A cross-sectional survey on university students' knowledge, attitudes, and behaviors regarding organ, tissue, and body donation.

PURPOSE: Body donors continue to have an important role in anatomy education in medical schools. Furthermore, the demand for organ transplantation is increasing as life expectancy increases. In Turkey, there are efforts to enable both donations to be made through a single system. These issues were addressed together, and it was aimed to evaluate the level of knowledge and attitudes of medical and law students regarding tissue-organ and body donation. METHODS: A questionnaire consisting of 29 questions was administered to 693 individuals to measure these aspects. Data were analyzed using a one-way analysis of variance with Bonferroni correction. Categorical data collected during the study were summarized in terms of frequency and percentage. RESULTS: When asked about their willingness to donate their bodies, 39.4% answered no, 29.5% responded yes, and 31.1% were undecided. Regarding organ donation, 61.8% of the participants expressed willingness, 22.8% were undecided, and 15.4% declined. Notably, there was a significant difference between those who had prior knowledge of organ tissue and body donation and those who did not (p < 0.001). CONCLUSION: The findings of our research indicate that knowledge about organ tissue and body donation, as well as the inclination to donate, increased as medical education progressed into clinical practice. Additionally, the level of knowledge among university students on this subject was found to be correlated with whether they had received prior training on the topic. It was observed that there is a need to provide more education for students to understand the importance of organ and body donation.

The Anatomy Act 1977 (NSW) Dissected: Review and Reform.

This column discusses the Anatomy Act 1977 (NSW) and its regulatory environment. The column begins with examining the history of anatomy regulation in the United Kingdom and Australia. It then goes on to analyse the history of the current anatomy regulation in New South Wales, pointing out areas for reform.

Negotiating humanity: an ethnography of cadaver-based simulation.

Human body donation (HBD) serves an essential function in many medical schools, particularly in institutions where people engage in cadaver-based simulation (CBS) as a pedagogical approach. The people who facilitate HBD and CBS have a highly specialized skill set, yet their expertise remains largely unacknowledged, and takes place out of sight from the broader medical school community. This manuscript, based on a two-year practice-based ethnography (Structured Observations n = 68 h, Unstructured Observations n = 150 + hours; Interviews n = 24; and Document/Policy Analysis n = 14) illuminates the complex work of HBD. We identify three primary functions of HBD and CBS (1. Cadaver Intake & Administration, 2. Cadaver Preparation, and 3. Cadaver-Based Pedagogy). We describe how medical educators involved in CBS have developed a skillset specific to their role: negotiating humanity.

Willingness toward post-mortem body donation to science at a Mexican university: an exploratory survey.

BACKGROUND: Voluntary post-mortem donation to science (PDS) is the most appropriate source for body dissection in medical education and training, and highly useful for biomedical research. In Mexico, unclaimed bodies are no longer a legal source, but PDS is legally possible, although scarcely facilitated, and mostly ignored by the general population. Therefore, we aimed to evaluate the attitude and willingness for PDS and to identify a sociodemographic profile of people with willingness toward PDS. METHODS: A validated on-line survey was distributed by the convenience method via the social networks of a Catholicism-inspired, private university in northern Mexico. Frequency analyses of all variables and coded free comments were complemented with association studies. RESULTS: Although the responder cohort (n = 143) was too small and biased to be representative of the university community (n = 13,500), willingness to post-mortem organ donation was 90.7% and to PDS 70.7%. In this cohort, PDS willingness had the strongest association with mature age (> 40 years old; P, 0.0008). Among young adults, willingness to PDS was the lowest among volunteers from technical and business schools and the highest among those from the social sciences (P, 0.009). Respondents from the social sciences were also the most consistent between attitude and behavior with respect to organ donation. A free comment option revealed respondents were interested in the unusual taboo topic. CONCLUSIONS: A small, but sufficiently large proportion expressed willingness toward PDS. In our university cohort, which was biased in higher education and altruism, mature age and social interest were associated with PDS willingness.

Assessment of reports on cadaver surgical training (CST) implementation in Japan: current status and challenges.

The contents and conflicts of interest of Cadaver Surgical Training (CST) programs in Japan were reported to the Japan Surgical Society CST Promotion Committee based on professional autonomy. After receiving the reports from participating universities, the committee evaluated the validity of these reports and provided advice on the proper implementation of CST. Over the past decade, 38 universities have been using cadavers for clinical education and research, such as CST. If inappropriate entries or unclear areas were identified, the universities could be asked to resubmit their report. This review clarifies the evaluation points of the CST reporting system, shows the status and problems of its reporting, and provides suggestions for the dissemination of CST in the future.

