [17]; and iv) a well-educated population that is well-informed on the topic [21,22], and extensive practical regulations and guidelines [23][24][25][26][27][28][29]. In studies among registered whole-body donors, informal communication between family and friends seemed important to raise awareness [21,30,31]. ...
Full-text available
Background Voluntary post-mortem donation to science (PDS) is the most appropriate source for body dissection in medical education and training, and highly useful for biomedical research. In Mexico, unclaimed bodies are no longer a legal source, but PDS is legally possible, although scarcely facilitated, and mostly ignored by the general population. Therefore, we aimed to evaluate the attitude and willingness for PDS and to identify a sociodemographic profile of people with willingness toward PDS. Methods A validated on-line survey was distributed by the convenience method via the social networks of a Catholicism-inspired, private university in northern Mexico. Frequency analyses of all variables and coded free comments were complemented with association studies. Results Although the responder cohort (n = 143) was too small and biased to be representative of the university community (n = 13,500), willingness to post-mortem organ donation was 90.7% and to PDS 70.7%. In this cohort, PDS willingness had the strongest association with mature age (> 40 years old; P, 0.0008). Among young adults, willingness to PDS was the lowest among volunteers from technical and business schools and the highest among those from the social sciences (P, 0.009). Respondents from the social sciences were also the most consistent between attitude and behavior with respect to organ donation. A free comment option revealed respondents were interested in the unusual taboo topic. Conclusions A small, but sufficiently large proportion expressed willingness toward PDS. In our university cohort, which was biased in higher education and altruism, mature age and social interest were associated with PDS willingness.
... A Federação Internacional de Associações de Anatomistas (International Federation of Associations of Anatomists, Ifaa) recomenda que a obtenção de material humano para o ensino deve ocorrer por meio de programas de doação de corpos (PDC), substituindo a utilização de corpos não reclamados para essa finalidade [9][10][11][12] . Além disso, entre as recomendações de boas práticas dessa federação para orientar o adequado funcionamento dos PDC para fins científicos, está a utilização de um termo de doação que contenha a assinatura reconhecida em cartório, como forma de consentimento do doador que se cadastra em vida 12 . ...
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Resumo: Introdução: As recomendações internacionais reforçam o estímulo à prática da doação voluntária para a disponibilidade de corpos destinados à formação de profissionais de saúde, substituindo o sistema de corpos não reclamados nas instituições de ensino superior (IES). Relato de experiência: Este trabalho reuniu informações sobre programas de doação de corpos (PDC) brasileiros, analisou lacunas e fatores impeditivos à doação do corpo, e propôs estratégias para ampliar as informações sobre o cadastro de participantes em PDC e a efetivação da doação. Discussão: No Brasil existem 39 PDC em funcionamento - seis no Nordeste, quatro no Centro-Oeste, um no Norte, 11 no Sul e 17 no Sudeste - e duas comissões de distribuição de corpos para ensino. O cadastro como participante no PDC pode agilizar as providências documentais, mas não garante a doação na ocasião da morte. No geral, as IES recebem o corpo doado e a documentação necessária. Quando o óbito acontece no município da IES, é possível ter o translado do corpo providenciado por parcerias com funerárias e prefeitura. Conclusão: Embora a legislação tenha regulamentado desde 2002 a doação do próprio corpo em vida, é necessária a implementação de campanhas de esclarecimento à população geral sobre essa possibilidade, além de mecanismos que possam promover a celeridade nos prazos de para obtenção das documentações com a finalidade de doação de corpo para fins científicos, a isenção das taxas cartoriais e a viabilização do translado do corpo doado por carro de funerária das prefeituras, sem custo. O apoio da IES por meio do cadastro do PDC como atividade de extensão universitária colabora para assegurar aspectos éticos relacionados à participação dos doadores no programa em vida, no que se refere ao tratamento com respeito e dignidade dos doadores e de suas famílias.
