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VIEWPOINT COMMENTARY
Formal Body Bequest Program in Nigerian Medical Schools:
When Do We Start?
Oluwole Busayo Akinola*
Department of Anatomy, Faculty of Basic Medical Sciences, University of Ilorin, Ilorin, Nigeria
Human body dissection is a prerequisite for the training of health professionals and the
conduct of medical research. However, most Nigerian medical schools experience difficulty obtaining an adequate and regular supply of human tissue. Presently, the major
source of anatomical material comes from unclaimed bodies collected from hospital mortuaries. However, one sure way to ensure a regular supply of bodies for anatomical dissection is to establish a whole body bequest program among the departments of anatomy
in Nigerian medical schools. If such a program were to be supported by an appropriate
legislative act of parliament, the supply of acceptable cadavers for anatomical teaching
and research would be substantially increased. The author advocates for establishing a
whole body bequest program among Nigerian medical schools. Anat Sci Educ 4: 239–242.
© 2011 American Association of Anatomists.
Key words: anatomical donor program; body bequest program; Nigerian medical
schools; unclaimed bodies; anatomy departments; anatomy education in Africa
INTRODUCTION
Anatomy is the foundational discipline of medicine and the
allied health professions (Older, 2004; Sugand et al., 2010).
To achieve a proper understanding of the fabrics of the
human body, cadaver dissection is essential. A recent study of
Nigerian medical students’ attitudes to dissection carried out
at the Ambrose Alli University in Ekpoma revealed that 90%
of students considered cadaver dissection to be an important
and indispensable component to their study of human anatomy (Izunya et al., 2010). Indeed, most medical schools
across the globe still maintain the practice of cadaver dissection (Kramer et al., 2008; Drake et al., 2009; Sugand at al.,
2010).
To keep this tradition of body dissection alive, a regular
supply of cadavers suitable for educational dissection is prerequisite. In most African countries, including Nigeria, cadavers are usually sourced from hospital mortuaries. These
largely consist of cadavers unclaimed by the deceased individ*Correspondence to: Dr. Oluwole B. Akinola, Department of Anatomy,
Faculty of Basic Medical Sciences, University of Ilorin, P.M.B. 1515,
Ilorin 240003, Nigeria. E-mail: akinolub@unilorin.edu.ng
Received 17 February 2011; Revised 7 April 2011; Accepted 15 April
2011.
Published online 12 May 2011 in Wiley
(wileyonlinelibrary.com). DOI 10.1002/ase.226
© 2011 American Association of Anatomists
Anatomical Sciences Education
JULY/AUGUST 2011
Online
Library
ual’s relatives (Gangata et al., 2010). Cadavers sourced from
felons are likewise accepted into the gross anatomy dissection
laboratory, although certain tissues may not be intact or
undamaged, thereby making whole body educational dissection impossible. With regard to those bodies sourced from
hospital mortuaries, departments of anatomy often encounter
shortages. Mortuary attendants often retain unclaimed bodies
on the grounds that relatives of the deceased may come for
them at any time. Moreover, even when these bodies are
released to departments of anatomy, the tissues may not be
well preserved or intact (having missing or damaged body
parts). Within these constraints, gross anatomy laboratories
in Nigerian medical schools are often faced with an inadequate supply of cadavers for anatomical teaching and
research.
BODY BEQUEST PROGRAMS
The concept of voluntary body donation is alien to Nigerian
society, unlike in other regions of the world where it is relatively accepted (Izunya et al., 2010). In many countries outside Africa, challenges associated with a regular supply of
suitable cadavers have been largely surmounted by the establishment of body bequeathal programs (or willed body programs). Liles and Ross (1998) indicated that in the United
States 85% of bodies for anatomical dissection are received
from willed body programs, and the remaining 15% were
donated by family members. They also determined that only
20% of institutions were willing to accept unclaimed bodies
Anat Sci Educ 4:239–242 (2011)
for medical education programs (Liles and Ross, 1998). Similarly, anatomy departments in Korean Universities have
achieved a regular supply of human tissue for teaching and
research by establishing successful body bequest programs
(Park et al., 2011). The same is true in Europe, where appropriate legislation is in place to support willed body programs
(Gunderman, 2008); presently, all cadavers used in the United
Kingdom are donated (Stott, 2008). At the University of
Otago in New Zealand, the Anatomy Department now
receives more than 40 human body donations per year; this
makes body sourcing for anatomic purposes considerably easier (Cornwall and Stringer, 2009). This suggests the need for
each department of anatomy to establish and sustain a body
bequest program.
