A 25-year scoping review of the organ donation system in Malaysia: past, present, and future.

Organ donation and transplantation are integral components of modern medicine. This scoping review thoroughly explores the historical evolution, current status, and future prospects of organ donation and transplantation in Malaysia. Historically, Malaysia faced significant challenges in establishing a robust organ transplantation system, with various factors hindering organ donation efforts. Currently, Malaysia continues to struggle with stagnant donation rates despite collaborative efforts from various sectors. There is an urgent need to amend the 50-year-old Human Tissue Act to strengthen the legal framework for organ donation and address ethical concerns. Looking to the future, Malaysia could adopt a soft opt-out system and prioritize advancements in organ preservation techniques by exploring new sources of organs through the donation after circulatory death program. Continued efforts are necessary to enhance education programs for professionals and the public, dispelling myths about organ donation and effectively educating on the concepts of brain death. Malaysia strives to create a more accessible future for organ transplantation, aligning with the Sustainable Development Goals to reduce the burden of organ failure and improve the population's health and well-being.

Use of thermal drone in detection and assessment of larval mass temperature in decomposed rabbit carcasses.

Manual ground searches and cadaver dogs are traditional methods for locating remains, but they can be time- and resource-intensive, resulting in the decomposition of bodies and delay in victim identification. Therefore, thermal imaging has been proposed as a potentially useful tool for detecting remains based on their temperature. This study investigated the potential of a novel search technique of thermal drones to detect surface remains through the detection of maggot mass temperatures. Two trials were carried out at Selangor, Malaysia, each utilizing 12 healthy male Oryctolagus cuniculus European white rabbits and DJI Matrice 300 RTK drone China, equipped with a thermal camera; Zenmuse H20T to record the thermal imaging footage of the carcasses at various heights (15, 30, 60-100 m) for 14 days for each trial. Our results demonstrated that the larval masses and corresponding heat emissions were at their largest during the active decay stage; therefore, all the carcasses were observable in thermal images on day 5 and remained until day 7. Statistical analyses showed that (1) no statistically significant differences in thermal images between clothed and unclothed subjects (p > 0.05); (2) 15 m above ground level was proven to be the optimal height, as it showed the greatest contrast between the carcass heat signature and the background (p < 0.005). Our data suggested the potential window of detection of thermal signatures was detectable up to 7 days post-deposition. This could be an important guideline for the search and recovery teams for operational implementation in this tropical region.

Management of unidentified and unclaimed bodies: a comparison of model from four countries in the Asia Pacific Region.

Managing mass fatality incidents or disasters involving multiple deaths are not uncommon among forensic practitioners. In fact, management of unidentified or unknown bodies is also a vital component of the day-to-day mortuary work practice. The unidentified and subsequently unclaimed bodies have always been a "silent mass disaster," a problem that needs to be tackled within the forensic community and raises the global issue of ethics, law, and human rights. Unidentified bodies' in Malaysia make up an average of 4.02% of all death cases where a total postmortem examination was performed which is comparable with other developing countries within 4-10% which can go up to 25%. Moreover, unstandardized procedures in all mortuaries in different states and districts in Malaysia have worsened the scenario even with guidelines in place. This study aims to address the issues surrounding unidentified and unclaimed bodies including body disposal from a social and legal perspective using case study methodology by comparing four different countries in the Asia Pacific Region through document analysis and interview methods. One of the major findings is evident in 3 out of the 4 models, whereby there is a considerable gap in consolidating the missing person report and information to match with the unidentified bodies received in forensic institutions in an attempt to enhance the identification process which ultimately intends as a closure for the family members. It is also timely to think out of the box beyond dental records and DNA profiling to improve the identification rate for skeletonized remains through means of anthropology biometrics comparison. With the limited literature published surrounding this domain, it is hoped that the suggestions and recommendations to standardize the management of unidentified and unclaimed bodies can benefit many forensic institutions and public mortuaries in this region.

Applications of drone in disaster management: A scoping review.

