An ethical solution to the challenges in teaching anatomy with dissection in the Chinese culture

Universities and medical schools in China are faced with an ongoing shortage of cadavers for education and research because of insufficient numbers of cadaver donations. This article will examine the main obstacles to cadaver donation in the Chinese culture. These include superstitious traditional views about the body, a lack of legislation regulating donations, and a deficiency of effective channels for cadaver donations. Cadaver dissection has always been the most important method of teaching anatomy to medical students. Today, ethics courses have also become essential to a complete medical education. Contemporary physicians need to be equipped to navigate the myriad of moral and ethical issues inherent to modern medicine. In China, cadaver donations lag behind those in other countries, threatening to create valid disadvantages in medical education. New legislation and public education are necessary to remove cultural barriers and change Chinese views on cadaver donation. For this reason, the Department of Human Anatomy at Nanjing Medical University has established the “Educational Center for Medical Ethics.” The goal of the Center is to promote proper respect for cadavers used for medical research and education, cherish the human lives the cadavers represent, and gain the trust of potential donors. Anat Sci Ed 1:56–59, 2008. © 2008 American Association of Anatomists.     

A shortage of cadavers: The predicament of regional anatomy education in mainland China

Both in mainland China and around the world, regional anatomy stands as one of the most important basic science courses in medical school curricula. As such, dissection of human cadavers and use of prosected specimens remains the most essential teaching method in anatomy education. However, medical educators have raised increasing concerns about an ongoing shortage of cadavers for medical use in mainland China, a problem which may seriously limit the future development of human anatomy education. Based on a survey on cadaver usage in anatomy education in mainland China, this study found that the cadaver resources of most given medical schools in mainland China are associated with their geographic location, academic ranking, and local support for body donation policies. Effective measures to alleviate this shortage of cadavers may include future efforts to promote national‐level body donation legislation, broader acceptance of body donation among Chinese citizens, and an efficient and humane protocol for body donation. Anat Sci Educ 11: 397–402. © 2018 American Association of Anatomists.     

The wider importance of cadavers: Educational and research diversity from a body bequest program

The debate surrounding the use of cadavers in teaching anatomy has focused almost exclusively on the pedagogic role of cadaver dissection in medical education. The aim of this study was to explore the wider aspects of a body bequest program for teaching and research into gross anatomy in a University setting. A retrospective audit was undertaken on body donation and the use of cadaver specimens for teaching and research at our institution between 1876 and 2009. The body bequest program, first established in 1943, now receives more than 40 donations per year. In addition to the medical course, nine other University degrees and courses currently use cadaver specimens for gross anatomy; four of these are research degrees and the remainder undergraduate degrees and courses. The use of cadaver specimens by non‐University groups has also increased, particularly during the past decade, such that there are now 16 different groups using cadaver specimens for instructional courses; most of these are professional medical courses. The use of cadavers for both research and teaching may encourage a more evidence‐based approach to clinical anatomy. This unique audit, spanning more than a century of anatomy education within a single University Medical School, highlights the utility of a robust body bequest program and the wide range of students and health professionals who interact with this precious resource. Anat Sci Educ 2:234–237, 2009 © 2009 American Association of Anatomists.     

The dissection room experience: A factor in the choice of organ and whole body donation—A Nigerian survey

The psychosocial impact of human dissection on the lives of medical and health science students has been noted. To assess the impact of the dissection room experience on one's willingness to become a whole body and organ donor, the attitudes of 1,350 students and professionals from the medical, health, and non‐health related disciplines to body and organ donation were studied. The participants were broken into categories according to degree of exposure to human dissection. Participants who were never exposed to the dissection experience showed more willingness to donate their bodies than those who were exposed. With the exception of the physiotherapy department, the students and professionals from the health science departments who were exposed to the dissection room but never engaged in dissection showed the most unwillingness to donate their bodies (P < 0.001). An unwillingness to donate oneself was noted as one of the negative impacts associated with exposure to the dissection room. Willingness to donate an organ correlated positively with the level of exposure to the dissection room (P < 0.001). Most of the reasons for unwillingness were traceable to negative perceptions of the dissection room as a result of poor and disrespectful management of the human cadavers. Anat Sci Educ. 7: 56–63. © 2013 American Association of Anatomists.     

