Use Of Unclaimed Bodies Research Articles

Historical trends and current experiences of anatomical body donation in two Zimbabwean medical schools

BackgroundBody donation is integral to anatomy education, but procurement can be ethically fraught. While voluntary donation is preferred, the use of unclaimed bodies, although considered unethical, is a primary means for body procurement in some countries. This mixed methods study examined historical trends and anatomy technical staff perspectives on body donation in two Zimbabwean medical schools. Methodology and main findingsIn Phase 1, 194 cadaver paper records from January 1984 to January 2021 were reviewed. Unclaimed bodies accounted for 67% while 33% (all white Zimbabweans) were voluntarily donated. Most cadavers were black Africans (62.4%) followed by white Zimbabweans (34.0%). Race was not indicated in seven (3.6%) records. In Phase 2, semi-structured interviews were conducted with seven technicians responsible for sourcing cadavers at the two institutions. Data were thematically analysed resulting in the development of eight themes, arranged into three domains. Cadaver procurement themes related to (1) cadaver source, (2) adherence to procurement guidelines, (3) screening for suitability, and (4) cultural and religious beliefs. Cadaver embalmment focused on (5) embalming practices, and (6) hospital mortuary-based embalming. Finally, (7) disposal processes and (8) resource constraints were found to influence cadaver disposal practices. ConclusionsContrary to best practice, there is continued reliance on the use of unclaimed bodies to support anatomy education in the two Zimbabwean medical schools. Improving the ethical sourcing of bodies requires increased efforts to educate all Zimbabweans, especially the black majority, about the role and importance of voluntary body donation in medical education. Additionally, well-structured, and well-resourced body donation programs could enhance ethical procurement.

Unclaimed Bodies and Medical Education in Texas

This study examines the trends in use of unclaimed bodies in medical education in Texas.

The Ethics of Sourcing a Cadaver Population–A Perspective from South Africa

We cannot deny the early, turbulent unethical history of the sourcing of human bodies for dissection during the 18th and 19th Centuries, but we most certainly can learn from the past. While the International Federation for the Associations of Anatomists (IFAA) has recommended ethical guidelines for the sourcing of bodies from donors only (IFAA, 2021), many institutions around the world have not been able to fulfil these recommendations. In South Africa, as an ethical imperative, most departments of anatomy have converted from the use of unclaimed bodies (although legal by South African law) to body donor programs which are founded on ethics and informed consent. South Africa has a diverse multicultural population derived from four main population groups (Black, Coloured, White and Indian) with health sciences classes being made up of predominantly Black students. As a consequence of the transformation from the use of unclaimed bodies to donor programs, the population diversity of the more recent cadaver populations has been impacted and White bodies now predominate. This transformation of the cadaver population will in time also impact the large skeletal collections in South Africa which are used for teaching and research by both local and international researchers. The change in the cadaver population with respect to population affinity particularly, may also impact our students and how they view the body they dissect. In South Africa and Africa, a number of factors including religious and cultural practices have a bearing on the diversity of the donors in donor programs. Donor programs are extremely important from the ethical perspective, and so too is the informed consent aligned to registration for these programs. In considering establishing diversity in the cadaver population of our donor programs for the future, some of the questions which should be pondered by South African anatomists and anatomists in general are: Is it important to have a body donor cohort that is representative of the demographics of the student population? How do we overcome the religious and cultural challenges which are prevalent in some of the population in order to maintain a donor program that is based on sound ethical behaviour and which is representative of the population at large? In addition, will anatomists be able to maintain ethical standards of sourcing bodies in the light of unexpected crises such as the recent pandemic? There is no doubt that in South Africa, widespread communication, educational programs and community outreach, particularly through the traditional leaders of each community, would assist with increasing the diversity of the donors.ReferenceIFAA. 2012. International Federation of Anatomical Associations. Federative International Committee on Ethics and Medical Humanities (FICEM). Recommendations of good practice for the donation and study of human bodies and tissues for anatomical examination. Plexus 2012: 4‐5.