The use of drones has rapidly evolved over the past decade involving a variety of fields ranging from agriculture, commercial and becoming increasingly used in disaster management or humanitarian aid. Unfortunately, the evidence of its use in mass disasters is still unclear and scarce. This article aims to evaluate the current drone feasibility projects and to discuss a number of challenges related to the deployment of drones in mass disasters in the hopes of empowering and inspiring possible future work. This research follows Arksey and O'Malley framework and updated by Joanna Briggs Institute Framework for Scoping Reviews methodology to summarise the results of 52 research papers over the past ten years, from 2009 to 2020, outlining the research trend of drone application in disaster. A literature search was performed in Medline, CINAHL, Scopus, individual journals, grey literature and google search with assessment based on their content and significance. Potential application of drones in disaster are broad. Based on articles identified, drone application in disasters are classified into four categories; (1) mapping or disaster management which has shown the highest contribution, (2) search and rescue, (3) transportation and (4) training. Although there is a significant increase in the number of publications on use of drone in disaster within the last five years, there is however limited discussion to address post-disaster healthcare situation especially with regards to disaster victim identification. It is evident that drone applications need to be further explored; to focus more on drone assistance to humans especially in victim identification. It is envisaged that with sufficient development, the application of drones appears to be promising and will improve their effectiveness especially in disaster management.

The first case of C4-Blast related death in Malaysia: A multidisciplinary approach illustrated with emphasis on conjoint anthropologic and radiologic expertise in forensic identification of skeletal remains.

BACKGROUND: Blast related deaths are often shrouded by diagnostic and medicolegal complexities requiring multidisciplinary expertise in order to gauge accurate identification of the victims and document scientific investigations comprehensively. In the advent of more sophisticated technology, anthropologic methods can now be applied into post mortem imaging interpretation. The traditional imaging roles of characterizing osseous fragmentation, detecting and localizing foreign bodies can be expanded to simulate and support physical anthropologic examination to assist in documentation for court proceedings. CASE PRESENTATION: An assemblage of unidentified, incomplete, highly fragmented skeletal remains were found scattered on a bare area of land in a forest. There was evidence of an explosion given the pattern of scattered evidentiary material of explosive and ballistic nature. Laboratory analysis of white powder found within the explosive material confirmed the presence of high impact C4-explosive trace containing cyclotrimethylene trinitramin [Royal Demolition Explosive (RDX)] & pentaerythritol tetranitrate (PETN). It took meticulous multidisciplinary efforts to confirm the identity of the victim that was marred by the severe fragmentation and skeletalization of the remains. The initial radiologic interpretation focused more on identification of foreign bodies and supporting documentation of fragmentation. With the current availability of post computed tomography (PMCT) in our center, we reexamined the value and potential of PMXR and PMCT as an adjunctive tool for biological profiling. CONCLUSION: This was the first case of C4-blast related death reported in Malaysia. The multidisciplinary approach in efforts to identify the victim may serve as a guide in managing, coordinating and maximizing the expertise of different forensic specialists, with emphasis on anthropologic and radiologic collaboration.

A dynamic forensic medicine approach: Management of the dead during COVID-19 outbreak in Malaysia.

It has been a difficult year ahead since the announcement of COVID-19 as a pandemic by the Director General of the World Health Organization (WHO). Many countries including Malaysia have struggled to take urgent and aggressive measures to advise, detect, screen, test, isolate and treat their citizens in order to fight against the virus. All countries must strike a balance between protecting health, minimizing economic and social disruption and at the same time, preserving human rights which includes managing the dead with dignity and respect. The National Institute of Forensic Medicine (IPFN) Malaysia has been proactively engaging the various agencies involved in a concerted effort to ensure smooth flow in the management of the dead for all COVID-19 and non-COVID-19 cases since the beginning of the outbreak in February 2020. This is in accordance with all existing guidelines and regulations vis-a-vis infection prevention and control in the country. However, new situations that arise during the pandemic are always challenging and dynamic. The COVID-19 crisis has uncovered a plethora of issues surrounding the margin of the Forensic Medicine fraternity. Therefore, this article highlights various emerging issues encountered by the IPFN and how they are resolved through good leadership to guide and direct operations and activities during the exponential rise of COVID-19 infection in Malaysia. In the provision of the management of the dead, it is of utmost importance to note that the humanitarian aspect needs to be emphasized even in times of an outbreak to give closure to the family and the opportunity to mourn their loved ones.

