University running short of cadavers for medical students

The University of KwaZulu-Natal (UKZN) continues to grapple with a shortage of cadavers or corpses for dissection by medical students, pinning its hopes on increased public awareness to encourage donations.

The medical school’s battle to get enough cadavers, seen as a medical student’s “first patient”, date back as far as 2015.

Bodies accepted by the Department of Clinical Anatomy are from donors that have consented and are fully informed of the dissection process by UKZN.

In the past, a shortage of donated corpses has resulted in anatomy lessons being compromised and medical students struggling to complete their studies, as they were often forced to share cadavers during dissection classes.

“Although the body donor numbers are slowly increasing we still have a critical shortage for a sustainable dissection programme,” UKZN senior clinical anatomy lecturer Dr Pamela Pillay said.

Other medical schools such as the University of Pretoria (UP), University of Cape Town (UCT) and University of Witwatersrand (Wits), however, are seemingly well bequeathed with bodies.

The situation has worsened at UKZN, with up to 20 students sharing a body instead of the normal ratio of four students per cadaver.

“Since 2016, we have received 28 bodies a year for the teaching and learning programme. There are about 15-20 students per cadaver for practicals, working on a rotational basis,” Pillay said.

Awareness raised about need for bodies

According to Pillay, awareness campaigns were resurrected by the Department of Clinical Anatomy in 2017, with an undertaking to visit old age homes and other institutions for the aged in order to create awareness of the body donor programme.

“We believe that awareness of the use of the body for teaching and learning will encourage others to donate. However, we are cognizant of the SA population and the diversity of culture and religion regarding the dead,” she said.

The acquisition of cadavers has often been mired in morality and ethical discomfort, with medical schools increasingly opting for donated human remains.

Also read: Searching for lost lives: SA’s unidentified corpses

Early accounts include body snatching, grave robbing and other immoral and unethical means of acquiring bodies for dissection halls.

Previously, SA medical schools acquired their cadavers from unclaimed bodies, which is still legal under the National Health Act.

But, according Brendon Kurt Billings, anatomical sciences senior lecturer at University of Witwatersrand, the change in social beliefs saw anatomy departments around the world, including SA, initiating body donation programmes.

He said Wits School of Anatomical Sciences’ body donor drive was designed to receive donations from individuals for their bodily remains to train doctors.

Old, young, healthy and sick – wide variety of bodies needed

He explained that human dissection remained a significant aspect of anatomy and the “gold standard” for teaching human anatomy in many parts of the world.

According to Billings, the success of the programme was anchored on the fact that they were able to convert the donor profile from a majority of unclaimed bodies, to bequeathed or donated individuals.

He said this meant they were acquiring human remains ethically, but said a challenge was a diverse demographic group of cadavers that represent the SA population.

“These include a diverse age range and representation by different gender and ethnic groups,” Billings said.

He said cadavers were important in that they also prepared doctors mentally and emotionally to not only deal with living patients, but to deal with death in their chosen health profession.

Billings said surgeons also developed highly important tactile skills during cadaver-based training, which is required in postgraduate training to successfully conduct surgical interventions.

Hail the silent teacher

Despite boasting a fairly large cadaver donor programme, with about 2,800 donors, UCT is ramping up awareness campaigns to inform the public of the body donation programme.

Dr Adhil Bhagwandin, senior lecturer in the division of clinical anatomy and biological anthropology at the University of Cape Town, said their body donor programme has been very successful in obtaining cadavers.

He said the contribution of donated bodies to the training of the future doctors and specialists was enormous, saying this offers future health practitioners a chance to learn a variety of important skills.

“Through dissection of donated bodies, students obtain a realistic 3D perspective of human anatomy, but also have an opportunity to view anatomical variations by observing other cadavers in the dissection halls – a practice which forms a cornerstone for future clinical application.

“Through this process the donor, or rather the ‘silent teacher’, non-verbally conveys knowledge and presents as the ‘first patient’ and in so doing becomes invaluable for the training of healthcare practitioners,” he said.

He added that as a gratification gesture for cadavers, a memorial service is held each year where students pay tribute to their “silent teachers”.

Bhagwandin said donated bodies were preferred since the individual stated their intention to serve in this way by signing consent.

Ensuring bodies are Covid-free

He said, however, because of Covid-19, the already strict health and safety measures had been enhanced to ensure all donor bodies received were Covid-19 free.

“The mortuary team has worked closely with hospitals, treating doctors and their contracted funeral undertakers to ensure this,” Bhagwandin said.

UP’s Anatomy Department in the Faculty of Health Sciences works collaboratively with the National Tissue Bank and has agreements with hospitals, funeral parlours and old age homes on body donation for medical research and training.

Professor Prashilla Soma, head of the anatomy department at UP, said they use about 70 cadavers a year and their intake was also in that region.

She said last year, because of Covd-19 pandemic and the subsequent lockdown, the programme and intake was severely affected.

Soma said a decision was then made not to receive Covid-19-positive donors as a safety precaution for students and staff until more information was available on the virus.

“Several studies to do away with cadaver dissection during medical training have been conducted at many medical schools. There are brilliant models, books, simulation computer based programs, videos and other aids available to teach anatomy or demonstrate dissection techniques,” she said.

Soma however said there was no substitute, in her view, for the real cadaver to gently and silently bring the student of medicine to terms with the intricacies, variation and wonders of the human body, but also with the reality of death.

She said they did not make any distinction between unclaimed or donated bodies.

“Where the details of the next of kin is available, additional information can be obtained about the deceased which might help in research, as well as arrangements regarding the ashes when the cremation is finally done,” Soma said.

She added that the only risk in using unclaimed bodies was that it might be claimed by the family during the research but said this risk was minimised if the initial work was done properly to search for any next of kin.

siphom@citizen.co.za

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