Ethical Considerations in the Use of Unclaimed Bodies for Anatomical Dissection: A Call for Action

Introduction: The continued practice of anatomical dissection in medical training has placed great demands on body acquisition. This paper aims to provide an overview of the ethical considerations in the use of unclaimed bodies for anatomical dissection. Materials and Methods: We explored major databases such as PubMed, MEDLINE, Ovid MEDLINE, Researchgate, Google Scholar, Web of Science, and Science Direct, from January 2004 to October 2019, using selected keywords to identify and extract articles relating and peculiar to the use of unclaimed bodies for anatomical dissection. Results: This review yielded 40 publications with 28 meetings of our quality and inclusion requirements. This paper highlighted the use of unclaimed bodies for anatomical dissection as seen in some medical schools, and the various ethical considerations associated with its continuous use in medical training globally. Conclusion: In conclusion, the continuous use of unclaimed bodies for anatomical dissection still carries strong ethical and legal uncertainties. It is therefore recommended that there is a need to formulate an all-inclusive regulation to control the use of cadavers for anatomical dissection. If appropriate legislation and guidelines are not put in place with strict monitoring, we may soon return to the cadaver trafficking era to meet up with the demand.

The Law, Ethics and Body Donation: A Tale of Two Bequeathal Programs.

Historically, legislature has been utilized to facilitate appropriate use of cadavers in the anatomical sciences. However, cadaver acquisition and use have also been guided by ethically appropriate and morally acceptable principles. Various global and regional frameworks of "ethical practice" guide body donation, including the use of unclaimed bodies by institutions. These frameworks are responsive to, and reciprocal with the various ethical, moral and legal factors that influence the development of body donation programs. This reciprocity supports the notion that anatomists and anatomical societies have a responsibility to advocate for legal reform when required. In this study, two body bequest programs from geopolitically and socially disparate countries are used as cases to contrast existing legal and governance frameworks for body donation and to examine whether anatomists can direct the acquisition of ethically donated cadavers. The study includes an Australian donor program that has exclusively accepted bequests since its inception, and a South African program that has recently transitioned to a bequest system. Elements such as consent by next-of-kin and Inspector of Anatomy, use of unclaimed bodies and ethics committee approval amongst others, are compared. It is acknowledged that legal frameworks for cadaver acquisition generally deliver broad guidance on acceptable utilization of bodies for the anatomical sciences. However, professional discretion is of importance in adapting to societal needs and values. Thus, while anatomists have been able to progress toward more ethical practice than that which is required by the law, they must continue to do so as societal values evolve.

Of Discomfort and Disagreement: Unclaimed Bodies in Anatomy Laboratories at United States Medical Schools.

Use of unclaimed bodies for anatomy teaching in undergraduate medical education continues, but is ethically controversial. The purposes of this study were to estimate the proportion of United States (US) medical schools using unclaimed bodies in first-year anatomy laboratories, to determine whether schools inform students of this use, and to explore anatomy course leaders' attitudes toward unclaimed body use. Anatomy course leaders from 146 US medical schools that had independent preclinical programs including anatomy were surveyed. Survey results were analyzed with descriptive statistics and statistical tests of association. Free text responses were analyzed using a thematic editing style of qualitative content analysis. Of 89 responses (response rate, 61.0%), 11 schools (12.4%) reported possible use of unclaimed bodies. Course leaders from these schools reported greater comfort with using unclaimed bodies compared to leaders from other schools (P<0.01). Although most course leaders (49/76, or 64.5%) believed it was important or very important to inform students about use of unclaimed bodies, respondents from schools where unclaimed bodies could be used were more neutral (P<0.01). Qualitative findings revealed deep disagreement and contradictory views about how unclaimed body use relates to ethical principles of respect for persons and justice. Continued use of unclaimed bodies, varying levels of comfort with their use, and disagreement about the practices' underlying morality suggest a need for greater ethical reflection about the permissibility of unclaimed body use in clinical anatomy and for educational interventions that teach students about its history, ethics, and contemporary practice.