... 6 Extensive ethical guidelines are in place not only for the donation of bodies, but also for every aspect of their use, transfer, storage, and disposal. [6][7][8][9] Furthermore, academic institutions have set in place ethical standards to be maintained in the GAL including limiting entrance into the GAL to enrolled students, prohibiting any photography in the GAL, and ensuring appropriate maintenance and handling of the cadavers. [10][11][12] Today, medical schools in the United States incorporate a significant amount of ethical education into their anatomical dissection courses. ...
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OBJECTIVES Cadaver dissection has become the gold-standard for anatomical education in US medical schools. Ethical issues regarding cadavers may not be as obvious as in living patients, which can lead to their potential neglect in medical school curricula. In this study, we assessed the different ethical concerns (ECs) of medical students regarding cadavers in the gross anatomy lab (GAL), gathered student information, including self-reported academic performance (AP) in the GAL, and determined the best predictors for a student's EC. METHODS All second-year medical students at the University of Toledo were invited to complete an anonymous, online-survey. Participants were presented with 10 hypothetical but realistic lab scenarios and asked to rate their EC for each on a 5-point Likert scale. Gender, age, and scores received in the GAL course were also collected. A multiple linear regression model was used to find the best predictors of the total EC score. RESULTS A total of 112 (63%) responses to the online-survey were recorded. The highest EC was for Q7: Taking pictures of the cadaver. The lowest EC was for Q10: The dissection of cadavers itself is an EC. Gender was the best predictor of total EC, followed by age. Female total EC was significantly higher than that for males (35.8 ± 5.5 vs 33.1 ± 7.9). Female scores for Q1 and Q2 were significantly higher than those for males. Total EC for students in the age group 25 to 34 was significantly higher than those in the age group 18 to 24 (35.9 ± 6.1 vs 33.9 ± 7.2). No significant difference was found for individual scenarios. AP was not significantly related to the total score or the scores of the individual scenarios. CONCLUSION The significant differences in ECs of medical students found in our study indicate that not all students have the same outlook towards the GAL specifically and ECs generally.
... As far as we know, there are no similar legislative provisions in other countries. Normative references on the management of cadavers tend to be formulated with general or forensic pathology activities in mind, which typically involve small numbers of users (Jones, 2016;Pallocci et al., 2020). Applying the same stringent legislation to training activities involving large groups of learners poses numerous organizational problems, however. ...
Introduction Recent Italian legislation (Law No. 10/2020) establishes the legal, ethical and technical requirements governing how individuals can donate their bodies or tissues post-mortem for study, training, and scientific research purposes. A ministerial working group has recently approved some of the law's implementing rules relating to technical issues. Materials and Methods The rules for implementing the new legislation, retrieved from the legal databases and translated into English, are discussed. Results For the first time in Italy, the law establishes compulsory requirements and minimum characteristics - in terms of logistics, safety, availability of staff, space, and equipment - for institutions to be recognized as reference centers for the conservation and use of bodies and tissues donated post-mortem for study, training and scientific research purposes. This makes it possible to standardize the features of such reference centers nationwide, and to coordinate their activities and potential future development, while ensuring basic operational efficiency and workplace safety, the provision of adequate facilities, buildings and equipment, and staff training. Conclusions The law and its implementing rules discussed here are the first to establish criteria and compulsory requirements for centers receiving body and tissue donations in Italy. This is a step forward for the whole anatomy community, providing practical guidelines for body donation programs and related facilities in other countries too.
... Informed consent is a central theme within the history of anatomy and an essential requirement for best ethical practice (Jones, 2016). A concerted effort within the anatomy community has been directed towards providing human remains for teaching and research which have been sourced from donors (Habicht et al., 2018). ...