Dissecting the dissectors: Knowledge,attitude, and practice of body bequests by Nigerian anatomists

Anatomy education in most African countries is limited by an insufficient number of cadavers for students to undertake dissection. This already significant shortage is exacerbated by an increasing number of medical schools and students. Virtual dissections are impractical in alleviating such a shortfall in African anatomy education, and further cadaver supply is challenged by unethical and dubious sources. This study was designed to assess the knowledge, attitudes, and practice of whole body and organ donation by Nigerian anatomists with the aim of finding solutions to the problems associated with the availability of cadavers in Nigerian medical schools. Out of 46 anatomists that participated in the survey, only 23.9% would consider donating their whole bodies and 60.9% their organs. More than 95% of respondents did not believe that body bequests could become the sole source of cadavers for anatomic dissection in Nigeria. Age and gender were not statistically significant in the choice of being a body or organ donor. The unacceptability to one's family members regarding body donation was the major reason for respondents' unwillingness to make a whole body donation. None of the 14 medical schools sampled in this study have yet instituted a body registration and donation program. The anatomists showed a high level of knowledge and awareness of body bequest programs, which were not reflected by their attitudes and practice. The authors recommend proactive measures aimed at improving the perception and attitudes of Nigerian anatomists. Anat Sci Educ. © 2012 American Association of Anatomists.     

Current status of cadaver sources in Turkey and a wake‐up call for Turkish anatomists

Persisting difficulties in body procurement in Turkey led to the acquisition of donated, unclaimed, autopsied, and imported bodies regulated under current legislature. Yet, no study had investigated the extent of the on‐going cadaver problem. This study was aimed to outline cadaver sources in anatomy departments and their effectiveness by means of an online survey. Additionally, official websites of each department were investigated regarding any information on body donation. Unclaimed cadavers (84.8%) were the major source for anatomy departments, followed by donated (50%) and imported cadavers (39.1%). Foundation‐based medical faculties were more likely to import cadavers (P = 0.008). There was a moderate increase (r_s = 0.567; P = 0.018) in donation registrations to our department after 2000. The departments in cities with significantly higher City‐Based Gross Domestic Product measures (US$9,900 vs. US$16,772, P = 0.041), frequencies for mid‐ or high‐school graduates (30.4% vs. 31.3%, P = 0.041), and frequencies for under‐ or post‐graduates (13.1% vs. 15.8%, P = 0.24) had managed to use donated cadavers. Anatomy departments’ major reasons for using unclaimed cadavers were education (45.9%), unclaimed cadavers being the only source (24.3%), and receiving inadequate donations (21.6%). Nine out of seventy‐four departments (12.2%) provided information regarding body donation on their websites. Body procurement remains as a serious problem in Turkey and it is apparent that current legislature does not provide a sufficient cadaver inflow. Similarly, anatomy departments’ effectiveness in public awareness of body donation and support in the National Body Donation Campaign seems questionable. Anat Sci Educ 11: 155–165. © 2017 American Association of Anatomists.     

Assessing the Impact of a Ceremony in Honor of the Body Donors in the Development of Ethical and Humanistic Attitudes among Medical Students

Activities related to body donation programs, such as donor memorial ceremonies, provide the opportunity to complement student training, especially with regard to the ethical and humanistic elements involved in medical training. This study sought to assess the impact of a ceremony in honor of the body donors has on ethical and humanistic attitudes in medical students. Medical students were surveyed about their perceptions of changes in themselves, respect for donors and donor families, and their relationship with patients. The effect of the students' contact with the family of the donor was analyzed in students who had contact with the cadaver in the dissection room and had either participated or not participated in the donor memorial ceremony. A total of 370 questionnaires were answered by first-, second-, and third-year medical students at the Federal University of Health Sciences of Porto Alegre in 2017. The students who participated in the ceremony presented more positive responses in relation to commitment to their studies, reflection on death, and positive development of empathy when compared to those who did not attend the ceremony. Most of the students that attended the ceremony suggested the event led to an improvement in the doctor–patient relationship. These results suggest that cadaver dissection with accompanied memorial ceremony involving contact with donor families is an effective means of fostering ethical and humanistic attitudes among medical students from the beginning of the course.     

The histopathologic reliability of tissue taken from cadavers within the gross anatomy laboratory

The purpose of this study was to examine the histopathologic reliability of embalmed cadaveric tissue taken from the gross anatomy laboratory. Tissue samples from hearts, livers, lungs, and kidneys were collected after the medical students’ dissection course was completed. All of the cadavers were embalmed in a formalin‐based fixative solution. The tissue was processed, embedded in paraffin, sectioned at six micrometers, and stained with H&E. The microscope slides were evaluated by a board certified pathologist to determine whether the cellular components of the tissues were preserved at a high enough quality to allow for histopathologic diagnosis. There was a statistically significant relationship between ratings and organ groups. Across all organs, there was a smaller proportion of “poor” ratings. The lung group had the highest percentage of “poor” ratings (23.1%). The heart group had the least “poor” ratings (0.0%). The largest percentage of “satisfactory” ratings were in the lung group (52.8%), and the heart group contained the highest percentage of “good” ratings (58.5%) The lung group had the lowest percentage of “good” ratings (24.2%). These results indicate that heart tissue is more reliable than lung, kidney, or liver tissue when utilizing tissue from the gross anatomy laboratory for research and/or educational purposes. This information advises educators and researchers about the quality and histopathologic reliability of tissue samples obtained from the gross anatomy laboratory. Anat Sci Educ 11: 207–214. © 2017 American Association of Anatomists.     