Evaluating the Attitude of Nigerian Anatomists Towards Body Donations for Medical Education

The use of dissection in anatomy has long been considered a cornerstone in medical education irrespective of nation, racial background or medical school. Anatomy education in Nigeria is faced with the challenge of insufficient supply of cadavers. Body donation could be a possible solution to the inadequate supply of cadavers for medical education in Nigeria. Very little is known about body donation in Nigeria as well as the attitude of Nigerians towards body donation. In this study the attitude of Nigerian anatomists towards body donation was evaluated. Questionnaires were sent to anatomists in three universities in Nigeria covering three geographical zones in Nigeria. A total of fifty-eight (58) responses were obtained. The use of unclaimed bodies (58.6%) and the use of 3D models (46.6%) were the major solutions proposed for cadaver insufficiency. 85.5% of the participants thought that body donation campaigns could increase people’s willingness to donate their body for anatomical study. Only 47% of the participants were willing to campaign for body donation while 53% of the participants were not willing to campaign. Only a few of the participants (25%) were willing to donate their bodies for anatomical study. Their unwillingness was mainly due to religious reasons (26.5%), culture and tradition (12%) and also restrictions from family members (18%). Some even had reasons they would not disclose (28.5%). They could recommend body donation to others but will not recommend it to their relatives.

The Transition from “Unclaimed Bodies” to Body Donation – an Ongoing Process

At a time when dissection as a teaching tool may be replaced by other educational approaches in some programs, and time allocated to it is reduced in others, dissection of a human body is still the cornerstone of anatomical education in most places. Historical developments in this respect are diverse, and anatomists around the world operate within multiple political, legal, cultural, and religious backgrounds to acquire bodies for this purpose. A look at the sources of bodies for anatomy teaching on a global scale reveals that many anatomists still depend on “unclaimed bodies”, while some even have to import bodies from abroad. Today, the ethical gold standard of anatomical dissection is body donation – also officially recommended by the International Federation of Associations of Anatomists (IFAA). While it can be argued that the use of unclaimed bodies can be acceptable for a time of transition in certain circumstances, when without their use anatomical education would be impossible, the aim should nevertheless be the establishment of voluntary body donation programs based on informed consent. The pace of this transition will differ between cultures and countries, but there are encouraging examples, including Taiwan and India, of the recent successful implementation of body donation programs.Support or Funding Informationno extra fundingThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Repeated Exposure to Dissection Does Not Influence Students' Attitudes towards Human Body Donation for Anatomy Teaching.

The use of unclaimed bodies for anatomical dissection has been the main method of instruction at our institution. There is however a shortage of cadavers for dissection given the increase in the number of medical schools as well as in the number of students enrolling in these schools. This shortage could be mitigated by having voluntary human body donation programs. This study aimed at assessing the attitudes of medical students and surgical residents towards body donation for anatomy learning. We conducted an online survey involving 72 first-year medical students and 41 surgical residents at University of Nairobi who had completed one year of anatomy dissection. For the medical students, this was their first dissection experience while it was the second exposure for the surgery trainees. Most of the surgical trainees (70.7%) and medical students (68.1%) were opposed to self-body donation. This was mainly due to cultural (37%) and religious (20%) barriers. Surprisingly, of those not willing to donate themselves, 67.9% (82.8% surgical trainees, 59.2% medical students) would recommend the practice to other people. Exposure to repeated dissection does not change the perceptions towards body donation. It is noteworthy that culture and religion rank high as clear barriers amongst this “highly informed” group of potential donors.

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 were outlined. These were the centrality of informed consent, their non-commercial nature, and the respect due to all associated with donations including family members. The latter was exemplified in part by the institution of thanksgiving services and commemorations. A number of issues in the recommendations were 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 included 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 included 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.

Body donations today and tomorrow: What is best practice and why?

