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Bagian LK, Davis DC, Parker RC, Mosley CF, Balta JY. Giving a voice to our silent teachers: Whole body donation from the donor perspective at one donation program in the United States. ANATOMICAL SCIENCES EDUCATION 2024; 17:893-908. [PMID: 38520129 DOI: 10.1002/ase.2410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 02/21/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024]
Abstract
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.
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Affiliation(s)
- Lauren K Bagian
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University School of Medicine, Washington, DC, USA
| | - Danielle C Davis
- Division of Anatomy¸ Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ryan C Parker
- Division of Anatomy¸ Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Claudia F Mosley
- Division of Anatomy¸ Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Joy Y Balta
- Anatomy Learning Institute, College of Health Sciences, Point Loma Nazarene University, San Diego, California, USA
- Division of Anatomy, Department of Surgery, School of Medicine, University of California at San Diego, San Diego, California, USA
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Bagian LK, Wyatt TB, Mosley CF, Balta JY. Investigating the status of whole-body donation across the United States of America. ANATOMICAL SCIENCES EDUCATION 2024; 17:646-659. [PMID: 38308395 DOI: 10.1002/ase.2387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Abstract
Dissection of human body donors is a valuable part of anatomical education, research, and clinical training. In the United States, deceased human bodies are predominantly sourced through whole-body donation programs (BDPs) housed by academic institutions. Due to the lack of information regarding BDPs, the aim of this study was to gather information from US BDPs through a survey to better understand the donation process and standard operating procedures of these programs. In 2021, a Qualtrics survey was distributed to 125 BDPs and yielded responses from 72 program leaders. Collectively, these programs received more than 26,000 whole-body donations annually. Findings show that 70% typically receive enough donations to fit the needs of their institutions, 17% receive a surplus of donations, and 13% receive too few donations. Sixty-eight percent of programs permit next of kin body donation regularly or in times of need, and 44% allow next of kin to make changes to a donor's donation form after death. On average, over 85% of the registered donor population is composed of white individuals, and only 6 institutions have methods in place to promote diversity among their donor population. Overall, there is considerable variability in the operation of BDPs across the United States. These findings can be used to make recommendations about donor enrollment and program operations to ultimately improve the donation process. Future research needs to investigate the opinions and preferences of body donors along with their next of kin on the body donation process and associated policies.
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Affiliation(s)
- Lauren K Bagian
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University School of Medicine, Georgetown University, Washington, DC, USA
| | - Taylor B Wyatt
- Division of Anatomy, Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Claudia F Mosley
- Division of Anatomy, Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Joy Y Balta
- Anatomy Learning Institute, College of Health Sciences, Point Loma Nazarene University, San Diego, California, USA
- Division of Anatomy, Department of Surgery, School of Medicine, University of California at San Diego, San Diego, California, USA
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Human body donation and surgical training: a narrative review with global perspectives. Anat Sci Int 2023; 98:1-11. [PMID: 36227535 PMCID: PMC9845172 DOI: 10.1007/s12565-022-00689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 10/06/2022] [Indexed: 02/01/2023]
Abstract
Utilization of human material in surgical simulation training has been well-established as an effective teaching method. Despite the value of donor-based surgical simulation training, its application may be hampered by difficulties regarding access to donated bodies. Therefore, the aim of this review is to assess body donation and body acquisition practices with regard to surgical simulation training programs around the world. The results of this review highlight discrepancies regarding body donation practices and surgical simulation programs among continents and countries. The utilization of donor bodies in surgical simulation appears to mirror body donation practices. In countries that rely mostly or exclusively upon unclaimed bodies or executed criminals, there are scant reports of donor-based surgical simulation programs. In countries where willed-body donation is the principal source of human material, there tend to be many surgical simulation programs that incorporate human material as part of surgical training. This review suggests that, in anatomical and surgical education, the utilization of active willed-body donation programs, as opposed to the utilization of unclaimed human bodies, positively corresponds with the development of beneficial donor-based surgical simulation programs. Likewise, donor-based surgical simulation training programs may have an influence on the perpetualization of willed-body donations.
