Body Donation in Beijing, China in the Last 20 Years: Current Status and Future Development

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

BACKGROUND

Body 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 FINDINGS

In 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.

CONCLUSIONS

Contrary 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.

An examination of the status, contexts of anatomical body donation, and perspectives in China

Body donation is a valuable resource in medical education, research, clinical diagnosis, and treatment. Consequently, donors are honored as "Silent Mentors" in Chinese medical schools. This article briefly reviews the history, current status, and strategies to promote body donation in China (excluding data from Hong Kong, Macao, and Taiwan regions) and discusses the problems encountered in body donation work in China. After establishing the People's Republic of China in 1949, the central government issued regulations on the use of dissected bodies. In 2001, the "Shanghai Regulations on Body Donation" were officially implemented and became China's first local legislative regulation on body donation. Subsequently, local legislative regulations and rules on body donation were issued in various regions to promote smooth and orderly body donation. There has been tremendous development in body donation in China for more than 40 years; however, the progress of this partial work has been uneven in various areas owing to the influence of traditional ethical concepts. It is, therefore, imperative to legislate body donations at a national level. Raising the public's scientific literacy and changing the traditional concept of funerals can create a positive social atmosphere for body donation, thus increasing the public's awareness and willingness to donate their bodies. Donating the body at the end of life contributes to life science and medical causes and is a noble act worthy of praise.

The relationship between body donation and attitudes toward death and altruism in Changsha City in China

In recent years, China has been facing a shortage of cadavers for teaching medical students. A better comprehension of the attitudes and factors influencing the general public's opinion toward body donation would be invaluable for planning and implementing body donation programs. Although altruistic attitude and attitudes toward death have received considerable attention in recent years globally, they have been largely understudied in China. Herein, the potential relationship between attitudes toward altruism and death, and willingness toward whole-body donation in a sample of university students in Changsha City in China were analyzed. A multi-stage sampling method was adopted to recruit 478 Chinese college students from two universities: the Medical College of Hunan Normal University (n = 272) and the College of Civil engineering of Hunan University (n = 206). The study participants were assessed by a sociodemographic questionnaire, the Death Attitude Profile-Revised (DAP-R-C) questionnaire, and the altruism scale. Moreover, Chinese University students demonstrated moderate willingness to donate their bodies. The mean score of the willingness of study participants to donate their bodies was 3.138 ± 0.933 (5-point Likert scale). Acceptance toward death, gender, and type of university were positive factors, whereas fear of death negatively affected willingness toward body donation. Regression analysis showed that factors, including gender (β = 0.237), type of university (β = 0.193), natural acceptance (β = 0.177), and fear of death (β = -0.160) influenced willingness toward body donation. Overall, the present study provides hitherto undocumented evidence on factors influencing willingness toward body donation among Chinese university students, which can assist in designing public awareness programs for encouraging body donation.

Reference centers for tissue and body donations: Compulsory requirements in Italy

Recent Italian legislation (Law No. 10/2020) establishes the legal, ethical and technical requirements governing how individuals can donate their bodies or tissues post-mortem for study, training, and scientific research purposes. A ministerial working group has recently approved some of the law's implementing rules relating to technical issues. The rules for implementing the new legislation, retrieved from the legal databases and translated into English, are discussed. For the first time in Italy, the law establishes compulsory requirements and minimum characteristics-in terms of logistics, safety, availability of staff, space, and equipment-for institutions to be recognized as reference centers for the conservation and use of bodies and tissues donated post-mortem for study, training and scientific research purposes. This makes it possible to standardize the features of such reference centers nationwide, and to coordinate their activities and potential future development, while ensuring basic operational efficiency and workplace safety, the provision of adequate facilities, buildings and equipment, and staff training. The law and its implementing rules discussed here are the first to establish criteria and compulsory requirements for centers receiving body and tissue donations in Italy. This is a step forward for the whole anatomy community, providing practical guidelines for body donation programs and related facilities in other countries too.