Altruism in death: Attitudes to body and organ donation in Australian students

Health education, research, and training rely on the altruistic act of body donation for the supply of cadavers. Organ transplantation and research rely on donated organs. Supply of both is limited, with further restrictions in Australia due to requirements for a next-of-kin agreement to donation, irrespective of the deceased's pre-death consent. Research suggests health workers are less likely to support the donation of their own bodies and/or organs, despite recognizing the public good of donation, and that exposure to gross anatomy teaching may negatively affect support for donation. Attitudes to body and organ donation were examined in Australian students studying anatomy. Support for self-body donation (26.5%) was much lower than support for self-organ donation (82.5%). Ten percent of participants would not support the election of a family member or member of the public to donate their body, and just over 4% would not support the election of a family member to donate their organs, with one-to-two percent not supporting this election by a member of the public. Exposure to gross anatomy teaching was associated with an increased likelihood of consideration of issues about body and organ donation, whether for self, family, or the public, and registration as an organ donor. Exposure decreased participants' willingness to donate their own body, with those who practiced a religion least likely to support body donation. Gross anatomy courses provide an opportunity to inform future healthcare workers about altruistic donation, albeit with a recognition that religious or cultural beliefs may affect willingness to donate.     

Evaluation of the willingness for cadaveric donation in Greece: A population‐based study

Despite the importance of body donation for medical education and the advancement of medical science, cadaveric donation remains suboptimal worldwide. The purpose of this study was to evaluate the willingness of body donation in Greece and determine the characteristics of donors. This cross‐sectional questionnaire survey was conducted from January to June 2011. A specially designed questionnaire was distributed to 1,700 individuals who were randomly selected from five major Greek cities. It was found that higher educational levels (P = 0.002), annual family income below 30,000 Euros (P = 0.001), guaranteed employment status (P = 0.02), and the presence of comorbid conditions (P = 0.004) seemed to affect potential donors' willingness for cadaveric donation. Those with strong religious beliefs were found to be unwilling to donate their bodies to medical science. Interestingly, the majority of participants who believed that hospitalized patients are deceived or are used for harmful experiments were willing to become whole body donors (P = 0.043). In Greece, the rate of body donation to medical science remains low, and most Greek citizens are not willing to become body donors. Efforts to encourage discussions about whole body donation should be implemented in order to improve current low levels of donation. Anat Sci Educ. © 2012 American Association of Anatomists.     

The Unintentional Effects on Body Donation Programs of a Competency-Based Curriculum in Postgraduate Medical Education

As medical programs place increasing importance on competency-based training and surgical simulations for residents, anatomy laboratories, and body donation programs find themselves in a position of adapting to changing demands. To better assess the demand for “life-like” cadaveric specimens and evaluate the possible impacts that competency-based medical education could have upon the body donation program of McGill University, Canada, the authors tracked, over the course of the last 10 years, the number of soft-embalmed specimens, along with the number of teaching sessions and the residents enrolled in competency-based programs that are using cadaveric material. The results reveal that the number of soft-embalmed specimens used within residency training increased from 5 in 2009 to 35 in 2019, representing an increase from 6% of bodies to 36.5% of the total number of body donors embalmed in this institution. Correspondingly, the number of annual teaching sessions for residents increased from 19 in 2012 to 116 in 2019. These increases in teaching are correlated with increasing number of residents enrolled in competency-based programs over the last 3 years (Pearson r ranging from 0.9705 to 0.9903, and R² ranging from 0.9418 to 0.9808). Those results suggest that the new skill-centered curricula which require residents to perform specific tasks within realistic settings, exhibit a growing demand for “life-like” cadaveric specimens. Institutions’ body donation programs must, therefore, adapt to those greater need for cadaveric specimens, which presents many challenges, ranging from the logistical to the ethical.     