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Noël GPJC, Dubé J, Venne G. The Unintentional Effects on Body Donation Programs of a Competency-Based Curriculum in Postgraduate Medical Education. ANATOMICAL SCIENCES EDUCATION 2021; 14:675-681. [PMID: 33152170 DOI: 10.1002/ase.2033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 10/05/2020] [Accepted: 11/02/2020] [Indexed: 06/11/2023]
Abstract
As medical programs place increasing importance on competency-based training and surgical simulations for residents, anatomy laboratories, and body donation programs find themselves in a position of adapting to changing demands. To better assess the demand for "life-like" cadaveric specimens and evaluate the possible impacts that competency-based medical education could have upon the body donation program of McGill University, Canada, the authors tracked, over the course of the last 10 years, the number of soft-embalmed specimens, along with the number of teaching sessions and the residents enrolled in competency-based programs that are using cadaveric material. The results reveal that the number of soft-embalmed specimens used within residency training increased from 5 in 2009 to 35 in 2019, representing an increase from 6% of bodies to 36.5% of the total number of body donors embalmed in this institution. Correspondingly, the number of annual teaching sessions for residents increased from 19 in 2012 to 116 in 2019. These increases in teaching are correlated with increasing number of residents enrolled in competency-based programs over the last 3 years (Pearson r ranging from 0.9705 to 0.9903, and R2 ranging from 0.9418 to 0.9808). Those results suggest that the new skill-centered curricula which require residents to perform specific tasks within realistic settings, exhibit a growing demand for "life-like" cadaveric specimens. Institutions' body donation programs must, therefore, adapt to those greater need for cadaveric specimens, which presents many challenges, ranging from the logistical to the ethical.
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Affiliation(s)
- Geoffroy P J C Noël
- Division of Anatomical Sciences, Department of Anatomy and Cell Biology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Joseph Dubé
- Division of Anatomical Sciences, Department of Anatomy and Cell Biology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Gabriel Venne
- Division of Anatomical Sciences, Department of Anatomy and Cell Biology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Jiang J, Zhang M, Meng H, Cui X, Yang Y, Yuan L, Su C, Wang J, Zhang L. Demographic and motivational factors affecting the whole-body donation programme in Nanjing, China: a cross-sectional survey. BMJ Open 2020; 10:e035539. [PMID: 32895264 PMCID: PMC7478054 DOI: 10.1136/bmjopen-2019-035539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Jiayi Jiang
- School of Pediatrics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mingyi Zhang
- School of Pediatrics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haojie Meng
- School of Pediatrics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiang Cui
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuxin Yang
- School of Basic Medical Sciences, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Li Yuan
- School of Basic Medical Sciences, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chuan Su
- School of Basic Medical Sciences, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jinfan Wang
- Research Center of Doctor-Patient Communication, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Luqing Zhang
- School of Basic Medical Sciences, Nanjing Medical University, Nanjing, Jiangsu, China
- Research Center of Doctor-Patient Communication, Nanjing Medical University, Nanjing, Jiangsu, China
- Body Donation Receiving Station, Nanjing Medical University, Nanjing, Jiangsu, China
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Champney TH, Hildebrandt S, Gareth Jones D, Winkelmann A. BODIES R US: Ethical Views on the Commercialization of the Dead in Medical Education and Research. ANATOMICAL SCIENCES EDUCATION 2019; 12:317-325. [PMID: 30240149 DOI: 10.1002/ase.1809] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 06/08/2023]
Abstract
With the ongoing and expanding use of willed bodies in medical education and research, there has been a concomitant rise in the need for willed bodies and an increase in the means of supplying these bodies. A relatively recent development to enlarge this supply has been the growth of for- profit willed body companies ("body brokers") in the United States. These companies advertise for donors, cover all cremation and other fees for the donor, distribute the bodies or body parts nationally and internationally, and charge their users for access to the body or body parts. In doing so, they generate substantial profits. This review examines the historical development of willed body programs, the legal and economic aspects of willed body programs, and then provides an ethical framework for the use of willed bodies. The ethical principles described include detailed informed consent from the donors, comprehensive and transparent information about the process from the body donation organizations, and societal input on the proper and legal handling of willed bodies. Based on the ethical principles outlined, it is recommended that there be no commercialization or commodification of willed bodies, and that programs that use willed bodies should not generate profit.
