Giving a voice to our silent teachers: Whole body donation from the donor perspective at one donation program in the United States

Human body donors play a crucial role in anatomical education, research, and clinical skills training, and those interested in anatomical donation may bequeath their bodies to body donation programs (BDPs). The purpose of this study was to evaluate the perspective of body donors on the donation process in order to make recommendations for improvement that align with donor values. A survey was administered via email to 2145 individuals that had enrolled in The Ohio State University's BDP and yielded a 40% response rate. Results showed that a majority of registered donors do not place high importance on detailed consent options during the enrollment process, but do value BDP oversight, such as through the use of an oversight committee to supervise the program. Only 9.1% of donors felt that their loved ones should be permitted to make changes to their consent forms after they have passed. Although 96.2% of participants would allow photos/videos to be taken of their donated bodies, females were significantly less likely to consent to this than males (p = 0.001), as well as less likely to allow their donations to be utilized for anatomy outreach (p = 0.023). Racial minorities were significantly less trusting of the university to treat their donation with dignity and respect compared to White registrants (p = 0.034). Suggestions for improving BDP protocols include the implementation of an annual newsletter for registrants, improving methods to spread awareness about donation, increasing transparency during the consent process, and creating resources for donors' families.

First patient project: Engaging pathology through the donor dissection experience and its role in professionalism

The peer-reviewed anatomical education literature thoroughly describes the benefits and drawbacks of donor dissection. Gross anatomy laboratory environments utilizing donor dissection are generally considered to be a premier environment where students foster non-traditional discipline-independent skills (NTDIS), including the acquisition of professionalism, empathy, resilience, emotional intelligence, and situational awareness. Therefore, this IRB-approved study explored the impact of a formal humanism and pathology thread, the first patient project (FPP), on the personal and professional development of pre-professional undergraduate students in a gross anatomy dissection-based course. Five reflections from each student were collected across four cohorts (n = 74 students, 370 reflections). A post-course questionnaire collected data on student perceptions of the project. The framework method was used to analyze reflection and free response data and descriptive statistics were performed on Likert-style items using Excel. Three themes were identified to encompass the impacts of the FPP on professional development and include: Socialization (through collective dissection experience and pathology), Humanistic Qualities (respect for the donor and their history, and introspection), and Content and Skills (technical and NTDIS, anatomical knowledge). The end of course FPP survey was completed by 29 students across three cohorts (65%) and their perspectives were generally favorable regarding the promotion of respect, empathy, and humanization of their donors. This study underscores the value of incorporating humanism, pathology, and reflection, facilitated through formal curriculum for pre-professional undergraduate students. It provides evidence of the positive impact on their personal and professional development, supporting the integration of NTDIS in curricula across various disciplines.

Educator perspectives on non-technical, discipline-independent skill acquisition: An international, qualitative study

Gross anatomy education utilizing body donors and human specimens assists the acquisition of non-traditional, discipline-independent skills (NTDIS) such as teamwork, communication, and leadership. Alterations to anatomy curricula, such as those resulting from the COVID-19 pandemic, likely impact NTDIS acquisition, yet how this manifests is unclear. This study, therefore, explored anatomy educator perspectives on NTDIS acquisition as a response to changes in teaching delivery. Gross anatomy educators across different countries were recruited and took part in one-on-one, semi-structured interviews that were audio recorded and transcribed. Data were analyzed using the framework method. Basic statistical analyses were performed on demographic and categorical data. Fifteen educators from five continents were interviewed (average length 32.5 min, range 17-51 min). Educator experience ranged from 0-4 years (n = 3) to 20+ years (n = 7). Most taught using dissection (n = 14) with prosection use (n = 13) also common. Themes relating to NTDIS included expected content (respect for donors, teamwork, communication skills, humanistic values), assessable content, assessment challenges, and impact of curriculum changes; NTDIS unique to anatomy education included cultural, ethical, and social considerations around dead bodies, including boundaries, and social norms. Informed by curriculum alterations during the COVID-19 pandemic, this first empirical study of anatomy educator perspectives on NTDIS highlights the potentially adverse educational impacts of decreased interaction with body donors and human specimens on NTDIS acquisition and difficulties with NTDIS assessment. Findings support gross anatomy education as unique in providing NTDIS that cannot easily be replicated elsewhere. Recommendations around NTDIS-specific educator competencies and promoting NTDIS are provided.

Ethical concerns surrounding artificial intelligence in anatomy education: Should AI human body simulations replace donors in the dissection room?

The potential effects of artificial intelligence (AI) on the teaching of anatomy are unclear. We explore the hypothetical situation of human body donors being replaced by AI human body simulations and reflect on two separate ethical concerns: first, whether it is permissible to replace donors with AI human body simulations in the dissection room when the consequences of doing so are unclear, and second, the overarching ethical significance of AI use in anatomy education. To do this, we highlight the key benefits of student exposure to the dissection room and body donors, including nontechnical, discipline-independent skills, awareness and interaction with applied bioethics, and professional identity formation. We suggest that the uniqueness of the dissection room experience and the importance of the key benefits accompanying this exposure outweigh the potential and so far unknown benefits of AI technology in this space. Further, the lack of engagement with bioethical principles that are intimately intertwined with the dissection room experience may have repercussions for future healthcare professional development. We argue that interaction with body donors must be protected and maintained and not replaced with AI human body donor simulations. Any move away from this foundation of anatomy education requires scrutiny. In light of the possible adoption of AI technologies into anatomy teaching, it is necessary that medical educators reflect on the dictum that the practice of healthcare, and anatomy, is a uniquely human endeavor.