SITUATION IN NIGERIA
However, in most of sub-Saharan Africa and Nigeria, a formal willed body program is unavailable in most anatomy
departments despite an inadequate supply of suitable human
tissue for anatomical dissection and the challenges associated
with sourcing human tissue for this purpose (Gangata et al.,
2010). It is therefore essential for departments of anatomy in
Nigerian medical schools to establish body bequest programs
to achieve a regular supply of suitable cadavers. To do this,
each university council must approve and support the establishment of a body bequest program for the anatomical sciences. More importantly, the state and/or federal legislature
should enact a law in support of donation programs similar
to laws enacted in the United States (UAGA, 2006), United
Kingdom (Human Tissue Act, 2004), New Zealand (Human
Tissue Act, 2008), India (Anatomy Act, 1957), or Australia
(Human Tissue Act, 1982). If such a law were in place, public body donation centers could be established in major cities
for easy collection of willed bodies after the death of donors.
Without such a legislative act, establishing these public centers would be practically impossible. In developed countries,
successful body bequest programs are supported by federal
legislation (Hutton, 2006; Taylor and Wilson, 2007; McClea,
2008; De Caro et al., 2009).
In 2007, the Lagos State House of Assembly passed an executive bill referred to as the Lagos State Coroner’s Law,
which was endorsed by the State Governor (Odebode, 2008).
In the present form, this legislation does not facilitate body
acquisition for anatomical science; in reality, it has the opposite effect by significantly reducing the number of cadavers
available to medical schools for anatomical education and
research. Section 14 of this law makes autopsy mandatory
for all deaths of unknown causes. This has an adverse effect
on the education and training of health care professionals,
especially medical doctors. Presently, Nigerian medical
schools receive most bodies for anatomical dissection from
hospitals. However, subjecting all deaths that occur in hospitals to autopsy would create a shortage of bodies destined for
educational dissection, as those that undergo autopsy are no
longer suitable for teaching anatomic structures and their
relationships.
In addition to legislative requirements to initiate a bequest
program, potential body donors must be motivated by altruism (the wish to be useful after death), as well as other personal benefits (Gunderman, 2008; Bolt et al., 2010). In the
past, grave robbers and slave owners were motivated by
profit in selling bodies (Halperin, 2007). Even today, some
240
families choose to provide bodies to help pay for funeral
expenses (Gunderman, 2008). To establish a successful
bequest program for anatomical sciences and medical education, anatomists must demonstrate prospective donors how
body donation promotes their own self-interest. As Gunderman (2008) indicated, this appeal could take several forms:
(1) if members of the public do not encourage others to
donate, they, too, may someday suffer unnecessarily from a
disease or injury that could have been prevented or effectively
treated if only more people had donated their bodies; (2) by
donating one’s own body, a person has the opportunity to
impress others with his or her generosity and enlightened attitude toward death; and (3) donation will make the donor feel
good (Gunderman, 2008). Anatomists, students, and other
trainees must serve as models to the public in their willingness to be enlisted in bequest programs at their respective
institutions. Studies show that the attitudes of anatomists,
medical students, and health care professionals toward donation of their own bodies vary around the world (ArráezAybar et al., 2004; Sehirli et al., 2004; Cahill and Ettarh,
2008; Perry and Ettarh, 2009).
It is understandable that such bequest programs cannot be
created simply by enacting the appropriate legislative acts. It
would also require time for the public and society to see the
benefits of body donation. In the meantime, the Nigerian
state and/or federal legislatures should also consider enacting
laws that will enhance the acquisition of unclaimed/abandoned bodies from hospital mortuaries. Similar to existing
laws in other countries, that is, India (Anatomy Act, 1957),
Nigerian legislation should provide clear provisions and specify a legal time frame for bodies to be retained in hospital
mortuaries, beyond which unclaimed cadavers should be
released to the jurisdiction of appropriate authorities for
transfer to departments of anatomy. This would confer legal
umbrella protection of both hospital management and
anatomy departments from potential lawsuits brought by the
relatives of individuals whose bodies were unclaimed.
CALL TO ESTABLISH BEQUEST
PROGRAMS IN NIGERIA
As commendable and desirable as whole body bequest programs in Nigerian medical schools would be, there are challenges. One such challenge is that the Nigerian populace is
not aware of the need for whole body bequests. Indeed, body
donation is an alien concept to Africa. The people must
therefore be enlightened (perhaps through broadcast media,
print media, etc.). Several studies examined the impacts of
different media in distributing information on organ donation. Conesa et al. (2004b) concluded that the largest impact
in this regard was generated by television, followed by radio,
printed magazines, and oral presentations. The most positive
impact on personal opinion was found among individuals
who received information at specialized meetings. Positive
attitudes toward living donation are very strongly related to
cadaveric donations (Conesa et al., 2004a; Chakraborty
et al., 2010). Therefore, educating the public about the importance of whole body donation not only by television
media or press but also by personal interaction with potential
donors and their families by the members of anatomy departments needs to be taken into consideration.