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Affiliation(s)
- Thomas H Champney
- Department of Cell Biology, University of Miami, Miller School of Medicine, Miami, Florida
- Institute for Bioethics and Health Policy, University of Miami, Miller School of Medicine, Miami, Florida
| | - Sabine Hildebrandt
- Divison of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - D Gareth Jones
- Department of Anatomy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Andreas Winkelmann
- Institut für Anatomie, Medizinische Hochschule Brandenburg - Theodor Fontane, Neuruppin, Germany
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Gürses İA, Coşkun O, Öztürk A. Current status of cadaver sources in Turkey and a wake-up call for Turkish anatomists. ANATOMICAL SCIENCES EDUCATION 2018; 11:155-165. [PMID: 28657659 DOI: 10.1002/ase.1713] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/21/2017] [Accepted: 06/06/2017] [Indexed: 06/07/2023]
Abstract
Persisting difficulties in body procurement in Turkey led to the acquisition of donated, unclaimed, autopsied, and imported bodies regulated under current legislature. Yet, no study had investigated the extent of the on-going cadaver problem. This study was aimed to outline cadaver sources in anatomy departments and their effectiveness by means of an online survey. Additionally, official websites of each department were investigated regarding any information on body donation. Unclaimed cadavers (84.8%) were the major source for anatomy departments, followed by donated (50%) and imported cadavers (39.1%). Foundation-based medical faculties were more likely to import cadavers (P = 0.008). There was a moderate increase (rs = 0.567; P = 0.018) in donation registrations to our department after 2000. The departments in cities with significantly higher City-Based Gross Domestic Product measures (US$9,900 vs. US$16,772, P = 0.041), frequencies for mid- or high-school graduates (30.4% vs. 31.3%, P = 0.041), and frequencies for under- or post-graduates (13.1% vs. 15.8%, P = 0.24) had managed to use donated cadavers. Anatomy departments' major reasons for using unclaimed cadavers were education (45.9%), unclaimed cadavers being the only source (24.3%), and receiving inadequate donations (21.6%). Nine out of seventy-four departments (12.2%) provided information regarding body donation on their websites. Body procurement remains as a serious problem in Turkey and it is apparent that current legislature does not provide a sufficient cadaver inflow. Similarly, anatomy departments' effectiveness in public awareness of body donation and support in the National Body Donation Campaign seems questionable. Anat Sci Educ 11: 155-165. © 2017 American Association of Anatomists.
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MESH Headings
- Anatomists
- Anatomy/education
- Awareness
- Cadaver
- Dissection
- Education, Medical, Undergraduate/economics
- Education, Medical, Undergraduate/methods
- Education, Medical, Undergraduate/organization & administration
- Faculty, Medical
- Female
- Human Body
- Humans
- Legislation, Medical
- Schools, Medical/economics
- Schools, Medical/organization & administration
- Surveys and Questionnaires
- Time Factors
- Tissue and Organ Procurement/economics
- Tissue and Organ Procurement/legislation & jurisprudence
- Tissue and Organ Procurement/methods
- Tissue and Organ Procurement/statistics & numerical data
- Turkey
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Affiliation(s)
- İlke Ali Gürses
- Department of Anatomy, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Osman Coşkun
- Department of Anatomy, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Adnan Öztürk
- Department of Anatomy, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Vargas R. How health navigators legitimize the Affordable Care Act to the uninsured poor. Soc Sci Med 2016; 165:263-270. [PMID: 26806315 DOI: 10.1016/j.socscimed.2016.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 01/06/2016] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
Abstract
Health navigators are a new health care workforce created by the Affordable Care Act (ACA) to assist low-income minority populations with acquiring health insurance. Given the high levels of distrust among the poor toward government and the medical profession, this article asks: How do health navigators build the legitimacy necessary to persuade low-income uninsured clients to enroll in health insurance? Through ethnography of face-to-face interaction between navigators and the uninsured poor in Chicago, this study shows that successful navigators deployed a combination of cultural repertoires for building trust and legitimacy. These repertoires included ceding control of the conversation, creating ethnic solidarity, and disassociating themselves from government bureaucrats or self-serving insurance employees. These findings demonstrate the usefulness of cultural sociology for understanding health insurance provision to the poor, ACA outreach efforts, and the more general study of how occupations legitimize themselves to clients.
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Affiliation(s)
- Robert Vargas
- University of Wisconsin-Madison Sociology, 1180 Observatory Drive, Madison, WI, 53703, United States.