Human body donors at academic institutions in the United States of America: An investigative study.

Work with deceased human bodies to enhance anatomical education was first documented in the 3rd century BCE. However, the development of body donation programs provided many new opportunities for medical education. The aim of this study was to investigate the work supported by human body donors at academic institutions in the United States and to evaluate the ethical oversight process and the preparation methods used. A questionnaire was developed using Qualtrics and sent to 125 body donation programs in the United States. Representatives from a total of 69 institutions completed the questionnaire. The data showed that human body donations across the United States are used in teaching, clinical skills training, research, and educational outreach. Most institutions worked with hard-fixed donors for teaching and some with soft-preserved and unembalmed donors for clinical skills training. Among the participating programs, only 33 representatives reported an ethical approval process for conducting research involving human body donors. These findings raise ethical concerns related to the operation of body donation programs due to the lack of oversight. Furthermore, some institutions allowed faculty and staff to take photographs of donated bodies for educational purposes, which is often not disclosed on the consent form. The data also showed the need for more discussion on anatomical legacy collections housed at these institutions in the United States.

The transversoclasiotome: a novel instrument for examining the vertebral artery.

Opening the foramen transversarium of the cervical vertebrae is necessary for accessing the vertebral vessels. There are no specialist tools for cutting the anterior lamina of the transverse processes, and alternatives lead to questionable results. A novel tool, the transversoclasiotome, is described and tested. The literature and patent databases were systematically reviewed. A blueprint of the transversoclasiotome was created, and the prototype was tested through autopsy on ten fresh-frozen cadavers within our Body Donation Program. The transversoclasiotome consists of two delicate branches mounted as a scissor, one a cutting jaw and the other a knocker with a rounded tip, both angled 30° to the principal axis. The jaws shut, facing each other in parallel. The cutting jaw corresponds to a slit on the knocker profile without protruding beyond it even when entirely closed. It acts by cutting and wedging. The testing autopsies demonstrated its suitability for its purpose, with an adequate response to the pressure exerted on the bone lamina. The section cut cleanly, without sliding off while closing on the bone. The vertebral vessels were not injured either during instrument insertion or cutting. Their morphological features are described. The transversoclasiotome has been proven appropriate for sectioning the anterior lamina of transverse processes of the cervical vertebrae. It meets the needs of clinical anatomy in teaching and training clinicians or surgeons, forensic clinical anatomy during medico-legal investigation, and research.

Advances in Digital Technology in Teaching Human Anatomy: Ethical Predicaments.

The study of human anatomy has long been inseparable from illustration, as the portrayal of the dissected body alongside a descriptive text supports the understanding of this complex topic. With the advent of new technologies, applications for revealing the details of the human body have increased to include Computed Tomography and Magnetic Resonance Imaging scanning, digital photography and videography, and three-dimensional (3D) printing. In addition, the distribution of the captured image has become widespread in both online teaching and in hard copy textbooks. While these digital images and applications are invaluable for online teaching, particularly during pandemics, anatomists must consider whether the use of the images and data derived from human bodies (either donor or unclaimed) is ethical, as it is not always clear whether permission has been obtained for their creation.Questions regarding the ethical sourcing and use of images will become more urgent as the utilization of electronic data becomes routine. Particularly concerning is the distribution of images and videos in the public domain on social media, where the context and link with education may be severed. Other considerations include respect for the privacy of the deceased, ownership of images, and commercialization. An initial question that should be posed is "Who is responsible for the oversight of digital and 3D printed models of bodies?" The ethical use of such images needs to be considered by the global anatomy community in order to ensure that anatomists do not retreat into the ethical mire of their forefathers.

Cadaver surgical training in Japan: its past, present, and ideal future perspectives.

The framework for cadaver surgical training (CST) in Japan was established in 2012, based on the "Guidelines for Cadaver Dissection in Education and Research of Clinical Medicine" of the Japan Surgical Society (JSS) and the Japanese Association of Anatomists. Subsequently, the Ministry of Health, Labor and Welfare allocated funding from its budget for CST. By 2019, CST was being practiced in 33 medical schools and universities. Currently, the CST Promotion Committee of the JSS reviews each CST report submitted by medical schools and universities and provides guidance based on professional autonomy. This paper outlines the history of CST in Japan and presents a plan for its future. To sustain and oversee CST implementation, an operating organization, funded by stakeholders, such as government agencies, academic societies, and private companies, is needed.

