Altruism in Death. Historic and contemporary use of mortal remains in anatomical examination for education and research in Australia and New Zealand

Abstract

Anatomical examination has occurred at the Sydney Medical School since 1883. The historic practices reflected the time and context in which the Medical School was established. The Anatomy Act 1881 (NSW) legalise procurement of unclaimed bodies from public institutions. Some 60 years after Sydney Medical School commenced operations, changing social circumstances and educational needs saw the Medical School shift to a consenting donor program rapidly and with great success. From the mid-1940s to early 1960s the number of donors increased steadily with the last unclaimed body accepted in 1961.

Exclusive local procurement of bodies from consenting donors and families is characteristic of all nineteen body donor programs across Australia and New Zealand. Many anatomical sciences programs and clinical training facilities import frozen human tissue for use in postgraduate education. This tissue is procured from “body brokers”, some of whom operate on a profit basis. The commercialisation of human tissue raises significant ethical issues and stands in contrast to the Australian and New Zealand legal and policy frameworks which explicitly prohibit commercial dealing in human remains.

Organ donation has high community support, however, a range of factors including securing next of kin consent for donation and the limited circumstances in which donation can occur limit the number of donors. Attitudes of students to body and organ donation were explored. A range of factors relating to culture, ethnicity, and religious practice were important in influencing student attitudes to donation. Ignorance of the policies and processes was evident in students’ understanding of altruistic donation. Exposure to gross anatomy was associated with a greater likelihood of consideration of donation, suggesting that participation in anatomical examination is a valuable activity in the development of students’ ethical and legal understanding of the use of human remains.

While body donation and anatomical examination are supported and sustainable in Australia and New Zealand, this study suggests that further active investment in community engagement, health professional education, and robust examination of all anatomy and human tissue practices for their ethical compliance and consistency is desirable.