The chemicals between us-First results of the cluster analyses on anatomy embalming procedures in the German-speaking countries

Hands-on courses utilizing preserved human tissues for educational training offer an important pathway to acquire basic anatomical knowledge. Owing to the reevaluation of formaldehyde limits by the European Commission, a joint approach was chosen by the German-speaking anatomies in Europe (Germany, Austria, Switzerland) to find commonalities among embalming protocols and infrastructure. A survey comprising 537 items was circulated to all anatomies in German-speaking Europe. Clusters were established for "ethanol"-, formaldehyde-based ("FA"), and "other" embalming procedures, depending on the chemicals considered the most relevant for each protocol. The logistical framework, volumes of chemicals, and infrastructure were found to be highly diverse between the groups and protocols. Formaldehyde quantities deployed per annum were three-fold higher in the "FA" (223 L/a) compared to the "ethanol" (71.0 L/a) group, but not for "other" (97.8 L/a), though the volumes injected per body were similar. "FA" was strongly related to table-borne air ventilation and total fixative volumes ≤1000 L. "Ethanol" was strongly related to total fixative volumes >1000 L, ceiling- and floor-borne air ventilation, and explosion-proof facilities. Air ventilation was found to be installed symmetrically in the mortuary and dissection facilities. Certain predictors exist for the interplay between the embalming used in a given infrastructure and technical measures. The here-established cluster analysis may serve as decision supportive tool when considering altering embalming protocols or establishing joint protocols between institutions, following a best practice approach to cater toward best-suited tissue characteristics for educational purposes, while simultaneously addressing future demands on exposure limits.

Profiting from public dissection: A new era of unethical practices

Historically, adverse events have reflected poorly on both the practice of dissection and the perception of the discipline of anatomy. The recent public dissection of a body donor is a regression to an unethical historical practice and was strongly denounced by anatomists around the world. The individual whose donated body was sourced from a 'for-profit" company in the United States had not given consent for a public dissection. This violates the ethics surrounding consent and body donation and potentially places the future of body donor programs in jeopardy as it compromises community frameworks around epistemic trust. Recent guiding frameworks by international anatomical associations on the ethical use of bodies have cemented the way in which body donor programs should operate. This viewpoint reflects on past and current events pertaining to public dissections and questions how these indignities may influence the public's interaction with human bodies. The authors argue that public dissection should be prohibited as it is against social mores. Social pressure should be applied to individuals or companies who wish to profit from unethical anatomical practice and legislation prohibiting public dissection should be introduced in those countries where it does not yet exist.

Current issues of body donation for teaching and research purposes and their use in the Czech Republic

Since time immemorial, bodies of deceased have been an integral part of teaching anatomy, and therefore the study of medicine. Without them, the teaching of anatomy, clinical anatomy and many research projects could not be realized. Nowadays, the European countries allow to use exclusively bodies of the deceased donors. Recently, we have registered a growing trend in the needs of the bodies not only for the purposes of medical education, but also for those of clinical anatomy. The question also arose of the suitability of using COVID-19 positive donors or the legislative possibility of obtaining bodies in the absence of donors in the donor program. Our communication addresses current issues of body donation for teaching and research purposes and their use in the Czech Republic.

"Why did you really do it?" A mixed-method analysis of the factors underpinning motivations to register as a body donor

Individuals who register as body donors do so for various reasons, with aiding medical science a common motivation. Despite awareness of several key reasons for donation, there are few in-depth explorations of these motivations to contextualize persons' reasons for donating. This study undertakes a mixed-method exploration of motivations for body donation to facilitate deeper understanding of the reasons underpinning donor registration. A survey of all newly registered body donors at a New Zealand university was performed over a single year. The survey included basic demographic information, a categorical question on reason for donation, a free-text question on donation motivation, and a free-text question allowing "other" comments on body donation. Basic statistical analysis was performed on demographic and categorical data, and thematic analysis used on free-text responses. From 169 registrants, 126 people (average age 70.5 years; 72 female) returned completed surveys (response rate 75%). Categorical data indicate a primary motivation of aiding medical science (86%). Fifty-one respondents (40%) provided free-text data on motivation, with other comments related to motivation provided by forty-one (33%). Common themes included reference to usefulness, uniqueness (pathophysiology and anatomy), gift-giving, kinship, and impermanence of the physical body. Consistent with previous studies, the primary reason for body donation was aiding medical science, however underpinning this was a complex layer of themes and sub-themes shaping motivations for choices. Findings provide important information that can guide development of robust informed consent processes, aid appropriate thanksgiving service delivery, and further contextualize the importance of medical professionals in body donation culture.

An atraumatic retractor for interdisciplinary use in conventional laparoscopy and robotic surgery

BACKGROUND

The removal of obstacles from the surgical field is a crucial aspect of any procedure in gynecological, urological or visceral laparoscopic surgery. Reliable instruments and skilled assistance are essential for the smooth execution of procedures. Blunt forceps are commonly used to keep tissue away from the operating field. The range of existing instruments has been enhanced by the introduction of laparoscopic retractors. However, no laparoscopic retractor can be used without causing tissue damage.

MATERIAL AND METHODS

We describe the ALKATOUT retractor, an innovative laparoscopic retractor designed for atraumatic assistance in any laparoscopic procedure including robotic surgery. The advantages of this laparoscopic instrument were evaluated in a single-center study.

RESULTS

The retractor has been used successfully in a variety of gynecological procedures and tested in laparoscopic procedures on human body donors.

CONCLUSIONS

The results of a single-center questionnaire completed by 25 operating room staff (surgical nurses, residents, and specialists) confirm the advantages of the ALKATOUT retractor.