Guidelines for cadaver dissection in education and research of clinical medicine (The Japan Surgical Society and The Japanese Association of Anatomists).

This article translates the guidelines for cadaver surgical training (CST) published in 2012 by Japan Surgical Society (JSS) and Japanese Association of Anatomists from Japanese to English. These guidelines are based on Japanese laws and enable the usage of donated cadavers for CST and clinical research. The following are the conditions to implement the activities outlined in the guidelines. The aim is to improve medicine and to contribute to social welfare. Activities should only be carried out at medical or dental universities under the centralized control by the department of anatomy under the regulation of Japanese law. Upon the usage of cadavers, registered donors must provide a written informed-consent for their body to be used for CST and other activities of clinical medicine. Commercial use of cadavers and profit-based CST is strongly prohibited. Moreover, all the cadaver-related activities except for the commercial-based ones require the approval of the University's Institutional Review Board (IRB) before implementation. The expert committee organized at each university for the implementation of CST should summarize the implementation of the program and report the details of the training program, operating costs, and conflicts of interest to the CST Promotion Committee of JSS.

The Lifecycle of a Clinical Cadaver: A Practice-Based Ethnography.

PhenomenonCadavers have long played an important and complex role in medical education. While research on cadaver-based simulation has largely focused on exploring student attitudes and reactions or measuring improvements in procedural performance, the ethical, philosophical, and experiential aspects of teaching and learning with cadavers are rarely discussed. In this paper, we shed new light on the fascinating philosophical moves in which people engage each and every time they find themselves face to face with a cadaver. ApproachOver a two-year period (2018/19-2019/20), we applied ethnographic methods (137 hours of observation, 24 interviews, and the analysis of 22 documents) to shadow the educational cadaver through the practical stages involved in cadaver-based simulation: 1. cadaver preparation, 2. cadaver-based skill practice with physicians and residents, and 3. interment and memorial services. We used Deleuze and Guattari's concepts of becoming and acts of creation to trace the ontological "lifecycle" of an educational cadaver as embedded within everyday work practices. FindingsWe delineated six sub-phases of the lifecycle, through which the cadaver transformed ontologically from person to donor, body, cadaver, educational cadaver, teacher, and loved one/legacy. These shifts involved a network of bureaucratic, technical, educational, and humanistic practices that shaped the way the cadaver was perceived and acted upon at different moments in the lifecycle. By highlighting, at each phase, 1) the ontological transitions of the cadaver, itself, and 2) the practices, events, settings, and people involved in each of these transitions, we explored questions of "being" as it related to the ontological ambiguity of the cadaver: its conceptualization as both person and tool, simultaneously representing life and death. InsightsEngaging deeply with the philosophical questions of cadaver-based simulation (CBS) helped us conceptualize the lifecycle as a series of meaningful and purposeful acts of becoming. Following the cadaver from program entry to interment allowed us to contemplate how its ontological ambiguity shapes every aspect of cadaver-based simulation. We found that in discussions of fidelity in medical simulation, beyond both the physical and functional, it is possible to conceive of a third type: ontological. The humanness of the cadaver makes CBS a unique, irreplaceable, and inherently philosophical, practice.

In their own words: impact of donor information and personal statements on humanization of donors in a gross anatomy course.

Humanization of donors in gross anatomy courses has been reported to facilitate professional behavior in healthcare students. However, there is a lack of research investigating whether students' knowledge of donor information is associated with humanization of whole body donors. To address this gap, the present study aimed to 1) determine whether knowledge of donor information is associated with greater humanization of donors and 2) investigate student perceptions of receiving donor information. Donor information was provided to students at the beginning of the course (cohort A) or at midsemester (cohort B). Questionnaires utilized quantitative and qualitative methods to assess humanization and student perceptions at the beginning, middle, and end of the semester. Independent t tests demonstrated that there was no statistically significant difference in mean humanization scores between cohorts A and B before the first dissection [t(37) = 0.449, P = 0.656], at midsemester [t(35) = -1.546, P = 0.131], or at the end of the semester [t(28) = 0.004, P = 0.997]. Thematic analysis demonstrated that as the semester progressed students' view of dissection as an invasion of privacy and the donor as a patient decreased. Themes delineated from students' open-ended responses revealed that students felt a connection with their donors; that the donors' consenting information gave permission to dissect; and that the information gave students an invaluable learning experience. Students demonstrated detached concern toward their donor, viewing the donor as a learning tool or educator rather than a patient. However, their responses also indicated the development of a deeper, personal connection to donors.NEW & NOTEWORTHY A look at the use of donor personal statements and information to humanize donors and how it influenced students' experiences in a gross anatomy laboratory.