An overview of the roles and responsibilities of Chinese medical colleges in body donation programs

The use of human tissue is critical for gross anatomy education in the health professions. Chinese medical colleges have faced a shortage of anatomical specimens over the past decade. While body donation plays an important role in overcoming this gap, this practice has only recently been introduced in China, and the donation rate is relatively low and fraught with a number of difficulties. In the past, traditional Chinese culture focused on preserving the human body intact, which often limited body donation. In recent years, the public has become more open toward body donation. At Nanjing Medical University, only 20 bodies were donated in 2001. After the university became involved in an organized body donation program, this number increased to 70 donated bodies per year (2007 to 2012). This article describes and reviews Chinese medical colleges as a special case study among body donation programs, particularly in terms of the multiple responsibilities and roles that such institutions must assume in the course of adopting these programs. Medical colleges in China must serve as advocates, coordinators, builders, managers, educators, and beneficiaries in undertaking body donation programs. It is important for medical colleges to recognize these pluripotent roles and educate the public in order to promote body donation programs. This case study may also effectively guide and encourage Chinese medical colleges in refining their own body donation programs in the future. Anat Sci Educ 7: 312–320. © 2013 American Association of Anatomists.     

Body donation in India: social awareness, willingness, and associated factors

With the attendant rise of the number of medical colleges in India over past few decades, the demand for cadavers used in medical education and research is growing. However, there is an insufficient supply of donated cadavers available for dissection. This study was undertaken to assess the general population's awareness of body donation programs and willingness to donate in the State of Maharashtra, India. The willingness of participants to donate was compared with age, gender, and education of the respondents. A total of 625 adult individuals from the State of Maharashtra participated in a survey composed of questions about age, sex, education, awareness of body donation programs, and willingness to donate. It was found that 90.9% of the medical colleges surveyed reported an inadequate supply of cadavers. Of the general population, 32.1% of respondents were aware of body donation, compared to 95.83% of health care professionals. However, only 19.5% of the general population and 44.9% of health care professionals were willing to donate their bodies for anatomical education. Younger age groups, males, graduates, and postgraduates were found more willing to donate their bodies. Organ donation was preferred over body donation. A lack of awareness about body donation was the main factor responsible for respondents' "no body donation" response in the general population, along with firm religious beliefs and customs, the fear that the donated body will not be treated with respect and dignity, and the unacceptability of the dissection of one's own body. To overcome the current shortage of donated cadavers, efforts should be undertaken to change the mindset of the wider Indian society toward body donation. The authors believe this is possible through awareness campaigns and that prospective donors' concerns should be addressed appropriately. Proper guidance and assistance regarding body donation should be easily available for potential donors.     

Attitudes of Anatomy Students toward Commemorations for Body Donors: A Multicultural Perspective

Many medical schools practice commemorative ceremonies to honor body donors. Attitudes of medical education stakeholders toward these ceremonies have not yet been fully investigated. The aim of this study was to explore anatomy students' attitudes toward commemorations at a multicultural institution which has not introduced these ceremonies yet. A survey was carried out on different groups of anatomy students that were exposed and not yet exposed to human remains. The survey was used to record basic demographic data from the respondents, ask if they would support the establishment of an anatomy commemoration and in which format. A total of 756 anatomy students participated in the survey (response rate 69.8%). The majority (76.3%) were in favor of introducing a commemoration for donors. The associations of students' gender, attitude toward body donation, and level of exposure to human remains with attitudes toward commemoration for donors were identified (P < 0.05), whereas ethnicity and religion seemed to have no influence on attitudes (P > 0.05). Most students believed that anatomy staff and students should organize the commemoration. There was a preference for the commemoration to be secular with revealed identities of donors, and not recorded for social media. The support for the establishment of commemorations transcended cultural and religious differences and confirmed students' respectful attitude toward donors. Anatomy commemorations seem to have potential not only to engage students with one another, and donor families, but also to pave the way for students to become life-long ethical and empathetic learners and practitioners.     

Ultrasound and cadaveric prosections as methods for teaching cardiac anatomy: a comparative study

This study compared the efficacy of two cardiac anatomy teaching modalities, ultrasound imaging and cadaveric prosections, for learning cardiac gross anatomy. One hundred and eight first-year medical students participated. Two weeks prior to the teaching intervention, students completed a pretest to assess their prior knowledge and to ensure that groups were equally randomized. Students, divided into pre-existing teaching groups, were assigned to one of two conditions; "cadaver" or "ultrasound." Those in the cadaver group received teaching on the heart using prosections, whereas the ultrasound group received teaching using live ultrasound images of the heart. Immediately after teaching, students sat a post-test. Both teaching modalities increased students' test scores by similar amounts but no significant difference was found between the two conditions, suggesting that both prosections and ultrasound are equally effective methods for teaching gross anatomy of the heart. Our data support the inclusion of either cadaveric teaching or living anatomy using ultrasound within the undergraduate anatomy curriculum, and further work is needed to compare the additive effect of the two modalities.     

