Promotion of body donation and use of cadavers in anatomical education at the University of Padova.

We read with interest the article by Richard B. Gunderman (2008) entitled “Giving ourselves: the ethics of anatomical donation”. Body donation poses ethical questions which should be addressed by all those involved in anatomical teaching and in articles such as that by Gunderman, which are very useful in stimulating discussion. The University of Padova has played a pivotal role in the history of Anatomy. In 1543, Andreas Vesalius, while Professor of Anatomy at the University of Padova, published his masterpiece De humani corporis fabrica, which is universally considered to be the beginning of modern anatomy and medicine. With respect to his predecessors, Vesalius, Renaissance anatomist, descended from his chair and carried out dissections with his own hands, believing that the direct observation of the human corpse was the basis of anatomical knowledge. Almost all the most important anatomists of the 16th, 17th and 18th centuries taught anatomy in Padova. Here, the first permanent theatre ever designed for public anatomical dissections was also built, in 1594, under the supervision of Hieronymus, thus revolutionising the teaching of anatomy (Smith et al., 2004). Even today, the Department of Human Anatomy and Physiology of the University of Padova stresses the importance of dissection in teaching anatomy. We would like briefly to present the Italian regulations covering anatomical dissections and illustrate our experience about teaching anatomy. Although a specific law regarding body donation is still lacking, we must stress that the Italian laws include references permitting the use of cadavers for anatomical dissection and, in some Italian Universities, anatomical dissections are still performed according to these rules. The possibility of using corpses for medical education and scientific research is expressly provided for in Article 32 of “Regio Decreto” no. 1592 of August 31 1933 about University Education, which states that: “cadavers [...] whose transport is not performed at the expense of relatives up to the sixth degree or by confraternities or associations who may have made commitments for the funerary transport of associates and those [cadavers] coming from medico-legal investigations (apart from suicides) and not claimed by relatives in the family group, are reserved for teaching and scientific study”. The use of corpses for medical education and scientific research is also regulated by the Regulation of the Mortuary Authorities (Decree of the President of the Republic no. 285/1990), which specifies that: “delivery to the university Anatomical Institutes of cadavers [...] for teaching and scientific study must occur after the period of observation prescribed [...]” (Art. 40) of 24 hours after death (Art. 8). In addition, “the acquisition and conservation of cadavers and anatomical specimens, including foetal material, must be authorised from time to time by the Local Health Authority” (Art. 41). These laws do not take into account the wishes of the deceased, but, in analogy with Italian regulations covering organ donation for transplantation (Law 91/1999) and cremation (Law 130/2001), anatomic dissections should be performed on the corpses of people who made an explicit declaration of such wishes during their lifetime. Their relatives should also sign a consent form and a declaration in which they state that they will not carry out burial. In analogy with Art. 23 of Law 91/1999, the relatives making such declarations are the non separated consort, common-law consort or, in the absence of the above persons, children of age, parents, or legal representatives (De Caro, 2008). The above declarations by the deceased and relatives are given to the Local Health Authority for authorisation. References to the fundamental principles of the Consitution of the Italian Republic (1948) may also be considered, with particular reference to the promotion and development of scientific and technical culture and research (Art. 9) and health safeguards as an individual’s fundamental right and for collective benefit (Art. 32). In recent years the Department of Human Anatomy and Physiology of the University of Padua promoted the donation of the body for teaching and scientific purposes. In 2004, the Council of the Medical School and the Faculty of Medicine and Surgery of the University of Padova unanimously approved the creation of an “Association for Donation of the Body for Morphologic Teaching”. A “Commission on Donation for Medical Education” was also established, with the declared aim of analysis of the principles and procedures to be followed in donating bodies. This Commission was composed of professors of anatomy, legal medicine, and medicine, members of the Ethics Committee for Experimentation of the University Hospital of Padova, and representatives of the College of Physicians of Padova. So far, the Department of Human Anatomy and Physiology has received many declarations of wishes to donate bodies and anatomic dissections are performed on donated anatomic material. We were also directly involved in the spread of information about principles and procedures of donation of the body through mass media and dedicated meetings, with particular attention to the ethical aspects. In the past few years, we have developed dissection courses for medical students and residents in order to transfer the unique ethical and technical anatomical science educational value of dissection to future physicians and surgeons (Macchi et al., 2003a; 2003b; 2007)