Human body donation: How informed are the donors?

Deceased human bodies are donated for education and research. Informed consent has become the standard for research on the living. A question could be asked on how informed are the donors and their families about the process before this generous gift is given. The aim of this study is to evaluate and compare the published donation forms used by body donation programs in the United States and assess them according to the guidelines published by the American Association of Clinical Anatomists. The findings of this study shows that the level of information given to donors and families, before consenting to whole body donation, varies greatly throughout the United States. Many of the forms fail to include the recommendations made by professional societies. Additional information needs to be added to whole body donation forms to better inform donors and families about the donation process, what happens to the body, and the final disposition of the bodies once studies are completed. Overall, it was concluded that in some cases consent is being obtained but much more needs to be done before institutions can claim to obtain informed consent.

What Happens if the Brain Goes Elsewhere? Reflections on Head Transplantation and Personal Embodiment.

Brain transplants have long been no more than the subject of science fiction and engaging thought experiments. That is no longer true. Neuroscientists have announced their intention to transplant the head of a volunteer onto a donated body. Response has been decidedly mixed. How should we think about the moral permissibility of head transplants? Is it a life-saving/life-enhancing opportunity that appropriately expands the boundaries of medical practice? Or, is it a bioethical morass that ought not to be attempted? For the purposes of this paper, I set aside questions regarding the surgical operation's technological plausibility so as to focus on very basic questions regarding personal identity and the morality of head transplantation. The analysis begins with an exploration of the embodiment of persons. It considers whether persons can be conceptually distinguished from all parts of their body, even if they cannot be physically separated from some parts without loss of personhood. It argues that in most cases replacing body parts with reasonably similar parts will not destroy the conditions for sustaining personhood. However, as I explore, the phenomenology of personhood is such that some physical changes may prove to be too significant to maintain personal identity successfully over time. Given such complexity and the significance of the costs involved, the moral permissibility of head transplantation likely depends on recognizing that persons may give permission to collaborate in common activities, including projects with which others deeply disagree, provided that they only utilize the services and resources of free and consenting others.

The place of ethics in practice of anatomical sciences: have we left our dark past behind and looking towards a bright future?

INTRODUCTION: Anatomical sciences involve handling of human tissues and, therefore, application of principles of bioethics is central to anatomical practice. For a considerable period of time, anatomy was practiced without ethical norms as concept of ethics developed during second half of twentieth century. Hence, possible glimpse into contrast in ethical standards between anatomy in the past and present was deemed as an intriguing research theme. METHODS: A literature search was undertaken from indexed databases (Medline and Pubmed, Scopus, Embase, CINAHL Plus, Web of Science and Google Scholar). Relevant data were extracted from 37 articles that were selected from an initial pool of 752 articles based on search criteria set for the study. RESULTS: Prevalent anatomical practices in the past such as dissection of executed criminals, acts of vivisection, illegal procurement of human remains, use of human tissues obtained as part of war crimes and dissection of human fetuses as well as their archival were analyzed through prism of established ethical norms in present day. The observations from past were presented vis-à-vis ethical practices undertaken in present times such as use of donated bodies and/or body parts procured through legal means for dissection, adherence to ethical norms during dissection, archival of human tissues mandating stringent regulation and dignified disposal of human remains. Existing loop holes were identified and future prospects regarding ethical standards in anatomy were highlighted based on rational judgment of existing trends. CONCLUSION: The article concludes with defense on future prospects of ethics in anatomy based on documented arguments.

Analysis of Population Representation Among Willed Whole-Body Donors to Facilitate the Construction of a Body Donation Program in China: From the Perspective of Medical Students and Anatomists.

The body donation program of Peking Union Medical College was established in May 1999. From May 1999 to December 2017, a total of 5,576 registrants registered and 1,459 donors donated their bodies. Demographic and medical characteristics of the donors were analyzed. The top four causes of death were neoplasms, heart diseases, respiratory diseases, and cerebrovascular diseases. Age at death among donors who died of neoplasms were significantly lower than other causes of death (all p < .05), and the interval between registration and donation among donors who died of neoplasms was significantly shorter than that among donors with other causes (all p < .001). The age of donors when they registered (p < .001) and donated (p < .001) was significantly older than that of general Beijing population. This study may provide a guide for medical colleges or research institutions to establish or enhance their own body donation programs.

Neutralisation of SARS-CoV-2 by anatomical embalming solutions.