The craniotomy box: an innovative method of containing hazardous aerosols generated during skull saw use in autopsy on a COVID-19 body.

During a disease pandemic, there is still a requirement to perform postmortem examinations within the context of legal considerations. The management of the dead from COVID-19 should not impede the medicolegal investigation of the death where required by the authorities and legislation but additional health and safety precautions should be adopted for the necessary postmortem procedures. The authors have therefore used the craniotomy box in an innovative way to enable a safe alternative for skull and brain removal procedures on suspected or confirmed COVID-19 bodies. The craniotomy box technique was tested on a confirmed COVID-19 positive body where a full postmortem examination was performed by a team of highly trained personnel in a negative pressure Biosafety Level 3 (BSL-3) autopsy suite in the National Institute of Forensic Medicine (IPFN) Malaysia. This craniotomy box is a custom-made transparent plastic box with five walls but without a floor. Two circular holes were made in one wall for the placement of arms in order to perform the skull opening procedure. A swab to detect the presence of the SARS-CoV-2 virus was taken from the interior surface of the craniotomy box after the procedure. The result from the test using real-time reverse transcriptase polymerase chain reaction (rRT-PCR) proved that an additional barrier provided respiratory protection by containing the aerosols generated from the skull opening procedure. This innovation ensures procedures performed inside this craniotomy box are safe for postmortem personnel performing high risk autopsies during pandemics.

Management of the dead during COVID-19 outbreak in Malaysia.

The emergence of a novel human coronavirus, SARS-CoV-2, causing severe respiratory tract infections in humans, is affecting all countries of the world and has become a global health concern. Since the virus was first identified in December 2019, the number of deaths have been propagating exponentially, causing countries across the world, including Malaysia, to increase emergency measures to combat the virus. Due to the fact that the COVID-19 pandemic does not discriminate its victims, it is of paramount importance to construct a plan for management of the dead for all suspected or confirmed COVID-19 cases, including the unidentified deceased, as an essential portion of the humanitarian forensic action approach. This document provides an overview on ways to maximize the local collective capacity from various government agencies to manage the dead based on the prevailing regulations and legislation in the country, in preparation for possible large scale deaths from this pandemic. The National Institute of Forensic Medicine Malaysia has improvised procedures and guidelines for management of the dead within the existing regulations in order to achieve a balance between medicolegal requirements and the safety of personnel managing the bodies of the deceased with suspected or confirmed COVID-19 infection; at the site of death, during transport, during postmortem procedures, storage and preparation before and during burial or cremation as well as environmental cleaning and disinfection, involving various agencies in the country. A form of temporary controlled burial is as an option to allow the reinvestigation of a decedent to help formally identify victims of the pandemic such as undocumented migrants or refugees who were previously not identified. Due to the different legal requirements and mortality rates between countries, there is no one-size-fits-all approach to the management of the dead. Whenever possible, every opportunity and assistance must be given to families to mourn their loved ones, even in times of crisis or an outbreak, in order to sustain an appropriate level of dignity and respect.

Durability of cling film plastic wrap usage on dead body towards human decomposition changes.

This study explores the practicability and usability of the cling film plastic wrap on the dead body with decomposition changes, whereby the feasibility of wrapping the remains to ensure the containment of the decomposition fluid within the cling film plastic wrap. Unknown and unclaimed dead bodies were used. Wrapping and preservation of human remains using the cling film plastic wrap could be the best operational practices for first responders rather than leaving bodies exposed on the disaster site, when the supplies of the cadaver body bags are inadequate. Thinking out of the box, the conventional way of using cadaver body bags to the cling film plastic wrap forms a new perspective in managing the dead and facilitating the human identification needs. New inventive idea of adopting the cling film plastic wrap as means of protecting the dignity of the dead person, could be the way forward in humanitarian forensic action.