Background The use of 21st Century technology in anatomy teaching and the recent crisis caused by the Coronavirus pandemic has stimulated anatomists to ponder the ethics surrounding the utilisation of digital images from human bodies of known and unknown provenance in teaching. Aim This novel study explores the awareness of southern African anatomy educators regarding the provenance and ethical use of human material in digital resources for E-learning purposes. Materials and method Anatomy educators (both members and non-members of the Anatomical Society of Southern Africa including postgraduate students in anatomy) located in 15 health sciences facilities in southern Africa were asked to participate in the survey which consisted of an anonymous, cross-sectional, questionnaire conducted on an online research data system, REDCap. Results While 52% of respondents used E-learning resources sourced from their own departments for teaching, only 58% of these had knowledge of the provenance of the human material used. Of the 72% of respondents using images from external E-learning resources, 64% did not know the provenance of the human material in these resources. Some southern African anatomists considered anonymity as equivalent to informed consent. Regarding the acceptability of unclaimed bodies for online images, 37% of respondents were against the use of these bodies, while 20% indicated that it was acceptable. Personal internal moral conflict was acknowledged regarding the use of material from unclaimed bodies, particularly during crises such as the Coronavirus pandemic when digital resources were limited. Discussion and Conclusions Factors such as lack of awareness of provenance, the law in South Africa and using anonymity for consent, influence the ethical behaviour of southern African anatomists. Clear guiding principles would be of value for anatomists globally with respect to consent to the taking and distribution of images, and transparency on the source of the digital images provided in digital texts and online platforms. The establishment of both an oversight and ethics committee at institutions where digital imaging will be used is recommended.
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Anatomy is the study of structure of human body. Dissection of human cadavers has always been an integral part of study of anatomy as well as research in it. Till now the only source for cadavers for dissection purposes were unclaimed bodies. Today the need for bodies for medical education has increased and most medical schools are experiencing difficulties in procuring the requisite number of cadavers. Body donation programs may help fulfil this need of the medical schools. The present study was an attempt to analyze the attitude of the anatomists towards different aspects of body donation. 24.7% of the participants stated that they have insufficient cadavers, 12.3% claimed surplus cadavers while 62.8% claimed sufficient cadavers. 26% of the anatomists were unaware of the necessity for a death certificate and 35% were unaware of the necessity for a unique identification document for carrying out body donation.
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Anatomy has been thrust into the public domain by the highly successful public displays of dissected and plastinated human bodies. This is anatomy in modern guise, anatomy as perceived by the general public. If this is the case, the message it is giving the public about the nature of anatomy is that it is an impersonal analysis of the human body of value within a medical and health care environment. While this is in part true, and while it reflects important aspects of anatomy's history, it fails to reflect the humanistic strands within an increasing swathe of contemporary anatomy. These are manifested in growing recognition of the centrality of informed consent in the practice of anatomy, awareness of the personal dimensions and relationships of those whose bodies are being dissected, and manifested in thanksgiving ceremonies involving staff and students. The notion that the bodies undergoing dissection can be students' first teachers and/or patients is gaining ground, another indication of the human dimensions of the anatomical enterprise. Exhibitions such as Body Worlds ignore these dimensions within anatomy by dislocating it from its clinical and relational base. The significance of this is that loss of these dimensions leads to a loss of the human face of anatomy by isolating it from the people whose body bequests made this knowledge possible. What is required is greater transparency and openness in the practices of all who deal with the dead human body, trends that owe much to the writings of scholars from within a range of humanities disciplines as they have responded to the public displays of dissected plastinated bodies. Anatomists have much to learn from these debates. This article is protected by copyright. All rights reserved.
