Charming Cadavers. Horrific Figurations of the Feminine in Indian Buddhist Hagiographic Literature. Liz Wilson. The University of Chicago Press, Chicago 1996. xvi, 258 pp. Cloth: $55.00; £43.95. ISBN 0-226-90053-3; paper: $19.95, £15.95. ISBN 0-226-90054-1.

This paper sketches how late seventeenth-century Dutch anatomists used printed publications to advertise their anatomical preparations, inventions and instructional technologies to an international clientele. It focuses on anatomists Frederik Ruysch and Lodewijk de Bils , inventors of two separate anatomical preparation methods for preserving cadavers and body parts in a lifelike state for decades or centuries. Ruysch's and de Bils's publications functioned as an ‘advertisement’ for their preparations. These printed volumes informed potential customers that anatomical preparations were aesthetically pleasing and (...) scientifically important but did not divulge the trade secrets of the method of production. Thanks to this strategy of non-disclosure and advertisement, de Bils and Ruysch could create a well-working monopoly market of anatomical preparations. The ‘advertising’ rhetorics of anatomical publications highlight the potential dangers of equating the growth of print culture with the development of an open system of knowledge exchange. (shrink)

One result of routine use in intensive care units of the medical apparatus known as the artificial ventilator has been the creation of human entities whose brains are diagnosed as irreversibly damaged, but whose bodies are kept alive by means of technological support. Such brain-dead bodies have potential value as a supply of human organs for transplant. This article, drawing primarily on ethnographic data collected in intensive care units, examines why procurement of organs from brain-dead bodies has been fully institutionalized (...) in North America for more than two decades, in contrast to Japan. It is argued that the basic medical discourse is essentially the same in both locations and that it is largely unexamined tacit knowledge formed from an amalgam of local values, discursive formations in law, medical guidelines, policy formulations and public commentary, that accountfor the difference. This situation, that has dramatically different effects on the transplant enterprise in the two locations, is not culturally determined and the respective dominant ideologies are widely disputed in both North America and Japan resulting in a situation of chronic flux. (shrink)

Tomando como referencia principal el performance artístico “Mundos corporales” del médico alemán van Haggens, se adelanta un esfuerzo por interpretar el suceso textual dentro de algunas pistas conceptuales del psicoanálisis. La visión museizada del cadáver actúa como un espejo del cuerpo humano a través del cual el espectador satisface una pulsión de muerte. El goce, ese excedente del enfrentamiento visual con ese tipo de texto est-ético, suscita una relación estrecha con un querer-saber sobre (el) ser humano que, a la (...) postre, que se acepta o se rechaza a voluntad del espectador. (shrink)

Recent technological developments have considerably transformed the supply, storage, and transportation processes of cadavers, creating new and previously unforeseen ethical challenges regarding cadaver usage. In this study, we analyzed two aspects of the cadaver processing system—cadaver supply and its use in research. Thereafter, we highlighted the major ethical concerns underlying these stages and correlated our search results with the ethical principles outlined in the Declaration of Helsinki (DoH), or Helsinki Declaration. To ensure the reliability and continuity of medical progress, human—especially (...) cadaver—research depends on the ethical priorities as outlined in the DoH: respect for autonomy, privacy/confidentiality, risks/burdens/benefits, and the protection of vulnerable groups. According to our ethics analysis, which also corresponds with the ethics guidelines of the Consensus Panel on Research with the Recently Dead, the most ignored values were respect for autonomy and privacy/confidentiality issues. Based on these ethical concerns, we provide recommendations to address these challenges in anatomy research. (shrink)

European Journal of Philosophy, EarlyView.

Recent ethics literature suggests that issues involved in non-heart-beating organ procurement are both highly charged and rather urgent. Some fear that NHB is a public relations disaster waiting to happen or that it will create a backlash against organ donation. The purpose of the study described below was to assess ethics committees' current level of involvement in and readiness for addressing the difficult issues that NHB organ retrieval raises—either proactively through policy development or concurrently through ethics consultation.

This is an invited submission from the Editor-in-Chief as the introductory piece for an ‘Ethics Roundtable’. This piece will include invited commentaries from experts in surgical education, medical ethics, law and the prospective body donor perspective.