Reprint of: Cling film plastic wrap: An innovation for dead body packaging, preservation and transportation by first responders as a replacement for cadaver body bag in large scale disasters.

Cadaver body bags are the conventional method to contain a human body or human remains, which includes the use for storage and transportation of the deceased at any crime scene or disaster scene. During disasters, most often than not, the first responders including the police will be equipped with cadaver body bags to do scene processing of human remains and collection of personal belongings at the disaster site. However, in an unanticipated large scale disasters involving hundreds and thousands of fatalities, cadaver body bags supplies may be scarce. The authors have therefore innovated the cling film plastic wrap as an alternative for the cadaver body bag used at the disaster site. The plastic wrap was tested on six different experimental subjects, i.e. both adult and child mannequins; body parts of the mannequin figure (arm and hand); a human adult subject and an unknown dead body. The strengths of the cling film plastic wrap are discussed in comparison with the cadaver body bag in the aspects of costing, weight, duration of the wrap, water and body fluid resistant properties, visibility and other advantages. An average savings of more than 5000% are noted for both adult body wrap and child body wrap compared to the cadaver body wrap. This simply means that the authors can either wrap 25 adult dead bodies or 80 children dead bodies with the cost of 1 cadaver body bag. The cling film plastic wrap has proven to have significant innovation impact for dead body management particularly by the first responders in large scale disasters. With proper handling of dead bodies, first responders can manage the dead with dignity and respect in an overwhelmed situation to facilitate the humanitarian victim identification process later.

Cling film plastic wrap: An innovation for dead body packaging, preservation and transportation by first responders as a replacement for cadaver body bag in large scale disasters.

Cadaver body bags are the conventional method to contain a human body or human remains, which includes the use for storage and transportation of the deceased at any crime scene or disaster scene. During disasters, most often than not, the first responders including the police will be equipped with cadaver body bags to do scene processing of human remains and collection of personal belongings at the disaster site. However, in an unanticipated large scale disasters involving hundreds and thousands of fatalities, cadaver body bags supplies may be scarce. The authors have therefore innovated the cling film plastic wrap as an alternative for the cadaver body bag used at the disaster site. The plastic wrap was tested on six different experimental subjects, i.e. both adult and child mannequins; body parts of the mannequin figure (arm and hand); a human adult subject and an unknown dead body. The strengths of the cling film plastic wrap are discussed in comparison with the cadaver body bag in the aspects of costing, weight, duration of the wrap, water and body fluid resistant properties, visibility and other advantages. An average savings of more than 5000% are noted for both adult body wrap and child body wrap compared to the cadaver body wrap. This simply means that the authors can either wrap 25 adult dead bodies or 80 children dead bodies with the cost of 1 cadaver body bag. The cling film plastic wrap has proven to have significant innovation impact for dead body management particularly by the first responders in large scale disasters. With proper handling of dead bodies, first responders can manage the dead with dignity and respect in an overwhelmed situation to facilitate the humanitarian victim identification process later.

The clandestine multiple graves in Malaysia: The first mass identification operation of human skeletal remains.