Understanding beliefs, preferences and actions amongst potential body donors

Body donation is a prosocial act providing a unique learning experience to students, ultimately impacting on patient care and science. With an increasing number of training professionals, there is an increasing need for body donors, yet little is understood about donors' beliefs and preferences. A four-center study aimed to understand donors' perceptions, 843 responses highlighted a significant relationship between completing a body donor consent form and being both an organ donor and having ever donated blood (p < 0.01). In exploring donor intentions, 69% had been considering donation for fewer than five years, 40% knew another body donor, and 27% had a family member or friend currently registered. Of those who had requested donor information packs, 97% had completed body donation consent forms. Of these, 92% had not selected any time restriction for their donation and 96% had consented to images being taken. Almost all (98%) were aware that their donation might not be accepted. Donors' motives highlighted a wish to: improve education, improve health care, advance science, and contribute to the greater good. A bimodal response was observed with body donation being used to save relatives money and inconvenience. Donors felt comfortable with their bodies being used by medical, dental, and allied health professionals; however, donors were less comfortable with their bodies being used by other groups. Only 57% were comfortable with artists, beauticians and yoga teachers using their remains. Understanding donors' motivations and decision-making process is vital to ensure resources for future and to meet any changing requirements of both donors and those studying them.

Altruism in death: Attitudes to body and organ donation in Australian students

Health education, research, and training rely on the altruistic act of body donation for the supply of cadavers. Organ transplantation and research rely on donated organs. Supply of both is limited, with further restrictions in Australia due to requirements for a next-of-kin agreement to donation, irrespective of the deceased's pre-death consent. Research suggests health workers are less likely to support the donation of their own bodies and/or organs, despite recognizing the public good of donation, and that exposure to gross anatomy teaching may negatively affect support for donation. Attitudes to body and organ donation were examined in Australian students studying anatomy. Support for self-body donation (26.5%) was much lower than support for self-organ donation (82.5%). Ten percent of participants would not support the election of a family member or member of the public to donate their body, and just over 4% would not support the election of a family member to donate their organs, with one-to-two percent not supporting this election by a member of the public. Exposure to gross anatomy teaching was associated with an increased likelihood of consideration of issues about body and organ donation, whether for self, family, or the public, and registration as an organ donor. Exposure decreased participants' willingness to donate their own body, with those who practiced a religion least likely to support body donation. Gross anatomy courses provide an opportunity to inform future healthcare workers about altruistic donation, albeit with a recognition that religious or cultural beliefs may affect willingness to donate.

Demographic and motivational factors affecting the whole-body donation programme in Nanjing, China: a cross-sectional survey

OBJECTIVES

To investigate the demographics and motivations of whole-body donors in China, and help suggest a solution to the problem of low body donation numbers.

DESIGN

A cross-sectional study on body donors in China. Demographic analysis of the donating information of deceased donors and in-depth interviews of potential body donors.

SETTING

Eleven districts in Nanjing, China.

PARTICIPANTS

Deceased whole-body donors who had donated their bodies to the body donation receiving station of Nanjing Medical University between 1 July 2009 and 30 June 2019 (n=835), and living registered whole-body donors (n=68).

RESULTS

Among the whole-body donor population, the numbers of males, people older than 65 years and those working as teachers, government officials, medical staff and farmers were significantly higher than those of the general Nanjing population. Donors with an education level of college or above accounted for nearly half of the deceased donors, and considered donating their bodies earlier in their lives than others. Cancer and heart disease were the major causes of death among donors. Interviews of the 68 living donors revealed the following major motivations for the decision to donate: to support medical education; to reduce their children's funeral burden; no longer holding traditional Chinese views on life and death; influence by role models and annoyance at complex funeral ceremonies.

CONCLUSIONS

Older people, people with an education level of college or above, labourers, teachers, government officials and farmers are the major groups that donate their bodies. Although people's motivations for donation are complex, their desire to support medical education is the most prevalent motivation. By helping focus on target groups for promotional messaging and identifying their prime motivations, this study's findings can provide a reference for promoting body donation in China.

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.