In my professional role as anatomy administrator and bequeathal secretary at a large surgical training centre, I am the first point of contact both for people wishing to donate their body, and for newly bereaved relatives telling us that their registered loved-one has died. I am involved in every stage of the process from that first phone call, through to eventual funeral service, cremation of the body and return of the ashes to the family. I am also a registered body (...) donor myself, as I strongly believe in the value of cadaveric training having seen it first hand. When prospective donors and relatives find out that I am also a registered body donor they find this to be very reassuring to know that having ‘behind the scenes’ access has not put me off, and is a good endorsement for the process, …. (shrink)

The rights of the various individuals involved in decision-making in cadaver organ donation are considered, and there is discussion of the relation of human cadavers to the planetary biomass. I conclude that the rights of the potential recipient should outweigh those of the other parties concerned and that education and legislation should recognise and promote this.

Hannah James makes a persuasive case for the use of donated bodies and body parts in surgical training, enabling high fidelity training, improved competency of surgeons and reduced risk of harm to patients from trainees ‘learning on the job’.1 She also identifies some pertinent ethical questions that arise from this practice that should be considered by training organisations, regulatory authorities and the trainees themselves. Many countries throughout the world have regulated programmes, governed by strict ethical principles, for donating bodies, usually (...) to academic institutions for the purposes of medical education.2 In the UK the Human Tissue Authority sets out guiding principles for institutions licensed to handle human tissue including donation of bodies for anatomical examination, education and research; consent, dignity, quality, and honesty and openness.3 The Nuffield Council on Bioethics, in its 2011 report, Human Bodies: donation for medicine and research, identified a number of relevant ethical values including autonomy, altruism, justice, dignity, reciprocity, maximising welfare, and honesty and respect.4 While this report did not focus specifically on donation of human tissue for education and training the principles identified are equally relevant in this context. In terms of maximising welfare whole body donation for education and training provides benefit to many patients over a relatively short time frame …. (shrink)

Recent ethics literature suggests that issues involved in non-heart-beating organ procurement are both highly charged and rather urgent. Some fear that NHB is a public relations disaster waiting to happen or that it will create a backlash against organ donation. The purpose of the study described below was to assess ethics committees' current level of involvement in and readiness for addressing the difficult issues that NHB organ retrieval raises—either proactively through policy development or concurrently through ethics consultation.

The case for cadaveric surgical training benefitting patients is clear. Surgeons must be trained to the highest standards to provide the best possible quality of care, and cadaveric simulation training offers a way to help achieve this.1 What is less clear is how the increasing demand for cadaveric training can be met in a way that is ethically considerate to the body donors, without whom this valuable training would obviously not be possible. As Ms Walker2 says in her paper, body (...) donation is primarily driven by the altruistic motive for others to benefit after the donor’s own lifetime. The sense of pride and satisfaction …. (shrink)

No one has the right to say what should be done to their body after deathIn my opinion any concept of property in the human body either during life or after death is biologically inaccurate and morally wrong. The body should be regarded as on loan to the individual from the biomass, to which the cadaver will inevitably return. Development of immunosuppressive drugs has resulted in the cadaver becoming a unique and invaluable resource to those who will benefit from organ (...) donation. Faced with the biological reality, the moral error of any concept of property in the body, and the quantitative failure of voluntary organ donation, I believe that the right of control over the cadaver should be vested in the state as representative of those who may benefit from organ donation.How one regards the dead human body, the cadaver, is in part governed by one’s familiarity with it. At the present time, very few people ever see a cadaver which has not in some way been altered after death, and even fewer touch, handle, deal in any way with the dead human body. In developed countries, death itself most frequently occurs away from the home, in an institution, under the supervision of professional caregivers. For most people, ideas concerning the cadaver, its nature, the proper way to deal with it, are formed under these conditions.As a pathologist specialising in forensic pathology, for 50 years I have been at the other end of the spectrum of experience. In my daily work I have been privileged to examine the cadaver in all its stages after death from the immediate postmortem moments through all the stages of decomposition to bare bones. Working in a relatively small community, I have sometimes been charged with examining the body of someone I …. (shrink)