Teaching and learning anatomy by using human cadaveric specimens has been a foundation of medical and biomedical teaching for hundreds of years. Therefore, the majority of institutions that teach topographical anatomy rely on body donation programmes to provide specimens for both undergraduate and postgraduate teaching of gross anatomy. The COVID-19 pandemic has posed an unprecedented challenge to anatomy teaching because of the suspension of donor acceptance at most institutions. This was largely due to concerns about the potential transmissibility of the SARS-CoV-2 virus and the absence of data about the ability of embalming solutions to neutralise the virus. Twenty embalming solutions commonly used in institutions in the United Kingdom and Ireland were tested for their ability to neutralise SARS-CoV-2, using an established cytotoxicity assay. All embalming solutions tested neutralised SARS-CoV-2, with the majority of solutions being effective at high-working dilutions. These results suggest that successful embalming with the tested solutions can neutralise the SARS-CoV-2 virus, thereby facilitating the safe resumption of body donation programmes and cadaveric anatomy teaching.

Tracking medical student emotionality in relation to whole body dissection and donation.

INTRODUCTION: For students studying anatomy, dissection of the human body can elicit a wide range of intellectual and emotional responses that are subject to change over the duration of a course. The purpose of this study was to determine how overall emotional responses change over time, if there are differences in responses by gender and previous laboratory exposure, and if these responses impact course performance. METHODS: First-year medical students enrolled in the Human Structure and Function course at the University of Vermont, and in the Organ Systems 1, 2, and 3 courses at Morehouse School of Medicine were given a series of four surveys across the first-year curriculum. Data were gathered regarding age, gender, and previous laboratory exposure. Students were asked to rate their level of 15 positive and negative emotions, and their desire to avoid or approach the laboratory and donors. These responses were translated to three measures: (a) a positive response index (PRI), (b) a negative response index (NRI), and (c) an avoid-approach index (AAI). Responses were followed longitudinally and matched with anatomy practical examination grades. RESULTS: Gender and previous laboratory exposure status were both significantly related to emotional responses at different points throughout the year, and unique patterns of responses across the year emerged within each group. Higher PRI and AAI were positively correlated with some practical examination scores. CONCLUSIONS: Data suggest that gender and previous laboratory exposure status influence emotional responses to dissection, and that these responses may have an effect on course performance.

The additional role of virtual to traditional dissection in teaching anatomy: a randomised controlled trial.

INTRODUCTION: Anatomy has traditionally been taught via dissection and didactic lectures. The rising prevalence of informatics plays an increasingly important role in medical education. It is hypothesized that virtual dissection can express added value to the traditional one. METHODS: Second-year medical students were randomised to study anatomical structures by virtual dissection (intervention) or textbooks (controls), according to the CONSORT guidelines. Subsequently, they applied to the corresponding gross dissection, with a final test on their anatomical knowledge. Univariate analysis and multivariable binary logistic regression were performed. RESULTS: The rate of completed tests was 76.7%. Better overall test performance was detected for the group that applied to the virtual dissection (OR 3.75 with 95% CI 0.91-15.49; p = 0.06). A comparable performance between groups in basic anatomical knowledge (p 0.45 to 0.92) but not muscles and 2D-3D reporting of anatomical structures was found, for which the virtual dissection was of tendential benefit (p 0.08 to 0.13). Medical students who applied to the virtual dissection were over three times more likely to report a positive outcome at the post-dissection test than those who applied to textbooks of topographical anatomy. This would be of benefit with particular reference to the understanding of 2D-3D spatial relationships between anatomical structures. CONCLUSION: The combination of virtual to traditional gross dissection resulted in a significant improvement of second-year medical students' learning outcomes. It could be of help in maximizing the impact of practical dissection, overcoming the contraction of economic resources, and the shortage of available bodies.

COVID-19 and anatomy: Stimulus and initial response.

The outbreak of COVID-19, resulting from widespread transmission of the SARS-CoV-2 virus, represents one of the foremost current challenges to societies across the globe, with few areas of life remaining untouched. Here, we detail the immediate impact that COVID-19 has had on the teaching and practice of anatomy, providing specific examples of the varied responses from several UK, Irish and German universities and medical schools. Alongside significant issues for, and suspension of, body donation programmes, the widespread closure of university campuses has led to challenges in delivering anatomy education via online methods, a particular problem for a practical, experience-based subject such as anatomy. We discuss the short-term consequences of COVID-19 for body donation programmes and anatomical education, and highlight issues and challenges that will need to be addressed in the medium to long term in order to restore anatomy education and practice throughout the world.