Willingness toward organ and body donation among anatomy professors and students in Mexico

Most anatomists agree that cadaver dissection serves as a superior teaching tool in human anatomy education. However, attitudes toward body donation vary widely between different individuals. A questionnaire was developed to determine the attitudes toward body and organ donation among those who learn the most from cadavers: medical students, medical student teaching assistants, medical students involved in research, and anatomy professors. A cross‐sectional, prospective study was designed in which the questionnaire was distributed among first‐year human anatomy students before undertaking cadaver dissection at the beginning of the semester, and then again after a commemoration service at the end of the course. The questionnaire items included demographic data, as well as questions designed to characterize participants' attitudes regarding body/organ donation from strangers, family members, and whether participants would consider such practices with their own bodies. Out of a total of 517 students enrolled in the Human Anatomy course in the Medical School at the Universidad Autónoma de Nuevo León, Mexico during January to June 2016, 95% responded to the first (491) and second (490) surveys. Participants' opinions on their own organ donation was similar before and after exposure to cadaver dissection, with between 87% and 81% in favor of such practices, and only 3% against it, in both surveys. Participants' willingness to donate their own bodies, as well as those of family members, increased, while reluctance regarding such practices decreased by half (P < 0.0001 and P < 0.05). Professors had the highest rates of positive opinions regarding their own body donation (74.9%), with 18.8% undecided. Low opposition toward organ and body donation remains prevalent among both anatomists and physicians in training in Mexico. Anat Sci Educ 10: 589–597. © 2017 American Association of Anatomists.     

Covid-19: Emerging Considerations for Body Sourcing and Handling. A Perspective View from Nigeria

The current Coronavirus disease (Covid-19) pandemic has spread to about 220 countries of the world and has resulted in a significant number of deaths globally. Infections are still on the rise, and the impact on the global death rate could be devastating. There are fears over the likely impact of a large number of deaths on body sourcing and handling of cadavers for teaching and research. Historically, epidemics come with several challenges and have often led to some level of negligence of ethical practices and health and safety regulations associated with body sourcing and handling. The authors highlighted some emerging problems in this article, focusing on Africa and Nigeria in particular. These problems include a higher risk of coronavirus exposure for body handlers, shortage of cadavers for teaching and learning, a lack of standard regulations leading to unethical body sourcing and handling, and a lack of monitoring and collaboration needed for a well-coordinated Covid-19 pandemic response strategy. If these issues are ignored, the previous gains made in anatomical ethical practices may be destroyed. Some useful recommendations for policymaking geared toward prevention or curtailing these emerging issues have been instilled in this article.     

Evaluation of Information on Body Donation Promotion at Official Websites of Turkish Anatomy Departments

Raising public awareness of body donation is crucial for countries like Turkey that have struggling donation programs. The official websites of anatomy departments may contribute to achieving this goal. Nevertheless, previous studies reported institutional or individual reluctance of departments or anatomists, respectively, due to an expectation of adverse publicity. This study aimed to investigate whether the official websites of Turkish anatomy departments provided information on body donation and analyzed the content of these websites. Websites of anatomy departments at 100 medical faculties were evaluated. Only 12 departments (12%) provided information on body donation with varying content. A thematic analysis of the information provided revealed five main themes. These were (1) legal aspects, (2) significance, (3) acceptance/rejection criteria, (4) availability, and (5) redirection. All departments (n = 12, 100%) outlined the legal aspects of body donation, seven departments (58%) highlighted the significance of body donation, seven departments (58%) provided contact information for potential donors, five departments (41%) covered acceptance/rejection criteria, and three departments (25%) provided a link to the official website of the Turkish Society of Anatomy and Clinical Anatomy. Thus, Turkish anatomy departments were reluctant to provide information on body donation, and the content of provided information varied greatly among departments. This lack of information, coordination, and participation in existing awareness activities for body donation in anatomy department websites may be contributing to the low numbers of body donations and donor registrations seen nationally.     

A technique to perfuse cadavers that extends the useful life of fresh tissues: The Duke experience

The demand for laboratory‐based teaching and training is increasing worldwide as medical training and education confront the pressures of shorter training time and rising costs. This article presents a cost‐effective perfusion technique that extends the useful life of fresh tissue. Refrigerated cadavers are preserved in their natural state for up to 45 days with a daily working period of ten hours. Tissues maintain their color and natural consistency throughout this period. This new process for preservation of tissue opens the door to improved surgical training and to numerous research opportunities. Anat Sci Educ. © 2010 American Association of Anatomists.