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Unclaimed Bodies at the Anatomy Table
Neela Dasgupta
Johns Hopkins School of Medicine, Baltimore, Md
JAMA. 2004;291:122.
Although no studies have conclusively demonstrated that anatomical dissection is necessary to future clinical abilities, use of cadavers to teach anatomy has long been deemed essential to medical education. In an 1824 Lancet aal described by Shultz,1 Thomas Wakely wrote, "If dead bodies can not be procured, it will be impossible for the pupils to learn anatomy, and without anatomy, neither surgeons nor physicians can practice with the least prospect of benefiting their patients." Procuring cadavers from willing donors has never been easy, however; accounts of early medical instruction dwell on the prisons, grave robberies, and pauper murders that often supplied early American anatomy labs. Two hundred years later, with regulations forbidding the sale of human bodies and programs encouraging people to donate their bodies to medical science, anatomy departments receive little criticism. However, unclaimed bodies are still the source of cadavers in anatomy laboratories at about 20% of US and Canadian medical schools.2
Historically, the desire for dissection-based learning was so strong that medical institutions often supported acts of grave robbery, and some physicians passively condoned murder for medicine. In 1829, 2 Irishmen, William Burke and William Hare, committed 16 murders and delivered the victims' corpses to Dr Robert Knox for payment.3 Similarly disturbing stories of grave robbing and murder in the name of anatomy were reported in US cities, including Baltimore, Cincinnati, and Philadelphia. Even today, medical schools in some countries benefit from questionable methods of cadaver acquisition. In Barranquilla, Columbia, in 1992, janitor Oscar Rafael Hernandez survived an attempt by local guards to murder him in order to sell his body to the local medical school's anatomy laboratory.4 As stories of grave robbing circulated in the 1800s, US states responded with specific anatomy acts to prohibit the use of bodies thus acquired.1 However, medical schools soon faced cadaver shortages, leading some states to introduce new acts specifically permitting the use of unclaimed bodies for medical school dissection.1
With the passage of Uniform Anatomical Gift Acts in the 20th century, voluntary donations became a substantial resource for anatomy departments.5 These acts permit individuals to bequeath their bodies to the state for the purpose of medical education and research. Some programs moved to entirely donor-based body acquisition while others continued to supply anatomy labs with unclaimed bodies. Geographic, demographic, and socioeconomic factors contributed to each state's decision regarding the use of unclaimed bodies.5 States relying entirely on voluntary donors have faced cadaver shortages in the past several years.6-7
Many states protect unclaimed bodies by contracting with funeral homes, which then assume burial responsibilities. New York, for instance, requires counties to bury anyone who cannot afford burial costs, a policy that has caused cadaver shortages for local medical schools, including Columbia University.8 However, some states, including Maryland, Pennsylvania, and Texas, automatically turn over unclaimed bodies to legislatively established state anatomy boards, whose sole objective is to support medical education and services.9 In Maryland, for example, where the state anatomy board was created in 1974, willing donors currently account for a little more than half of cadavers used for medical education and research study programs each year. In 2002, 40% of bodies used for study in Maryland were unclaimed bodies, individuals who died in a hospital and were not claimed by any friend or relative for 72 hours.10
Certainly, there would be no cadaver shortages if medical schools could attract more willing donors. Donor programs vary widely in efficacy and rigor, but some specific approaches to voluntary donation are documented. The Associated Medical Schools of New York sends nursing homes a video called The Most Precious Gift to encourage consideration of body donation.11 Other responses to cadaver shortages include assigning more students per cadaver and calling on alumni to encourage donation when appropriate.8
Progress has been made since the days when grave robberies supplied anatomy laboratories, but methods of cadaver acquisition may still not be ideal. Studies evaluating the methods and efficacy of donor solicitation programs could reveal superior approaches and, ultimately, reduce both cadaver shortages and states' reliance on unclaimed bodies to fill the void in the anatomy laboratory.
REFERENCES
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1. Shultz S. Body Snatching: The Robbing of Graves for the Education of Physicians. Jefferson, NC: McFarland & Co Inc; 1992:78-82.
2. Liles KL, Ross LM. Donor program survey. Paper presented at: American Association of Clinical Anatomists Conference; June 10, 1998; Lexington, Ky.
3. Guttmatcher A. Bootlegging Bodies: A History of Body-Snatching. Fort Wayne, Ind: Public Library of Fort Wayne and Allen County; 1955.
4. Roach M. Stiff: The Curious Lives of Human Cadavers. New York, NY: WW Norton & Co; 2003:50.
5. Coelho D, Caplan A. The unclaimed cadaver. Acad Med. 1997;72:741-743.
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6. Renstrom J. Cadaver shortage faces medical students. Michigan Daily. March 13, 1997:9.
7. Buchanan K. A difficult, valuable gift. Pittsburgh Post-Gazette. February 10, 1997:A6.
8. Cadaver Shortage Jeopardizes Teaching. Available at: http://cpmcnet.columbia.edu/news/journal/journal-o/archives/jour_v15n3_0035.html. Accessed December 4, 2003.
9. Anatomical gifts. Reports of Board of Trustees, American Medical Association. Available at: http://www.ama-assn.org/ama1/upload/mm/interim01/BOT_Reports_1-17.pdf. Accessed December 8, 2003.
10. M00F01.01 Executive Direction Report. Deputy Secretary for Public Health Services. Performance Measures, Actual and Estimated, 2001-2004. Available at: http://www.dhmh.state.med.us/. Accessed December 8, 2003.
11. Jeffrey NA. Getting into a good med school is no problem for this crowd. Wall Street Journal. June 23, 1998:B1.
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