RESEARCH ARTICLE
The whole body donation program at the university of Bologna: A report based on the experience of one of the oldest university in Western world

This paper is dedicated to the memory of Professor Gabriella Giuliani Piccari Scarpa who recently passed away.
https://doi.org/10.1016/j.aanat.2020.151660Get rights and content

Abstract

Human body dissection is fundamental in medical education, as it allows future physicians to learn about the body’s morphology in three dimensions, to recognize anatomical variations and to develop and increase the essential qualities of respect, compassion and empathy for patients. It is equally important in clinical training as it allows surgeons to improve their manual dexterity and practical skills and to test innovative surgical techniques and devices. In Italy prior to 2020, body acquisition and use for study and research purposes were regulated by a generic set of old directives and national decrees which dealt only marginally with these issues. However, in 2013, a whole body donation program was officially set up at the Institute of Human Anatomy of the University of Bologna. Completely free and voluntary informed consent has always been regarded as a core prerequisite and, since its inception, the program exclusively accepted bequeathed bodies. On February 10, 2020, a specific law governing the disposition of post mortem human body and tissues for study, training and scientific research purposes was definitively enacted. The present work traces the University of Bologna’s experience leading to the whole body donation program and the brand new dissecting room. It describes the program of Bologna as an example of “good practice” in body donation, aimed at ensuring education and clinical training by means of both traditional gross anatomy and innovative technology. Moreover, it analyzes the results achieved in terms of increased donor enrollment and improved teaching/training quality and the strengths of this program in light of the provisions enshrined in the new law.

Introduction

The Institute of Human Anatomy of the Alma Mater Studiorum, University of Bologna, has a long-standing tradition of using human body dissection for the purposes of studying and teaching gross anatomy. Under the law “Codignola” (no. 910/1969) access to all university faculties was extended to any high-school diploma holder. The number of students enrolled in the Schools of Medicine increased so drastically that it became impossible to organize and perform dissection activities and consequently this practice was dismissed. In 2014, thanks to the farsightedness of Professor Giovanni Mazzotti, a brand new dissecting room was finally constructed. As a display of the intention, on the back wall of the dissecting room there is a Latin motto that reads “Hic mors gaudet succurrere vitae” or “in this place death is pleased to help life”, which was present on the wall of the previous dissecting room. Body dissection and prosections are still worldwide considered essential to gross human anatomy courses of medical curricula (Garment et al., 2007; McHanwell et al., 2008; Bolt et al., 2010; Chiu et al., 2012; da Rocha et al., 2013d).

They contribute to develop a sound knowledge of anatomy and help to visualize in situ topographical landmarks and anatomical 3D relations. They also provide opportunities to observe pathological conditions, anatomical abnormalities and variations while promoting advancements in medical research and surgical training and instilling in students the fundamental value of respecting life (Ellis, 2001; Korf et al., 2008; Cornwall and Stringer, 2009; Chakraborty et al., 2010; Park et al., 2011; Jones, 2014). The main challenges we had to address concerned ethical issues, a lack of specific legislation and the need for social recognition. When we decided to resume traditional anatomical dissections, the post mortem body donation issue in Italy was regulated by a generic set of directives, national decrees and protocols, which only marginally dealt with it. The University of Bologna therefore developed its own working guidelines in accordance with current Italian legislation and established a whole body donation program related to the dissecting room of the Institute of Human Anatomy. Since its establishment there has been a steady, year to year increase in donors’ enrollment and therefore in the number of bodies received annually. Due to the increased number of bodies received it was possible to organize not only hands-on educational courses but also higher training activities such as post-graduate courses, masterclasses and accredited surgical dissection workshops in partnership with pharmaceutical and biomedical companies. These activities are extremely important also in order to interconnect the Institute of Human Anatomy with other universities and hospitals creating the opportunity for conducting translational research projects and allowing the sustainability. They can also meet the health professionals need to re-study anatomy with a different perspective in order to adapt their knowledge to the new techniques that may require a different visual approach to the topographical regions of interest. On February 10, 2020 a law under the title “Regulations about the disposition of post mortem human body and tissues for study, training and scientific research purposes” has been definitively enacted. The present paper aims to trace the University of Bologna experience leading to the whole body donation program and to the new dissecting room. We include data on the characteristics of donors who have bequeathed their bodies to the donation program since its inception in 2013 and analyze the results achieved in terms of increased donor enrollment and improved teaching/training quality. By presenting our program we also aim to analyze its strengths in the light of the entry into force of the new law and to suggest triggers for reflection to the whole Italian academic community and legislators in view of the Implementing Regulation enacting.