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Champney TH. The business of bodies: Ethical perspectives on for-profit body donation companies. Clin Anat 2015; 29:25-9. [DOI: 10.1002/ca.22643] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 10/07/2015] [Accepted: 10/15/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Thomas H. Champney
- Department of Cell Biology, Institute for Bioethics and Health Policy, Miller School of Medicine; University of Miami; Miami Florida
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10
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Gatica-Araneda JP, Alfaro-Toloza P. Donation of bodies for anatomy teaching in Chile. ANATOMICAL SCIENCES EDUCATION 2014; 7:248. [PMID: 24376245 DOI: 10.1002/ase.1427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 11/14/2013] [Indexed: 06/03/2023]
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11
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Asad AL, Anteby M, Garip F. Who donates their bodies to science? The combined role of gender and migration status among California whole-body donors. Soc Sci Med 2014; 106:53-8. [PMID: 24534732 DOI: 10.1016/j.socscimed.2014.01.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 01/16/2014] [Accepted: 01/24/2014] [Indexed: 11/28/2022]
Abstract
The number of human cadavers available for medical research and training, as well as organ transplantation, is limited. Researchers disagree about how to increase the number of whole-body bequeathals, citing a shortage of donations from the one group perceived as most likely to donate from attitudinal survey data - educated white males over 65. This focus on survey data, however, suffers from two main limitations: First, it reveals little about individuals' actual registration or donation behavior. Second, past studies' reliance on average survey measures may have concealed variation within the donor population. To address these shortcomings, we employ cluster analysis on all whole-body donors' data from the Universities of California at Davis, Irvine, Los Angeles, and San Francisco. Two donor groups emerge from the analyses: One is made of slightly younger, educated, married individuals, an overwhelming portion of whom are U.S.-born and have U.S.-born parents, while the second includes mostly older, separated women with some college education, a relatively higher share of whom are foreign-born and have foreign-born parents. Our results demonstrate the presence of additional donor groups within and beyond the group of educated and elderly white males previously assumed to be most likely to donate. More broadly, our results suggest how the intersectional nature of donors' demographics - in particular, gender and migration status - shapes the configuration of the donor pool, signaling new ways to possibly increase donations.
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Affiliation(s)
- Asad L Asad
- Department of Sociology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.
| | - Michel Anteby
- Organizational Behavior Area, Harvard Business School, Harvard University, Morgan Hall 321, Boston, MA 02163, USA.
| | - Filiz Garip
- Department of Sociology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.
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Bolt S, Venbrux E, Eisinga R, Gerrits PO. Anatomist on the dissecting table? Dutch anatomical professionals' views on body donation. Clin Anat 2011; 25:168-75. [DOI: 10.1002/ca.21215] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 05/10/2011] [Accepted: 05/12/2011] [Indexed: 11/10/2022]
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13
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Ballala K, Shetty A, Malpe SB. Knowledge, attitude, and practices regarding whole body donation among medical professionals in a hospital in India. ANATOMICAL SCIENCES EDUCATION 2011; 4:142-150. [PMID: 21548060 DOI: 10.1002/ase.220] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 03/15/2011] [Accepted: 03/30/2011] [Indexed: 05/30/2023]
Abstract
Voluntary body donation has become an important source of cadavers for anatomical study and education. The objective of this study was to assess knowledge, attitude, and practice (KAP) regarding whole body donation among medical professionals in a medical institute in India. A cross sectional study was conducted at Kasturba Hospital, Manipal, India, among medical doctors. Data was collected from consenting individuals in the age group of 25-65 years by convenience sampling method. A semi-structured, pretested, questionnaire designed to assess KAP regarding whole body donation was provided to the study population (n = 106); 97 individuals returned the completed questionnaire. Results showed that 8% of the medical professionals were unaware of the term body donation and 85% believed that donated bodies were misused. A large proportion of the respondents did not know about the authority that oversaw body donation, or its criteria for accepting donated bodies and diseases for which bodies were screened before acceptance. Only 22% of polled physicians were willing to donate their bodies for medical education, but 68% expected the public to do the same. While only 7% had already registered their own names for body donation, 64% were not aware of any known person having registered and 72% indicated that their decision would not be influenced even if they knew of friends who had registered. These results suggest that educating medical students and professionals regarding the altruistic act of body donation is as important as educating the general public.
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Affiliation(s)
- Kirthinath Ballala
- Department of Community Medicine, Kasturba Medical College, Manipal, India.
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