As reported previously, many factors influence people’s
opinions toward body donations (Golchet et al., 2000; ConAkinola
esa et al., 2004a, b; Ajita and Singh, 2007). These include
age, religion, culture, personality characteristics, level of
education, views on death and mortality, body image,
previous experience of donation, and humanitarian concerns
(Golchet et al., 2000; Conesa et al., 2004a, b). In Nigeria, religious, socioeconomic, and cultural factors may likewise
hinder willing donors from signing up for bequest programs.
Certain Nigerian religions demand immediate burial of bodies
following death, and adherents of such teachings may not
bequest their bodies to anatomy departments for dissection.
Nigeria is a mixed society where different tribes have different cultures. In some cases, there are rites associated with the
burial of diseased family members, and observance of such
rites may generate opposition by family members against the
bequest of bodies of potential donors (Izunya et al., 2010).
Many similar obstacles once existed in other countries
which later developed successful body donation programs,
such as in Korea (Park et al., 2011), Israel (Notzer et al.,
2006), and Thailand (Nayak, 2004; Wilkelmann and Güldner, 2004). However, the initial negative reactions of the
public were eventually overcome by an extensive education
campaign that emphasized the social benefits of body and
organ donation. Meanwhile, despite the above potential
threats to the establishment of body bequest programs in
Nigeria, the challenges are not insurmountable. A similar situation with regard to body shortages faced Tzu Chi College
of Medicine in Taiwan, where the majority of the population
holds the belief that deceased persons’ bodies should not be
disturbed after death (Lin et al., 2009). The college implemented a gross anatomy dissection course using only voluntary, nonanonymous donors, emphasizing humanitarian
aspects of the body gift within the Taiwanese social and cultural setting. Cadavers were regarded by students as ‘‘great
body teachers’’ or ‘‘silent virtuous teachers’’ (Lin et al., 2009)
and appropriate religious ceremonies were held with invited
family members. This unique course curriculum has inspired
many individuals in the community to bequeath their bodies,
and cadaver donation has consequently increased.
With focused educational media campaigns, redesigned
anatomy curricula that connect potential donors to medical
students, and legislative support, individuals in the community will certainly consider bequeathing their bodies to medical education.
One important benefit of an increased supply of bodies for
departments of anatomy (by body bequest programs) is in the
training of better-qualified doctors and healthcare providers.
As a result, community health services will improve significantly. In return, anatomy departments and medical colleges
can reciprocate by organizing some medical support for families of donors similar to those implemented in China (Zhang
et al., 2008). Moreover, donors must be assured of respectful
and ethical use of their gifts in the anatomy laboratory, as
well as benefiting from ritual ceremonies and appropriate
burial of the remains. Such remains should be buried in accordance with the religious inclinations of the donors
(Nayak, 2004; Wilkelmann and Güldner, 2004; Lin at al.,
2009; Park et al., 2011) and the family members should be
familiarized with the burial sites, thereby enabling them to
pay respect to their departed members. Besides, it is also recommended that anatomy departments and medical colleges
organize an annual convocation of thanks, where donors are
publicly acknowledged and appreciated for their postmortem
contributions to medical education (Elansary et al., 2009; Lin
et al., 2009; Pawlina et al., 2011). In South Korea, for examAnatomical Sciences Education
JULY/AUGUST 2011
ple, after the dissection of bequeathed bodies, funeral services
are organized by medical schools to publicly honor the
donors (Park et al., 2011). Such practices are proven to
increase public awareness about body bequests, as well as encourage body donation from the surrounding community. In
such an educational environment, medical students learn to
handle and treat donated bodies with the utmost respect. In
addition, they also gain experience in nurturing the doctor–
patient relationship by meeting the donor’s families (Lin
et al., 2009). In the Netherlands, an altar was erected by the
anatomy department of Radboud University Nijmegen Medical Centre to honor body donors, and donors’ families and
friends were invited to unveil the monument erected in honor
of their loved ones (Kooloos et al., 2010). Because of the rich
media coverage of this public event, the surrounding community was better sensitized and informed about body bequest
programs, as well as about the benefits of such a gesture to
society.
It is therefore the responsibility of all departments of anatomy in Nigerian medical schools to work with the newly
established Anatomical Council of Nigeria, the Medical and
Dental Council of Nigeria, the Anatomical Society of Nigeria,
as well as the Ministry of Health to solve the issue of cadaver
shortages. It is recommended that a Ministerial Panel be
appointed to facilitate the implementation of the above recommendations in support of a formal body bequest program
in Nigeria, as this would substantially increase the supply of
cadavers for anatomical teaching and research. Perhaps this
may be one of the first tasks of the newly appointed Anatomical Council of Nigeria to establish a formal body bequest
program. The time to begin this process is now.
NOTES ON CONTRIBUTOR
OLUWOLE BUSAYO AKINOLA, Ph.D., is a lecturer I in the
Department of Anatomy at the University of Ilorin, Ilorin,
Nigeria. He teaches anatomy to second- and third-year medical and biomedical students.
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