THE use of body donation for medical science has been around for over 200 years, and is most often used to train new surgeons.
But how relevant is it today? In the age of 3D printers, more realistic dissection models, and thousands of instructional YouTube videos, is body donation still relevant?
I meet Dr Riccardo Natoli at the ANU Medical School.
He’s the Medical School’s co-ordinator of the body bequest program.
“In general, the acceptance rates for body donation are much higher than organ donation,” Riccardo explains.
This is because donated bodies are used solely for anatomical studies, for the training of future surgeons and doctors. By contrast, organ and tissue donation are concerned with function, with transplantability and therapy. For anatomical studies, structure and architecture are more important.
“Once a donor dies, there’s an assessment of whether their body can be used,” says Riccardo. “Reasons for exclusion include obesity, emaciation, jaundice, dementia, gastrointestinal cancer, and recent chemotherapy.”
Potential donors have to be of sound body and mind and at least 18 years old. Riccardo says they send out about 200 information packs per year; of those, about half are returned completed. ACT registration rates for body donation are comparatively high due to the population being generally very literate and having a sizeable number of people involved in medical research or care.
Riccardo explains that the ANU Medical School’s catchment area is a 200-kilometre radius of the ACT. Bodies need to be received within 24-48 hours of death.
The funeral home delivers the body to the mortuary technician. Blood is collected for testing, the samples de-identified but given priority by ACT Pathology at the Canberra Hospital, with results available in 24 hours. Once the donor is declared safe, the embalming process can begin.
“Embalming makes the body inert,” Riccardo continues. “When our studies are complete, the body is cremated. This is a requirement under the Transplantation and Anatomy Act 1978. If a body was buried, the embalming fixative could leach into the ground, which has contamination issues. We have a small plot at Broulee Memorial Gardens where ashes are scattered.”
We leave Riccardo’s office. As we walk downstairs to the basement level, I ask about donors.
“The vast majority of our donors have had some form of medical training like anatomy, pathology, nurse, clinician, researcher, and they see body donation as a way of giving back,” says Riccardo. “It was, after all, the only way they learned things in the first place.”
I’m introduced to the mortuary technician. In the same way Riccardo handles the living, Hannah Lewis expertly takes care of the dead. Hannah is in her 20s with a fresh face and bright eyes.
Showing me through their rooms, I see a large number of body and tissue models, along with a real human skeleton. I notice how imperfect the ribs and bones appear alongside a factory-made plastic model. This reminds me to ask about whether body bequest is still even necessary. I mean, everything’s now on YouTube, right? Not to mention brand new virtual reality apps and hologram dissection systems.
“Let me answer that question with a question,” says Riccardo, smiling gently. “Let’s say you go to get your car fixed. One mechanic has never touched an engine before, although they’ve worked in a virtual environment with 3D-engines. Another mechanic has worked on engines their entire life, their fingernails dirty with grease and oil. Which would you use?”
I smile back, the answer obvious.
“It’s the same idea here,” says Hannah. “Models are great teaching resources, but dissection with embalmed bodies remains the closest to replicating surgery. Students may work up to a human body after viewing videos and practising their dissections on animals and 3D-printed bodies. Even removing the skin from fruit with surgical scalpels helps a medical student develop the right dexterity for surgery.”
We enter the teaching lab, which contains about 20 stainless steel tables. The anatomy instructor stands at the front of the room, a video camera positioned above their table. Their dissections are projected onto large monitors above the students’ tables. It is 21st century teaching.
Imagining a room of students busily examining and cutting, I ask about the issue of identity. Riccardo assures me that all cadavers are de-identified before dissection, with identifier information kept highly secure.
“Donor information is stored on secure servers, not on any individual computer, with the hard copy paperwork double-locked behind a door and cabinet. All the bodies are de-identified with a number, and that number and name are never correlated in any location other than the database.”
Entering the tissue preservation room, I’m surrounded by large plastic buckets containing harvested limbs and organs. I’m shown a tub with brains, which I can see floating through clear plastic. Another is sealed tight, non-transparent, and I’m told contains dissected fingers and thumbs.
The next room is the holding bay, where the bodies are delivered. Blood samples are collected for pathology testing with a large needle from the left ventricle. Bodies are then bathed and their hair shaved. They are double-bagged and stored in fridges.
Finally, we reach the cold room with the storage fridges. An adjoining room contains the embalming equipment. Everywhere I look there is new stainless steel, silvery and clean and dull.
A large embalming table dominates the room, surrounded by big plastic bottles containing the chemicals for the embalming fixative. The prepared fixative is stored in a stainless steel tank attached to a large metal hook. It is slowly placed into the venous system with an arterial tube. A whopping 20-30 litres of fluid is pumped in.
“The chemical reactions of embalming usually take 6-9 months to complete,” Hannah explains. “The dissections themselves also take time, sometimes 1-3 months.”
The current capacity at ANU is 16 bodies, four per fridge. Just up the highway, UNSW has capacity for 120.
Hannah says that bodies are kept a minimum of six years. The maximum is indefinite. There is one donation from over 10 years ago which is still being used.
Riccardo explains that they encourage prospective donors to sign up for all three categories of donation — organ, tissue, body — and then leave it for the medical staff to decide the best outcome.
“Organ and tissue donation are mutually exclusive with body donation, since the removal of organs and tissues interferes with the embalming process. So the order we perceive is: organ donation first, for transplantation with immediate lifesaving outcomes; tissue second, for therapeutic benefits; and body last. Today, we work closely with DonateLife to bolster organ and tissue donations.”
I point out the high visibility of organ donation, with prominent advertising campaigns and promotions. And yet, as it turns out, acceptance rates are low due to the quality of the donor material required. By contrast, body donation has much higher rates of acceptance, yet isn’t particularly visible.
“I think this is because people still aren’t comfortable talking about death,” Riccardo says. “This is slowly changing.”
Peter Papathanasiou is a freelance writer and former research geneticist
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