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Considerable attention is being given to the availability of bodies for anatomical education. This raises the question of the manner in which they are obtained, that is, whether they are unclaimed or donated. With increasing emphasis upon the ethical desirability of using body bequests, the spotlight tends to be focused on those countries with factors that militate against donations. However, little attention has been paid to cultures where donations are readily available. One such country is Sri Lanka where the majority of the Buddhist population follows Theravada Buddhism. Within this context, the expectation is that donations will be given selflessly without expecting anything in return. This is because donation of one's body has blessings for a better outcome now and in the afterlife. The ceremonies to honor donors are outlined, including details of the "Pirith Ceremony." The relevance for other cultures of these features of body donation is discussed paying especial attention to the meaning of altruism and consent, and justification for the anonymization of cadavers. The degree to which anatomy is integrated into the surrounding culture also emerges as significant. Anat Sci Educ. © 2015 American Association of Anatomists. © 2015 American Association of Anatomists.
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The use of unclaimed bodies has been one of the distinguishing features of the anatomy profession since the passing of nineteenth century legislation aimed at solving the problem of grave robbing. Only in more recent years has the use of bequeathed bodies supplanted dependence upon unclaimed bodies in many (but not all) countries. We argue that this dependence has opened the profession to a range of questionable ethical practices. Starting with contraventions of the early Anatomy Acts, we trace the manner in which the legitimacy of using unclaimed bodies has exposed vulnerable groups to dissection without their consent. These groups have included the impoverished, the mentally ill, African Americans, slaves, and stigmatized groups during the Nazi era. Unfortunately, ethical constraints have not been imposed on the use of unclaimed bodies. The major public plastination exhibitions of recent years invite us to revisit these issues, even though some like Body Worlds claim to use bequeathed bodies. The widespread use of unclaimed bodies in institutional settings has lent to these public exhibitions a modicum of legitimacy that is needed even when donated bodies are employed. This is because the notion of donation has changed as demonstrated by consideration of the principles of beneficence and non-maleficence. We conclude that anatomists should cease using unclaimed bodies. Difficult as this will be in some cultures, the challenge for anatomists is to establish relationships of trust with their local communities and show how body donation can assist both the community and the profession.
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Steven C Lin, Julia Hsu, and Victoria Y Fan describe how the dissection course at Tzu Chi College of Medicine in Taiwan has motivated and inspired people to donate their bodies for scientific endeavours, an otherwise culturally avoided gesture in the East Dissection is a core component of gross anatomy in medical education worldwide. Human dissection provides an opportunity to learn about the human body in three dimensions and, more recently, a chance to introduce medical students to humanistic approaches to confronting death. At least two challenges exist in creating and offering a successful dissection course. The first is having sufficient numbers of people donate their bodies. In Taiwanese society there is a belief that cadavers should not be disturbed after death. People have therefore been unwilling to donate their bodies for medical purposes that require that their bodies be handled after death (for example, for dissection, organ transplantation, and autopsies), leading to cadaver shortages. Consequently, medical schools in Taiwan have historically depended on unclaimed bodies from mental institutions or the streets. The second challenge is ensuring that students treat cadavers with due respect, and thereby develop humanistic values, which may prove useful in coping with stressful emotions. We describe how the dissection course at Tzu Chi College of Medicine has navigated around these cultural concerns surrounding death, to the benefit of medical students, body donors, and their families. We analyse the humanistic effects of this course on students, as well as on donors and their families, by drawing on examples of participant observation and students' reflections in Chinese language literature. We suggest that the design of this curriculum fosters accountability and offers inspiration that may have otherwise been omitted through cadaver anonymity.
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To explore why and by whom body bequests to the Otago Medical School have been made since the 1960s. We sent out a questionnaire to people who have bequeathed their bodies to the medical school, the people being randomly selected on the basis of the inclusion of the initial J in a forename. The questionnaire sought information on sex, marital status, age, occupation at the time of bequest and bequest information source, as well as reasons for the bequest, expectations of cadaver use and attitudes towards organ donation. The most common reasons for making a bequest were--to aid medical science, and gratitude to the medical profession. There was, however, widespread confusion between cadaver use for medical teaching and for research. These center around the ethical implications of our findings for organ donation and attitudes towards usage of the dead body.