Since 1995, thousands of people in Taiwan have pledged each year to donate their cadavers to the medical college run by the Buddhist Tzu Chi (Ciji) Foundation. The “surge of cadavers” seems intriguing in a society where ancestor worship continues to be salient. Drawing on my fieldwork in 2012–2013 and 2015, the purpose of this paper is to describe a series of practices involving the transformation of a cadaver into a Buddhist moral subject: the donor, the family, and the medical (...) school engage in various endeavors and rituals involving “emotional practices” to honor the deceased; situate the donation as a “good death”; and fulfill the family's obligations to ancestor worship. I argue what makes the ritual transformation efficacious is the dominant currency of emotional practices. Emotional practices “authenticate” the ritual transformation. The main ethic for commemorating the cadaver donation is not generosity or dāna but equanimity. (shrink)

The author discusses the ways in which she finds the University of Pittsburgh Medical Center protocol for procuring organs from "non-heart-beating cadaver donors" medically and morally questionable and irreverent. She also identifies some of the factors that contributed to the composition of this troubling protocol, and to its institutional approval.

Marlise Muñoz had told her husband, Erik, that if it were ever necessary, she opposed being kept alive through the use of artificial sustenance. Two days before Thanksgiving in 2013, Erik found his wife unconscious on their kitchen floor; she had, by that point, suffered from oxygen deprivation for about an hour. When she arrived at John Peter Smith Hospital, Muñoz was put on a ventilator as hospital workers sought to revive her. They did not succeed. She was declared brain-dead, (...) meaning that she had suffered the irreversible loss of all brain activity. Her family requested that her ventilator be removed, and were shocked to hear their request denied. The Texas advance directive statute prohibits the removal of... (shrink)

Richard Thaler and Cass Sunstein (2008) contend that mandated choice is the most practical nudge for increasing organ donation. We argue that they are wrong, and their mistake results from failing to appreciate how perceptions of meaning can influence people's responses to nudges. We favor a policy of default to donation that is subject to immediate family veto power, includes options for people to opt out (and be educated on how to do so), and emphasizes the role of organ procurement (...) organizations and in-house transplant donation coordinators creating better environments for increasing the supply of organs and tissues obtained from cadavers. This policy will provide better opportunities for offering nudges in contexts where in-house coordinators work with families. We conclude by arguing that nudges can be introduced ethically and effectively into these contexts only if nudge designers collaborate with in-house coordinators and stakeholders. (shrink)

Organ transplantation is an accepted therapy for major organ failure, but it depends on the availability of viable organs. Most organs transplanted in the U.S. come from either "brain-dead" or living related donors. Recently organ procurement from patients pronounced dead using cardiopulmonary criteria, so-called "non-heart-beating cadaver donors" (NHBCDs), has been reconsidered. In May 1992, the University of Pittsburgh Medical Center (UPMC) enacted a new, complicated policy for procuring organs from NHBCDs after the elective removal of life support. Seventeen months later (...) only one patient has become a NHBCD. This article describes her case and the results of interviews with the health care team and the patient's family. The case and interviews are discussed in relation to several of the ethical concerns previously raised about the policy, including potential conflicts of interest, the definition of cardiopulmonary death, and a possible net decrease in organ donation. The conclusion is reached that organ procurement from non-heart-beating cadavers is feasible and may be desirable both for the patient's family and the health care providers. (shrink)

Chronic organ diseases and the increasing demand for organ transplantation have become an important health care problem within the last few decades. Campaigns and regulations to encourage people to donate organs after their death have not met much success. This article discusses the subject from an Islamic perspective. It begins with some basic information on how Muslims reach legal rulings on a particular issue, and goes on to debate contemporary thinking among Islamic scholars on the ethical‐legal issues of organ donation (...) and organ transplantation.It is shown that there are two groups of scholars, one allowing organ donation and organ transplantation, the other refusing it in any circumstances. Both groups agree that it is fundamentally wrong to harvest organs from cadavers without the prior permission of the deceased or the relatives. This dogma is re‐examined, and it is argued that, under the rule of necessity and the imperative to preserve life, there is enough moral and theological ground to allow the state to harvest organs from the deceased without prior permission. (shrink)

