Analysis of statements in documents of gift for academic body donation programs in the United States, and recommendations for future practice.

In US anatomical gift law, the record on which a person consents to body donation after death is referred to as a document of gift (DG). Due to the lack of legal requirements around minimum information standards, enacted recommendations in the United States, and the unknown variation across extant DGs, a review of publicly-available DGs from US academic body donation programs were performed to benchmark existing statements and recommend specific foundational content for all US DGs. From 117 body donor programs identified, 93 DGs were downloaded (median length three pages, range 1-20). Statements within the DG were qualitatively categorized into 60 codes within eight themes (Communication, Eligibility, Terms of Use, Logistics, Legal References, Financials, Final Disposition, and Signatures), using existing recommendations of academics, ethicists, and professional associations to guide analysis. Of 60 codes, 12 had high disclosure rates (67%-100% of DGs included; e.g., donor personal information), 22 had moderate rates (34%-66%; e.g., discretion to decline a body), and 26 had low disclosure rates (1%-33%; e.g., testing bodies for disease). Some codes with the lowest disclosure frequency were those previously recommended as necessary. Findings highlighted substantial variation in DG statements, with a higher number of baseline disclosure statements than previously recommended. These results present an opportunity to better understand disclosures that have importance for programs and donors alike. Recommendations suggest minimum standards of informed consent practices for body donation programs in the United States. These include clarity around consent processes, consistency of language, and minimum operational standards for informed consent.

A transparent oversight policy for human anatomical specimen management: the University of California, Davis experience.

The authors describe the development and implementation of a University of California (UC) system of oversight, education, tracking, and accountability for human anatomical specimen use in education and research activities. This program was created and initially implemented at UC Davis in 2005. Several incidents arising out of the handling of human anatomical specimens at UC campuses revealed significant challenges in the system for maintaining control of human anatomical specimens used in education and research. These events combined to undermine the public perception for research and educational endeavors involving anatomical materials at public institutions. Risks associated with the acquisition, maintenance, and disposal of these specimens were not fully understood by the faculty, staff, and students who used them. Laws governing sources of specimens are grouped with those that govern organ procurement and tissue banking, and sometimes are found in cemetery and funeral regulations. These variables complicate interpretations and may hinder compliance. To regain confidence in the system, the need to set appropriate and realistic guidelines that mitigate risk and facilitate an institution's research and educational mission was identified. This article chronicles a multiyear process in which diverse stakeholders developed (1) a regulatory policy for oversight, (2) a policy education program, (3) procedures for tracking and accountability, and (4) a reporting and enforcement mechanism for appropriate and ethical use of human anatomical specimens in university education and research.

An assessment of a tracheal tube introducer as an endotracheal tube placement confirmation device.

INTRODUCTION: Early detection of an inadvertent esophageal intubation can be particularly challenging in cases when the current standard of care, carbon dioxide detection, is unreliable. We sought to determine the sensitivity and specificity of an inexpensive and portable device, the gum elastic bougie (Eschmann Tracheal Tube Introducer, SIMS Portex, Inc, Keene, NH), as an endotracheal tube placement confirmation device. METHODS: We conducted a prospective blinded trial in 20 human cadavers. Each cadaver was randomized to a mixed series of 5 esophageal and 5 tracheal intubations. Each intubation was assessed with the bougie twice, once by a novice to the technique, and once by an assessor who was constant through the trial. Assessors used the bougie to "feel" for "clicks" of the tracheal rings and to appreciate "hang up" of the bougie as it was advanced into the smaller airways. Absence of these findings was presumed to indicate an esophageal intubation. Actual placement was confirmed by bronchoscopy. Each assessor made an independent determination of tube location. Descriptive statistics were used to summarize the data. RESULTS: Overall, 93% (95% confidence interval [CI], 86%-97%) of tracheal placements were correctly identified. The constant assessor was able to correctly identify 98% (95% CI, 90%-100%). Tracheal rings were detected in 92% of tracheal placements. Ring clicks were 95% specific for tracheal intubation. Hang up was reported in 100% of tracheal placements with a specificity of 84%. Overall, 95% (95% CI, 88%-98%) of esophageal intubations were detected. The constant assessor detected 100% of esophageal intubations. CONCLUSION: In the cadaver model used in this study, the gum elastic bougie (Eschmann Tracheal Tube Introducer) shows promise as an endotracheal tube confirmation device.