Section snippets

The whole body donation program of the Alma mater studiorum

In 2013, a whole body donation program was officially established at the Institute of Human Anatomy of the University of Bologna. At that time in Italy, there was not a specific law regulating citizens’ free choice to bequeath their bodies to science after death and the use of corpses for scientific and didactic purposes. The reference regulatory framework did not regulate the path of body donation from the bequeathed to the competent beneficiary institution or the self-determination

Legislative framework

In Italy, the post mortem body donation issue has always been regulated by a generic set of directives, national decrees, guidelines and protocols that only marginally dealt with it. Prior to 2020, the Italian juridical system did not even consider the possibility that a person may decide to donate his or her body to science through a living will. The regulatory approach focused on the “unclaimed” bodies and on the possibility to make them available to higher education institutions and

The whole body donation program vs law no.10/2020: critical comments and challenges

The recent Italian Law no. 10/20, a specific law concerning disposition of post mortem human body and tissues, led us to report on the whole body donation program of the University of Bologna experience and to reflect on future possible scenarios. The use of the human body and tissues involves ethical, legal, and medical issues. The program at Bologna has always been based on a rigorous legal and ethical framework and therefore already includes most of the cardinal principles of

Ethical statement

Since this study has been fullyperformed on body donors, the authors wish to sincerely thank those who donated their body to science so that anatomical research could be performed. Results from such research can potentially improve patient care and increase mankind’s overall knowledge. Therefore, these donors and their families deserve our highest gratitude.

Conflicts of interest

The authors declare no conflicts of interest.

CRediT authorship contribution statement

Ester Orsini: Conceptualization, Writing - original draft, Writing - review & editing. Marilisa Quaranta: Conceptualization, Writing - original draft, Writing - review & editing. Stefano Ratti: Data curation, Writing - review & editing. Giulia Adalgisa Mariani: Formal analysis, Investigation, Resources. Sara Mongiorgi: Methodology, Resources. Anna Maria Billi: Supervision, Writing - review & editing. Lucia Manzoli: Supervision, Writing - review & editing.

Acknowledgements

Authors wish to sincerely thank those who donated their body to science so that anatomical research could be performed. Results from such research can potentially improve patient care and increase mankind’s overall knowledge. Therefore, these donors and their families deserve our highest gratitude. Authors also wish to thank Professor Lucio Ildebrando Maria Cocco, full professor of human anatomy at the Medical School of the University of Bologna and head of the Cellular Signalling Laboratory at

References (26)

  • H.Y. Chiu et al.

    Voices of donors: case reports of body donation in Hong Kong

    Anat. Sci. Educ.

    (2012)
  • J. Cornwall et al.

    The wider importance of cadavers: educational and research diversity from a body bequest program

    Anat. Sci. Educ.

    (2009)
  • A.O. da Rocha et al.

    The body donation program at the Federal University of Health Sciences of Porto Alegre: a successful experience in Brazil

    Anat. Sci. Educ.

    (2013)
  • Cited by (23)

    • Evaluation of the effectiveness of online education in anatomy for medical students during the COVID-19 pandemic

      2022, Annals of Anatomy
      Citation Excerpt :

      There is fear of getting infected by the cadavers, so there is more thought about protection and using well ventilated rooms during the embalming process (Lemos et al., 2021). New laws in Italy have limited the use of body donations (De Caro et al., 2021), and some universities, like the University of Bologna, asked for some changes in this law, as they feared their successful body donation programme might have a reduction in donors as a result of the new laws in Italy and the COVID-19 pandemic (Orsini et al., 2021). Moreover, healthcare providers need to have a thorough understanding of anatomy as it is considered the cornerstone of basic medical education (Saverino, 2021).

    View all citing articles on Scopus
    1

    These authors contributed equally to the work.

    View full text