Procurement of organs from non-heart-beating cadaver donors raises concerns. Standards for optimal patient care during withdrawal of life-sustaining therapy are evolving and continue to be debated and studied. Consensus on specific procedures and methods has not been attained, however, and protocols for the procurement of organs from patients following the withdrawal of life-sustaining therapies may compromise the evolving standards and harm the patient and the attendant family. In addition, there is little evidence to suggest that such protocols will significantly increase (...) the number of organs procured. "Non-heart-beating cadaver" protocols that do not give comprehensive attention to optimal patient/family care at the time of withdrawal of life-sustaining therapy ought not to be endorsed. (shrink)

Research on human cadavers is an important mechanism of scientific progress and comprises a large industry in the United States. However, despite its importance and influence, there is little ethical or regulatory oversight of cadaver-based research. This lack of transparency raises important ethical questions. Thus, this paper serves as a call for ethicists and regulators to pay increased attention to cadaver research. I argue that cadaver research ought to be considered a subset of human subjects research and held accountable to (...) higher ethical standards. After describing current practices, I argue that oversight of cadaver research as a form of human subjects research is appropriate because cadaver research is similar to other types of human research, participants in cadaver research incur risks of harm, and a current lack of oversight has allowed the cadaver industry to entice research participation through ethically questionable practices. This paper urges greater dialogue among human subjects research ethicists and regulators about what constitutes appropriate protections for participants in cadaver research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Back to the Future:Obtaining Organs from Non-Heart-Beating CadaversRobert M. Arnold (bio) and Stuart J. Youngner (bio)Organ Transplantation requires viable donor organs. This simple fact has become the Achilles' heel of transplantation programs. Progress in immunology and transplant surgery has outstripped the supply of available organs. Between 1988 and 1991, for example, the number of transplant candidates on waiting lists increased by about 55 percent, while the number of donors (...) increased only about 16 percent.1 By the end of March 1993, more than 30,000 potential recipients awaited transplantation (United Network for Organ Sharing Database (UNOS) 1993). Every day six of these patients die prior to receiving a heart or liver transplant, while patients needing kidney transplants must tolerate a lower quality of life on dialysis (Grenvik 1992; Evans, Orians, and Ascher 1992).This scarcity is likely to get worse. As transplantation becomes more successful, it is being offered to sicker and older patients. Attempts to transplant other solid organs, such as small bowel and pancreas, will only fuel the demand for donors. However, the current source of organs is unlikely to grow. Most organs come from patients who have been declared dead by neurologic criteria (commonly referred to as "brain dead" or heart-beating cadaver donors (HBCDs) because their hearts are beating at the time of procurement). Estimates of the potential pool of HBCDs have been revised downward from 20,000-27,000 to roughly 10,000-12,000 (Nathan et al. 1991). Improvements in automobile safety and handgun legislation will likely lead to further reductions. Moreover, the rate of procurement from HBCDs has remained relatively flat despite extensive public awareness campaigns and legislation requiring hospitals to routinely request donation from families of dead patients (Caplan et al. 1992).If organ transplantation is going to continue to flourish, alternative [End Page 103] sources of organs must be found. Recently the University of Pittsburgh Medical Center (UPMC) proposed procuring organs from patients who have been declared dead by traditional cardiopulmonary rather than brain-oriented criteria after they or their families have decided to forgo life-sustaining treatment—hereafter referred to as the Pittsburgh protocol (UPMC Policy 1993). These patients are typically referred to as non-heart-beating cadaver donors (NHBCDs) because their hearts are no longer beating at the time of organ procurement.Although NHBCDs were a major source of transplantable kidneys prior to the institution of death by neurologic criteria, their usefulness was limited by "warm ischemia time." This term refers to the injury to tissues that occurs when the blood supply is interrupted and before the organs are cooled and reperfused. Under the Pittsburgh protocol, therapy is withdrawn in the operating room where a waiting surgical team removes organs immediately after death is declared. By controlling the place and time of death, it has been possible to minimize warm ischemia time and thus solve the technical problems previously associated with procurement from NHBCDs.The potential contribution of NHBCD organs is significant. Nathan (1992), using data from Delaware Valley Transplant Program, concludes that the use of severely brain injured, but not "brain dead" patients, would increase the donor pool by 20-25 percent. Moreover, unpublished data from the Pittsburgh organ procurement organization, the Center for Organ Recovery and Education (CORE), suggests that these organs, particularly kidneys, function as well as those procured from HBCDs (Broznick 1993).This volume is devoted to the ethical, psychosocial, and public policy implications of procuring organs from non-heart-beating cadaver donors after a discussion to forgo life-sustaining treatment. The genesis of this volume was a project in which we invited leading experts in transplantation, ethics, and public policy to use the Pittsburgh protocol as a starting point for exploring a broad range of issues associated with attempts to procure organs from NHBCDs. The issues raised by NHBCDs turned out to have important implications about the fundamental conceptual and moral assumptions underlying organ procurement.Although each of the papers in this volume can be read separately, we intend the volume to be read as a whole. Many of the latter pieces on the ethical implications of the policy are best understood in light of the earlier background papers... (shrink)

