Cadaver Donation- The Choice of a Lifetime
–Divya Samat, Final Year MBBS
KJ Somaiya Medical College, Mumbai
While studying Forensic Medicine, it’s likely that you’ve encountered the term ‘burking’ which is used to refer to a form of traumatic asphyxiation and smothering that is homicidal in nature. The origins of this term make for quite an interesting story:
In 1828, two Irishmen living in Edinburgh, William Burke and William Hare murdered and sold the bodies of at least 16 people to Robert Knox as dissection material for his anatomy classes. Burke and Hare crafted a method of murder, which became infamous as ‘Burking’ and went completely undetected. Ironically when they were arrested, Burke himself was awarded capital punishment and his corpse was dissected. [1]
This, however, was not an isolated incident. As the practice of hands-on anatomical dissection became popular in the late 18th century, the demand for cadavers exceeded the supply as a result of which ‘grave robbing’ became a popular practice. In addition to this, slave owners sold the bodies of their deceased chattel to medical schools for anatomic dissection.
It was in light of such events and in order to ensure dignity of the dead and ethical and humane practices that the following laws were put into place. The Anatomy Act, enacted by various states in India provides for the supply of unclaimed bodies to hospitals, medical and teaching institutions for any therapeutic purpose or for the purposes of medical education and research including anatomical examination and dissection. This Act has been implemented in different states with minor modifications in the stipulated time for claiming the body, the officer in charge, differentiation between ‘unclaimed’ and ‘unidentified bodies, etc as seen in the Karnataka Anatomy Act and the Bombay Anatomy Act. In 2000, the Anatomy Act was further amended by the State Legislative Council to permit donation before the death of one’s body or any part thereof, after death by a person, to a hospital, and medical & teaching institution. [2]
As a first-year medical student, the vast majority of weekday mornings are spent in the Anatomy Dissection Hall. It is rightly said that the cadaver is our ‘first teacher’. It helps medical students learn relations of human anatomic structures, develop a spatial and tactile appreciation for the fabric of the human body and connect information in a way that words and pictures of a textbook never could. Furthermore, the attitude developed during dissection may influence interactions with future patients and guide students towards becoming humane physicians.
In addition to the importance of cadaver dissection as a teaching tool for medical undergraduate students and aspiring surgeons, whole body donation also helps researchers identify better ways to treat a comprehensive range of illnesses and conditions, aids advances in medical and physician training, and development of novel surgical procedures. It facilitates improved understanding of how diseases progress; paves the way for treatment breakthroughs in areas such as gynecology, colon and liver illness, diabetes, and HIV; development of life-changing medical devices; cancer protocols; treating spinal injuries; and enhanced drug delivery mechanisms. In the Netherlands for example, patients with neurodegenerative diseases may register with the Dutch Brain Bank to donate brain and/or spinal cord tissue for scientific purposes. Current diagnostic procedures can be performed reliably only by including appropriate positive and negative control samples from previous patients. Likewise, future patients can be optimally diagnosed and treated only by using material from today’s patients.[3]
The significant contribution of cadaver donation to the advancement of medical science and research can be aptly summarized by the line- “If you’ve ever been a patient in life, you’ve benefited by body donation.”
Even though India is one of the most populous countries in the world, there still exists a scarcity of cadavers for medical and research purposes. The most important reason for this is the lack of awareness amongst the Indian population. While there is increasing awareness regarding organ donation, only 22 % of the general population is aware that the whole body can be donated. Another major hindrance to body donation is spirituality and religious beliefs. The majority want to have their last rites performed as per their religious belief. The fear that the organs may be sold, that the body may not be used for the right cause and that the body may not be treated with respect and dignity are also important factors standing in the way of whole body donation.
It might be shocking to learn that members of the medical fraternity too can’t accept the concept of dissection of their own body. Although anatomists encourage cadaver donation, in a survey researching the attitude of anatomists towards donating their own bodies for dissection it was found that only 15.7% are willing to donate their bodies. The main reasons cited were – unacceptability to getting dissected by a colleague, the unacceptability of donation by family, the anxiety of disrespectful behavior to cadavers, and religious belief. Organ donation is preferred over whole body donation not only by the general population but also by the medical fraternity. [4]
As there is no suitable alternative to cadavers, organized efforts are needed to raise the awareness and change the mindset of society towards body donation. The stigma regarding this issue should be addressed and correct information disseminated among the general public with the help of pamphlets, seminars, electronic, and print media, etc. Proper guidance, resolution of queries and other assistance regarding body donation should be easily available for the willing people. Body donation cells should be made mandatory for all medical colleges for effective implementation of the programme. Furthermore, some of the medical colleges in India receive more cadavers than required. Hence, appropriate legal measures should be undertaken to permit the transfer of cadavers from one medical college to another.
Alashek et al (2009) suggested that the public education campaigns should be coordinated with religious leadership [5] in order to combat the misconception that donation of the body is not looked upon favorably by any religion and the possible implications of the same. The donors and their families may be given social honor and recognition as well as due assurance that their bodies will be treated with respect and dignity. The practice of honoring the cadaver at the commencement of medical course session and dissection, by students and teachers, and taking the cadaveric oath should be made mandatory.
A paradigm shift can only be achieved by combined efforts of the government and medical fraternity towards raising awareness and dispelling the stigma surrounding whole body donation. We must learn to lead by example and abide by these impactful words:
‘Mortui Prosumus Vitae’ (Even in death do we serve life)
References:
[1] Ghosh, Sanjib Kumar. “Human Cadaveric Dissection: a Historical Account from Ancient Greece to the Modern Era.” Anatomy & cell biology. Korean Association of Anatomists, September 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582158/.
[2] Rokade, Shrikant A., and B. H. Bahetee. “Body Donation in India: a Review.” International Journal of Research in Medical Sciences, 2013. https://www.msjonline.org/index.php/ijrms/article/view/2583.
[3] Diest, P J van, N W J Lopes Cardoso, and J Niesing. “Cadaveric Tissue Donation: a Pathologist’s Perspective.” Journal of Medical Ethics. Institute of Medical Ethics, June 1, 2003. https://jme.bmj.com/content/29/3/135.full. [4] Saha, Anubha, Aniruddha Sarkar, and Shyamash Mandal. “Body Donation after Death: The Mental Setup of Educated People.” Journal of clinical and diagnostic research : JCDR.
