Anatomy Associations Advisory Committee
Guidelines during anatomical examination
The use of human cadavers
Anatomy Associations Advisory Committee
The Anatomy Associations Advisory Committee (formerly PGaPAC) was established to develop best practice relating to the use of human tissue for Anatomical Examination. Members of the Committee are drawn from the Anatomical Society, the British Association of Clinical Anatomists and the Institute of Anatomical Sciences, that together represent the Anatomy Sector in the UK and Ireland.
The three representatives nominated by the council of the Institute of Anatomical Sciences (IAS) are Wendy Birch, Tom Cornwall and Natasha Russell
Please see below for more information. If you have further questions, feel free to contact us.
Anatomy facilities will be inspected by the HTA either as scheduled by the HTA or at any time if there is reason for concern raised by the HTA. However each facility is expected to perform an annual audit of its own facility. It is good practice to invite a neighbouring Designated Individual (DI) and accompanying Person Designate (PD) to review the facility on an annual or biannual basis to provide an external view of processes being used, procedures being carried out and the premises and equipment being used for the licensed activities.
Normally embalming or other preservation (e.g. freezing) of a donor’s body will begin providing a valid donor consent form, a signed Medical Certificate of the Cause of Death (MCCD) and a green Disposal Form from the Registrar are available.
NB It is not unlawful to start preparing a body in order to proceed to timely preservation and storage, if (a) the DI/PD (or bequeathal secretary designated by DI/PD) has seen a copy of the signed and witnessed donor consent form or last will, clearly indicating the donor’s wishes, and (b) has good reason to believe that there is a signed MCCD or is in possession of the number of the certificate.
However Anatomical examination must not begin until the appropriate donor consent form and MCCD are in place and the death has been registered (to provide the “green Disposal Form” obtained from Registrar without which final disposal will be impossible).
Although the Human Tissue Act does not provide a definition of ‘parts’, if consent has been given for a body to be used for anatomical examination with retention of ‘parts’. It is suggested that for good practice at the end of 3 years (or before), a minimum of 2/3 of the body mass of the individual should be sent for cremation / burial, accompanied by the green Disposal Form. This period may be longer if the donor has consented to a longer or an unlimited period of body retention.
Retained cadaveric parts not accompanied by a green Disposal Form are usually disposed of in hospital or commercial incinerators, depending upon local circumstances. Arrangements for respectful disposal of parts via crematoria are to be encouraged where possible. A Service Level Agreement between the institution disposing of the parts and the contractor, outlining appropriate procedures, should be in place. Good practice is that the parts should be incinerated in a designated human tissue burn and there should be a ‘Duty of Care’ visit to the incinerator at least once a year. Ideally all deliveries of parts to the incinerator should be attended by the DI or PD.
The suitability of packaging should be determined by the amount and nature of the parts and the distance they are to be transported, e.g. bagged or bagged and placed inside appropriately sized containers. A list of the contents of each consignment and the part numbers within should accompany the consignment and a copy should be retained by the DI on the individual donor’s record/file and kept for a minimum period of 5 years from the date of disposal as advised by the relevant legislation e.g. England, Wales and Northern Ireland vs Scotland.
Images may be used for medical education (including anatomical, clinical undergraduate and postgraduate), research and clinical audit without consent providing that the donors cannot be identified. Although the Human Tissue Act is silent on the taking and use of images, good practice is to request consent at the time of joining the list of potential donors through the consent form. Any image to be used in the dissecting room or in a ‘secure’ practical can directly reflect the wet specimen material in the dissecting room. No individual should be identifiable in images for use in other circumstances. Images should not be uploaded onto the internet, from which they may be downloaded and inappropriate use made of them. Local practice(s) for uploading images onto an intranet must be appropriate and secure. A record should be kept of electronic images taken of cadaveric material, to whom they have been disseminated and for what purpose: good practice is to use an appropriate, standardised form for this purpose. All use of images from licensed establishments must be agreed and sanctioned by the DI.
When a dissecting room or laboratory contains visible specimens (wet or otherwise preserved body parts), access should be restricted to the following groups of individuals: registered students with a justifiable reason for requiring access; healthcare professionals attending courses; others, such as medical artists and police and those who have applied/been accepted as students, whose courses involve gross anatomy can be admitted at the discretion of the DI. Any other category of visitor should normally only be admitted to an ‘empty’ dissecting room, i.e. a room either stripped of cadaveric material, or where such material is covered. When maintenance staff require access, cadaveric material should be covered. Whilst in the dissection room all students and visitors should be supervised by the DI, a PD or a member of staff designated by the DI/PD.
Specimens must be treated with respect at all times. Human parts should be clearly labelled with their unique identifier. When in store (tank/buckets/cold rooms etc), specimens may be grouped together/ placed on top of/in contact with each other). While being transported, parts should be covered and secure and transport through public areas should be avoided when possible. When being used for teaching, specimens should not be in contact with each other unless it is specifically necessary.
Human and non-human animal parts should be stored separately: each part should be clearly labelled with its unique identifier. When being used in a class for comparative purposes, human and non-human animal parts should normally be placed on separate trays on separate tables: it is acknowledged that there may be times during a class when this separation is not appropriate.
It is not appropriate to make a charge for cadavers freely given for Anatomical Examination under the Human Tissue Act. However, it is reasonable to apply a charge to cover the costs of embalming bodies, preparing retained parts for use in other establishments and transport etc. These charges should reflect the costs involved.
Anatomical specimens (wet or otherwise preserved prosections, potted material, dry bones) may be loaned to unlicensed premises for the purposes for which consent was originally given (e.g. Anatomical examination). A written agreement should be put in place between the 2 parties to outline where the material will be stored and used, how long it will be away from the licensed premises, who will take responsibility for the material while it is on loan and when it will be returned. Specimens should be stored securely in an appropriate locked cupboard (or other suitable container) in a locked room. The agreement should be signed by both parties and copies kept on file. The HTA have produced a model form for this purpose which can be downloaded from the HTA website.
The Human Tissue Act allows anatomical research to be undertaken on consented donated bodies and does not necessitate further ethical permission or records to be requested. However it is good practice that a record of anatomical research projects, researchers, and the DI or PD responsible for each project be kept and reports made available for inspection by the HTA and reported in summary to the Local Research Ethics Committee of the University or Hospital. The DI, aided by the Local Research Ethics Committee if required, may refuse a project if it is considered to be outside the furtherance of gross anatomical knowledge.
The Human Tissue Act allows surgical training to be undertaken on consented donated bodies. It is good practice to retain records of the procedures undertaken including imaging and the use of images.
Documentation pertaining to individual donors and their next of kin, executors, or other contacts
It is best practice that all documentation should be regularly audited to ensure that it is still valid and should only be retained if necessary and in line with General Data Protection Regulation (GDPR) requirements. If documentation is stored solely in a digital format, with subsequent destruction of the original hard copy, the digital information should be stored on a secure ‘backed-up’ server. The person with the legal responsibility for Anatomical Examination should ensure that the digital versions are a faithful reproduction of the originals. Consent forms and any accompanying documentation should be retained for whole cadavers and body parts that are being stored or used for Anatomical Examination. Any decisions made regarding processing or disposal of documentation relating to donors who have been used for Anatomical Examination and whose remains have been released for cremation or burial should be recorded. It is reasonable to dispose of documentation relating to individuals who have died and have not been accepted for Anatomical Examination. It is also reasonable to dispose of documentation relating to individuals whose deaths have not been notified, if the individual’s age would be greater than 120 years at the time of disposal. Consideration should be given to the fact that documentation relating to donors and potential donors may be of interest to future scholars or the donors’ descendants.