Fat, in the context of dissection, is a nuisance, an obstruction to anatomical order and orientation. Yet it makes up a large part of the human body, and in the practice of dissection becomes one of the most prominent materials in the room, as it sticks to gloves and spreads through the dissection hall, making chairs greasy and instruments slippery. In this article I explore the role and significance of fat tissue in anatomical dissection for medical students. In anatomy, fat (...) remains largely an excess material; something superfluous, insignificant, left-over when the body is turned into an anatomical body consisting of muscles, nerves, blood vessels, and bones, cleaned and displayable. But fat is also something which appears in experience as excessive, omnipresent, proliferating, and resistant to attempts to keep it in order. Much anthropological work within dissection practices has described the process of ‘cleaning’ the bodies, but often—mirroring medicine—these accounts follow the becoming of the anatomical body and leave the fat behind. In this article, I try to ‘stick with’ the fat and suggest that fat tissue, as an embodiment or material manifestation of the more-than-anatomical-body, may tell us something about bodies, subjectivity, scientific order, and dissection. (shrink)

Interest in the retrieval of organs from non-heart-beating cadaver donors has been rekindled by the success of transplantation of solid organs and the insufficient supply of donor organs currently obtained from heart-beating cadaver donors. There are currently two retrieval techniques being evaluated, the in situ cold perfusion approach and the controlled death approach. Both, however, raise ethical concerns. Reanimation is a new method which has been used successfully in animals. We believe this new approach overcomes the ethical objections raised to (...) these other methods. (shrink)

The non-heart-beating cadaver donor procurement process might come in conflict with the organ sharing system by diverting organs from potential recipients. It might also have a negative effect on public attitudes about transplantation. The process could start society down a slippery slope leading to extending donor criteria. Some of these scenarios are merely theoretical, but the procedure should be monitored to avoid such problems.

Much of the ethical debate about controlled non-heart-beating cadaver (NHBC) organ recovery has focused on the University of Pittsburgh Medical Center (UPMC) protocol. Some commentators have voiced serious reservations about the ethical acceptability of that protocol; others have argued that the protocol contains sufficiently stringent ethical safeguards to warrant a limited and carefully monitored trial at UPMC. UPMC is not the only organization pursuing controlled NHBC organ procurement, however. The study of organ procurement organizations described in this article suggests that (...) controlled NHBC organ procurement is a practice that, if not yet widespread, is certainly no longer isolated to a few organizations in which it is carefully monitored. Rather, it is being carried out under a variety of circumstances, many of which are less carefully constrained ethically than at the University of Pittsburgh Medical Center. The next stage of the ethical debate should focus on issues that are arising in a variety of settings as the practice spreads. (shrink)

The University of Pittsburgh policy for procuring organs from non-heart-beating cadaver donors recognizes the potential for conflicts of interest between caring for a "hopelessly ill" patient who has forgone life-sustaining treatment and caring for a potential organ donor. The policy calls for a separation between those medical personnel who care for the gravely ill patient and those involved with the care of transplant recipients. While such a separation is possible in theory, it is difficult or impossible to attain in practice. (...) However, such a separation of duties would be unnecessary if an arbitrator were appointed to monitor the proceedings as they take place on a case-by-case basis. In this way, the biases—real or potential—of the individuals involved could be identified, and the harmful effects of the unavoidable conflicts of interest could be minimized. (shrink)