There is considerable agreement that the use of human bodies for teaching and research remains important, yet not all universities use dissection to teach human gross anatomy. The concept of body donation has evolved over centuries and there are still considerable discrepancies among countries regarding the means by which human bodies are acquired and used for education and research. Many countries have well-established donation programs and use body dissection to teach most if not all human gross anatomy. In contrast, there are countries without donation programs that use unclaimed bodies or perhaps a few donated bodies instead. In several countries, use of cadavers for dissection is unthinkable for cultural or religious reasons. Against this background, successful donation programs are highlighted in the present review, emphasizing those aspects of the programs that make them successful. Looking to the future, we consider what best practice could look like and how the use of unclaimed bodies for anatomy teaching could be replaced. From an ethical point of view, countries that depend upon unclaimed bodies of dubious provenance are encouraged to use these reports and adopt strategies for developing successful donation programs. In many countries, the act of body donation has been guided by laws and ethical frameworks and has evolved alongside the needs for medical knowledge and for improved teaching of human anatomy. There will also be a future need for human bodies to ensure optimal pre- and post-graduate training and for use in biomedical research. Good body donation practice should be adopted wherever possible, moving away from the use of unclaimed bodies of dubious provenance and adopting strategies to favor the establishment of successful donation programs.

Using and respecting the dead human body: an anatomist's perspective.

In his stimulating article enquiring into what the living owe the dead, Wilkinson (2013, Clin. Anat. DOI: 10.1002/ca.22263) sought to unpack a range of ethical questions of considerable interest to anatomists. In this, he looked closely at the extent to which we are or are not to respect all the prior wishes of the deceased, and the implications of this for the role of the family in providing consent, the use of unclaimed bodies, and the public display of bodies. Some of his conclusions challenge widely encountered views by anatomists. In this response I have re-visited these topics in an attempt to ground his arguments in the experience of anatomists, by emphasizing the many intimate connections that exist between each of these areas. The following emerge as issues for further debate. I accept that the wishes of the deceased are preeminent, so that authorities should make every effort to abide by these. This reiterates the importance of body bequests over against unclaimed bodies, and provides a context for assessing the role of family consent. This has repercussions for all activities employing dead bodies, from the dissecting room to public plastination exhibitions. In determining the extent to which the wishes of the deceased are followed the input of other interested parties is a relevant consideration. An ethical assessment of the public display of bodies needs to take into account the nature of the plastination process.

Cadaver donation program and anatomy teaching at the University of São Paulo Medical School, Brazil (721.5)

Several reasons have led to progressive replacement of cadavers for anatomical models and computerized images in Anatomy courses. To obviate the scarcity and pitfalls related to the use of unclaimed bodies, a cadaver donation program was implemented in our Department. The aim of this study is to analyze the impact, benefits and problems of the program in the last decade.A retrospective evaluation of the documents related to cadaveric donation to our department was obtained from 2002, analyzing the characteristics of the donors and the availability of cadaveric material to our courses. Additionally, we searched possible variables related to voluntary donation.All donors were causcasians and gender distribution varied throughout the decade, mainly concerning female donors. Our cadaver donation program has been successful to maintain adequate cadaveric material for teaching and research purposes and completely replaced the use of unclaimed bodies.Alternative methods to teach Anatomy to be valuable but their role, alone or in conjunction with traditional cadaveric dissection and prosection, still need to be established. We consider that the use of cadavers to be essential in medical graduation and a comprehensive voluntary donation program is the best alternative to achieve the educational targets without the ethical and legal problems related to the use of unclaimed bodies.

Respect for the dead and the ethics of anatomy

Dead bodies are not persons but nor are they just things. What, ethically speaking, do the living owe the dead when it comes to using their bodies in anatomy? The article begins with the general question of respect for the dead. It distinguishes between why we should respect the dead, how we should respect them, and the weight to be given to respect. It sets out an account of the reason to respect the dead based on their interests. The article then turns to how the dead should be respected and the importance of doing so. Specifically, it considers three ethical issues in anatomy: the role of the family, the use of unclaimed bodies, and the public display of bodies donated for that purpose. This article claims that what it is to respect the dead is substantially determined by their wishes. Nonetheless the article argues that respect is consistent with allowing the family to veto anatomical use even when the deceased has consented because respect for the dead does not require following all their possible wishes. Respect is also consistent with using unclaimed bodies to which no one--deceased or family--has consented because the interests of the dead do not directly require consent and the interests of the family are unlikely to be relevant. Finally, the article does not see anything disrespectful in the public display of the bodies of those who have consented.

