The altered profile of a donated cadaver population: challenges for teaching and research?

Efforts by anatomists over the recent past, have converted the cadaver population in a South African institution from a predominantly unclaimed population into one purely derived from donors. Concurrent with this transformation were noticeable changes in cadaver demographics, which raised concerns for aspects of teaching and research. The aim of this study was therefore to explore the effects of donation on the demographics and anatomical integrity of the School's 2017 cadaver population. The provenance, ancestry, sex and age of 74 cadavers were investigated. Dissected cadavers were studied to ascertain the general condition of their anatomy. Variations in tissue integrity, morphology and overt pathologies were surveyed. Cadavers represented only one population group with slightly more females (54%). The majority of the cohort (62%) was aged between 71 and 90 years. With regards to anatomical integrity, 60% of the cadavers presented with adhering fascia, but no significant differences in the quantity of fat were found across the sample. High levels of muscle tearing and atrophy (76%) occurred and variations in visceral anatomy were noted. Various surgical interventions and overt pathologies were also observed. The donated cadaver population differed from previous unclaimed cadaver populations in that they consisted of only White, older individuals. Variations, surgical interventions and pathologies offer staff in anatomy an opportunity to engage with more clinically-oriented teaching, as well as introducing students to the discipline of gerontology

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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.

Making the Ethical Transition in South Africa: Acquiring Human Bodies for Training in Anatomy.

While dissection remains the method of choice for teaching human anatomy, ethical requirements for obtaining cadavers has made the process of acquiring human bodies more strenuous for institutions. In Africa and at the School of Anatomical Sciences in South Africa, dependence on unclaimed bodies has been prevalent. The aim of the present study was to determine whether more rigorous application of ethical consent has altered the provenance of the cadavers in the School of Anatomical Sciences, University of the Witwatersrand. The numbers of bequeathed/donated/unclaimed cadavers received over the period 2013-2017, as well as their sex and population affinity were analyzed. The majority (96.8%) of the cadavers dissected over the period were from bequests/donations. Marginally more females than males were available. In addition, the population affinity of the cadavers had changed from a majority of South African African (unclaimed) bodies to a majority of South African White (bequest/donated) bodies. The study shows that even with ethical constraints it is possible to transition from the use of mainly unclaimed bodies to the acquisition of bequeathed/donor bodies. However, there may be challenges in relation to anatomical collections in the School as few of the bequest/donated cadavers remain in the School to be added to the collections. These changes also affect the demographics of the Schools' collections.

Stature estimation from the femur and tibia in Black South African sub-adults.

Stature estimation can play a role in the positive identification of unknown individuals and as such it is routinely assessed during the examination of adult remains. Unfortunately, this is not a standard procedure when dealing with sub-adult remains due to the general lack of standard procedures for the estimation of sub-adult stature. The aim of this study was therefore to derive regression equations for the estimation of stature in black South African sub-adults. Fifty nine black South African sub-adult males and females, aged 10-17 years, voluntarily participated in the study by undergoing a full body Magnetic Resonance Imaging (MRI) scan. Living stature was measured with a stadiometer and the maximum and diaphyseal lengths of the femur and tibia were measured from the MRI scans using the image processing software OsiriX. Pearson's correlation coefficients and linear least square regression analyses were used to assess the correlations between living stature and the measurements and to generate sub-adult stature estimation equations for males, females and a combined sex sample. Measurements of the femur, tibia and the combined measures thereof showed strong statistically significant positive correlations with living stature, while the obtained regression equations were characterized by low standard error of estimates. The strong correlations and low standard error of estimates are comparable to stature estimation models reported for Black South African adults and therefore these variables can be considered good estimators of sub-adult stature which will contribute valuable information to the biological profile of unidentified sub-adult skeletal remains.

Quantification of the subpubic angle in South Africans.

Due to the high crime rate in South Africa, forensic anthropologists are increasingly approached to aid in the identification of skeletonized remains, with sex and population affinity assignment being some of the most critical tasks they face. For over a century, the pelvis has been known to be one of the most sexually dimorphic bones of the human body and the subpubic angle is one of the most accurate, albeit scarcely quantified, features thereof. Hence, the aim of this study was to quantify the size of the subpubic angle and compare it between male and female South Africans of African (black) and European (white) descent. One hundred and forty five (145) pelves were selected, consisting of 68 white (43 male and 25 female) and 77 black South Africans (44 male and 33 female), from the Raymond A. Dart Collection of Human Skeletons housed at the University of the Witwatersrand, Johannesburg, South Africa. Each of the pelves were articulated and placed into a custom built stand for photographing. Measures of the subpubic angle from these digital images were subjected to numerous statistical analyses. Results indicated that significant differences exist between the sexes, as well as between the two population groups. For black individuals it was found that males generally possessed a subpubic angle of 74.9° or less, with larger values being indicative of the female sex. For white individuals, subpubic angles of 81.4° and less indicated males whilst larger values indicated females, with an average accuracy of 86% for both population groups. These results illustrate the advantages of using the subpubic angle to assist in the estimation of sex and population affinity and also reinforce the need for population specific parameters to be applied.