The first ever mass identification operation of skeletal remains conducted for the clandestine graves in Malaysia consisted of 165 individuals unearthed from 28 human trafficking transit camps located in Wang Kelian, along the Thai-Malaysia border. A DVI response was triggered in which expert teams comprising of pathologists, anthropologists, odontologists, radiologists and DNA experts were gathered at the identified operation centre. The Department of Forensic Medicine, Hospital Sultanah Bahiyah, Alor Star, Kedah, located approximately 75km away from Wang Kelian, was temporarily converted into a victim identification centre (VIC) as it is the nearest available forensic facility to the mass grave site. The mortuary operation was conducted over a period of 3 months from June to September 2015, and was divided into two phases; phase 1 involving the postmortem examination of the remains of 116 suspected individuals and for phase 2 the remains of 49 suspected individuals. The fact that the graves were of unknown individuals afforded the mass identification operation a sufficient duration of 2 weeks as preparatory phase enabling procedurals and daily victim identification workflow to be established, and the setting up of a temporary body storage for the designated mortuary. The temporary body storage has proven to be a significant factor in enabling the successful conclusion of the VIC operation to the final phase of temporary controlled burials. Recognition from two international observers, Mr. Andréas Patiño Umaña, from the International Committee of Red Cross (ICRC) and Prof. Noel Woodford from Victoria Institute of Forensic Medicine (VIFM) had proven the mortuary operation was in compliance to the international quality and standards. The overall victim identification and mortuary operation identified a number of significant challenges, in particular the management of commingled human remains as well as the compilation of postmortem data in the absence of antemortem data for future reconciliation. CF Index in this DVI operation is 9%, indicating the primary identifications in this operation were effective. Limitations and further improvements of the mass identification operation will be discussed. This paper details the planning, preparations and management of the mass identification operation on the exhumed human remains which was also a forensic humanitarian service for the dead with dignity and respect.

Underwater DVI: Simple fingerprint technique for positive identification.

An underwater disaster can be declared when a maritime accident occurred or when an aircraft is plunged into water area, be it ocean, sea or river. Nevertheless, handling of human remains in an underwater recovery operation is often a difficult and demanding task as working conditions may be challenging with poor to no visibility, location of remains at considerable depths and associated hazards from surrounding water. A case of the recent helicopter crash, into a famous river in Sarawak, domiciled by huge crocodiles, is discussed in this paper. Search and recovery team as well as the combat divers from the Special Elite Troop Commando, known as VAT 69, were deployed to the scene to perform the underwater recovery to search for all the victims on board involving five Malaysians with a pilot of Philippines nationality. This paper highlights the limitations and challenges faced during the underwater search and recovery. All the bodies recovered were in moderate decomposition stage with crushed injuries and mutilated face and body. A simple and conventional fingerprint technique were used to record the fingerprint. The prints impressions were later photographed using a smartphone and transferred back to the RMP headquarters in Kuala Lumpur for fingerprint match by using WhatsApp Messenger, a phone application. All the first five victims were identified within an average of 10min. The last victim recovered was the pilot. For foreign nationals, the Immigration Department of Malaysia will record the prints of both index fingers only. The lifting of the fingerprint of the last victim was the most challenging in which only one index finger left that can be used for comparison. A few techniques were attempted using the black printer's ink, glass and tape techniques for the last victim. Subsequently, images of the prints impression were taken using the same smartphone with additional macro lens attached to it to enhance the resolution. The images were transferred to the RMP headquarters through WhatsApp Messenger. The prints were confirmed to be the pilot 20min later.

Effectiveness of bone cleaning process using chemical and entomology approaches: time and cost.

Skeletal examination is an important aspect of forensic pathology practice, requiring effective bone cleaning with minimal artefact. This study was conducted to compare between chemical and entomology methods of bone cleaning. Ten subjects between 20 and 40 years old who underwent uncomplicated medico-legal autopsies at the Institute of Forensic Medicine Malaysia were randomly chosen for this descriptive cross sectional study. The sternum bone was divided into 4 parts, each part subjected to a different cleaning method, being two chemical approaches i.e. laundry detergent and a combination of 6% hydrogen peroxide and powder sodium bicarbonate and two entomology approaches using 2nd instar maggots of Chrysomyia rufifacies and Ophyra spinigera. A scoring system for grading the outcome of cleaning was used. The effectiveness of the methods was evaluated based on average weight reduction per day and median number of days to achieve the average score of less than 1.5 within 12 days of the bone cleaning process. Using maggots was the most time-effective and costeffective method, achieving an average weight reduction of 1.4 gm per day, a median of 11.3 days to achieve the desired score and an average cost of MYR 4.10 per case to reach the desired score within 12 days. This conclusion was supported by blind validation by forensic specialists achieving a 77.8% preference for maggots. Emission scanning electron microscopy evaluation also revealed that maggots especially Chrysomyia rufifacies preserved the original condition of the bones better allowing improved elucidation of bone injuries in future real cases.