Anatomy's use of unclaimed bodies

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.

The centrality of the dead human body for teaching and research – social, cultural and ethical issues

Study of the cadaver is integral to both medical education and research, but how is cadaveric material to be obtained in the 21st-century world? Historical precedents are of little assistance, built as they are on the most unethical of practices, including body snatching and murder. This constitutes a major challenge for modern anatomy: has it been able to cast off all semblance of this unsavoury past? In this paper it is contended that the continued use of unclaimed bodies has proved problematic, ignoring as it does the fundamental ethical impetus of altruism. The use of bequeathed bodies is regarded as ethically preferable, even though cultural practices vary significantly, with the result that the availability of cadavers is uneven across societies. Recent legislation has brought the role of informed consent to the fore, and this is a welcome development. Nevertheless, immense challenges remain for anatomists, a major one being that posed by the large-scale public exhibitions of plastinated bodies, the prime exponent of which is Body Worlds. In assessing the manner in which the plastinates are displayed, those with Renaissance allusions have most in common with an educational rationale, although lacking a research ethos. The contemporary genre plastinates are the furthest removed from any traditional anatomical approach, and generally lack any teaching focus. They are also the most problematic ethically when assessed in terms of the principles of beneficence and non-maleficence. Additionally, the character of donation is changed within the context of these public exhibitions.

The reliance on unclaimed cadavers for anatomical teaching by medical schools in Africa

The study of gross Anatomy through the use of cadaveric dissections in medical schools is an essential part of the comprehensive learning of human Anatomy, and unsurprisingly, 90% of the surveyed medical schools in Africa used cadaveric dissections. Donated cadavers now make up 80% of the total cadavers in North American medical schools and all the cadavers used for dissection in the United Kingdom are donated. Because the sources of cadavers used in Africa are not clearly known, a questionnaire to gather information on cadavers used at medical schools was designed from the relevant literature and was sent by electronic mail to 123 Anatomy lecturers in 23 African countries (48 medical schools). Fourteen lecturers from 14 medical schools in ten countries responded to the questionnaires. The results indicate that, in most countries, the cadavers are unclaimed bodies from the hospitals and prisons, and the bodies of dead bandits. In South Africa and Zimbabwe, the donations are mostly from the white community, and medical school in the Islamic country of Libya is importing cadavers from India. The lack of knowledge about body donation programes and firmly held cultural and religious burial traditions may explain the lack of bequests from black communities. The use of unclaimed bodies may disproportionally affect people who were homeless and poor, criminals, people with fewer social links, and social outcasts. The Anatomy lecturers felt that there should be broader national awareness programes for body donations, although the benefits of this could take decades to materialize.

Use of bequeathed and unclaimed bodies in the dissecting room

AbstractThe bodies used in dissecting rooms have either been unclaimed or bequeathed. Although bequeathed bodies constitute the major source of bodies in many countries today, this is not a universal situation. The use of unclaimed bodies for dissection is traced historically from its origins in grave robbing and murder, and against the background of the thesis that it involves exploitation of the poor and the lack of informed consent. The ethical significance of the treatment of cadavers is considered in terms of the intrinsic and instrumental value ascribed to cadavers. The use of unclaimed bodies is assessed in relation to the ethical principles underpinning organ donation, including respect for the autonomy of the deceased, and the interests of family members, as well as reference to altruism as a basis of donations and the possible redemptive aspects of organ donations. It is argued that the use of unclaimed bodies does not correspond to any procedure we use today in the realm of organ donation. It is concluded that the use of unclaimed bodies is never to be the procedure of choice, since taking a body even for good purposes is ethically inferior to giving a body for the same purposes. Nevertheless, what is done with dead bodies for good reasons is not the most important of ethical matters, and a balance has to be attained between these ethical considerations and the potential benefits accruing to society. © 1994 Wiley‐Liss, Inc.