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The furore over the retention of organs at postmortem examination, without adequate consent, has led to a reassessment of the justification for, and circumstances surrounding, the retention of any human material after postmortem examinations and operations. This brings into focus the large amount of human material stored in various archives and museums, much of which is not identifiable and was accumulated many years ago, under unknown circumstances. Such anonymous archival material could be disposed of, used for teaching, used for research, or remain in storage. We argue that there are no ethical grounds for disposing of the material, or for storing it in the absence of a teaching or research rationale. Nevertheless, with stringent safeguards, it can be used even in the absence of consent in research and teaching. Regulations are required to control the storage of all such human material, along the lines of regulations governing anatomy body bequests.
Human cadavers are a scarce resource that have educational, research and clinical value. While the tissues have great value, it is illegal in many countries to pay for them. In the United States, a number of for-profit body acquisition companies have been established over the past decade. These companies obtain bodies which were donated by the individuals or their families. The companies distribute the specimens to surgical training organizations, researchers and educational institutions. These businesses do not charge the receiving organizations for the bodies; they do, however, charge a fee that covers the transport, handling and other services which creates a profit for their companies. These types of businesses are described and analyzed as to whether they constitute an ethically appropriate mechanism to obtain and distribute bodies. The role of organizations and governments in establishing policies and regulations for the appropriate treatment of human remains is addressed. Recommendations are given for best practices in the ethical use and regulation of willed bodies. This article is protected by copyright. All rights reserved.
Body donor programs rely on the generosity and trust of the public to facilitate the provision of cadaver resources for anatomical education and research. The uptake and adoption of emerging technologies, including those allowing the acquisition and distribution of images, are becoming more widespread, including within anatomical science education. Images of cadavers are useful for research and education, and their supply and distribution have commercial potential for textbooks and online education. It is unclear whether the utilization of images of donated cadavers are congruent with donor expectations, societal norms and boundaries of established public understanding. Presently, no global 'best practices' or standards exist, nor is there a common model requiring specific image-related consent from body donors. As ongoing success of body donation programs relies upon the ethical and institutional governance of body utilization to maintain trust and a positive relationship with potential donors and the community, discussions considering the potential impact of image misuse are important. This paper discusses the subject of images of donated cadavers, commenting on images in non-specific use, education, research, and commercial applications. It explores the role and significance of such images in the context of anatomical science and society, and discusses how misuse - including unconsented use - of images has the potential to affect donor program success, suggesting that informed consent is currently necessary for all images arising from donated cadavers. Its purpose is to encourage discussion to guide responsible utilization of cadaver images, while protecting the interests of body donors and the public. This article is protected by copyright. All rights reserved.
The recent publication of a story regarding anatomical dissection in a medical school has revealed the need for increased attention to the ethical and policy aspects of anatomical education. While most of the attention devoted to these questions thus far has been focused on procedures before and after dissection, from the perspective of medical students, there are important considerations during the process of dissection itself. This proposal was developed by two third-year medical students through a review of the relevant published literature, reflection upon their personal experiences in anatomy courses in two separate institutions, and informal discussion of these topics with peers. The proposal is that basic ethical guidelines should be established and monitored by an independent committee tasked with reviewing them. The proposed guidelines include: First, a clear set of expectations about what the student is expected to learn with respect to anatomical knowledge and dissection technique; second, the establishment by schools or national bodies of minimal ethical standards regarding respectful behavior toward the donor bodies, and the communication of these standards to teachers and students involved in educational dissections; third, the use of materials that encourage students to view their donors with respect and ensure proper treatment of them; and fourth, the establishment of an oversight group (at each medical school and at national level) comprising students, faculty, community members, and staff, who will regularly review the anatomical education program and update these ethical guidelines as appropriate. While many of these proposals are already implemented in some anatomy departments, the establishment of clear guidelines at a national as well as a school-by-school level will permit students the freedom to participate fully in their education, knowing they have met the highest ethical standards as they prepare for a career as a humanistic physician.