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Clinical Anatomy 00:000–000 (2011)
ORIGINAL COMMUNICATION
Anatomist on the Dissecting Table?
Dutch Anatomical Professionals’
Views on Body Donation
SOPHIE BOLT,1* ERIC VENBRUX,1 ROB EISINGA,2
AND
PETER O. GERRITS3
1
Center for Thanatology, Faculty of Philosophy, Theology and Religious Studies,
Radboud University Nijmegen, Nijmegen, The Netherlands
2
Department of Social Science Research Methods, Faculty of Social Sciences,
Radboud University Nijmegen, Nijmegen, The Netherlands
3
Department of Neuroscience, Section Anatomy, University Medical Center Groningen,
University of Groningen, Groningen, The Netherlands
Anatomical professionals know better than anyone else that donated bodies
are a valuable asset to anatomical science and medical education. They highly
value voluntary donations, since a dearth of bodies negatively affects their
profession. With this in mind, we conducted a survey (n ¼ 54) at the 171st scientific meeting of the Dutch Anatomical Society in 2009 to see to what extent
anatomical professionals are willing to donate their own body. The results
reveal that none of the survey participants are registered as a whole body donor and that only a quarter of them would consider the possibility of body donation. We argue that the two main constraints preventing Dutch anatomical
professionals from donating their own body are their professional and their
social environments. In contrast to the absence of registered body donors, half
of the anatomical professionals are registered as an organ donor. This figure
far exceeds the proportion of registered organ donors among the general
Dutch population. Clin. Anat. 00:000–000, 2011. V 2011 Wiley-Liss, Inc.
C
Key words: anatomy; whole body donation; motivation for donation; dissecting
room
INTRODUCTION
Every day anatomical professionals, such as prosectors and anatomists, work with dead bodies that
were donated to their institute. They know better than
anyone else does that human corpses are a valuable
asset to anatomical research and medical education. A
sufficient supply of donor bodies is essential to the
anatomy practice and the shortage of body donors
that is frequently reported by anatomical institutes in
other countries (Boulware et al., 2004; McHanwell
et al., 2008) severely obstructs the advancement of
the discipline.
Over the past several years, Dutch body donor
registrations have been increasing (Wijbenga et al.,
2010). Currently, about 0.1% of the Dutch are registered as body donors. Out of a total population of
16.5 million, this means that there are around
C 2011
V
Wiley-Liss, Inc.
16,000 registered body donors in the Netherlands.
This number is much smaller than the three million
Dutch people (28% of the entire population aged 12
and over, registration below the age of 12 is not
allowed) who are registered as organ donors (Rijksoverheid, 2011a). Nevertheless, there is still a shortage of organ donations. For example, at the end of
2009, there were 1,288 people on the waiting list for
*Correspondence to: Sophie Bolt, Radboud University Nijmegen,
Faculty of Philosophy, Theology and Religious Studies, P.O. Box
9103, 6500 HD Nijmegen, The Netherlands.
E-mail: [email protected]
Received 2 May 2011; Revised 10 May 2011; Accepted 12 May
2011
Published online in Wiley Online Library (wileyonlinelibrary.com).
DOI 10.1002/ca.21215
2
Bolt et al.
organ donation and only 215 post-mortem donors
who had actually donated organs that year (Leiden
van et al., 2009). In contrast to the insufficient numbers of Dutch organ donations, the number of whole
body donations is sufficient to meet the demands of
the anatomical institutes. Each year, *650 whole
bodies are donated to the institutes. Much smaller
amounts of registrations are needed because it is
easier to donate a whole body than an organ. For a
whole body to be bequeathed, for example, it is not
necessary for a patient to die of brain death, as is
necessary for organ donation.
There are marked differences between organ donation and whole body donation in the Netherlands.
First, organ donation is regulated by the Organ
Donation Act (Wet op de Orgaandonatie), which regulates organ and tissue donation both during life and after death (Ministry of Health, Welfare and Sport,
2000). Body donation is regulated in the Burial and
Cremation Act (Wet op de Lijkbezorging), in which
body donation to science is mentioned as a third option
of body disposal (Rijksoverheid, 2011b). The recruitment of organ donors is nationally organized by the
Dutch government. Body donors, in contrast are not
actively recruited and are locally administered by anatomical institutes. The eight Dutch anatomical institutes
each have their own rules and formal procedures. To
donate one’s body requires personal approval in the
form of a signed contract between an anatomical institute and the potential donor. The primary objective of
organ donation is to help people who are in need of an
organ or tissue transplant. The primary objective of
body donation is to facilitate anatomical education and
science. In organ donation, only body parts are
donated. Afterwards the body is available for a burial
or cremation. In body donation, the whole body is used
and the corpses are not returned to family and friends.
When the body is no longer of use for the anatomical
institutes, they are disposed of by cremation.
Several studies, such as those conducted in New
Zealand (Fennell and Jones, 1992; McClea and
Stringer, 2010) and the United Kingdom (Richardson
and Hurwitz, 1995), have analyzed the motivational
behaviors of whole body donors. A recent body donor
survey (n ¼ 759) was conducted in the Netherlands
(Bolt et al., 2010). The general outcome of the Dutch
survey was that body donors have strong motivations for their decision and that the majority of their
motives stem from the wish to be useful after death.
Donors want their death to be meaningful. They
strive to contribute to science and education and
they feel that despite their death, they can still help
others. Also notable is that one quarter of the survey
respondents were health care professionals, of
whom the majority either were currently working
with or had worked in the past with living patients
and had little or no dissecting room experience.
Among the body donor respondents there were only
five medical doctors and there were no reported
anatomical professionals (Bolt et al., 2010).
The attitudes of anatomists towards donation for
dissection have been explored in previous surveys
among anatomical professionals in Spain (ArráezAybar et al., 2004) and Turkey (Sehirli et al., 2004).
In the Spanish survey, anatomy teachers reported
that they were in favor of donation and that 53%
would donate organs while only 11% would donate
their own body to science (Arráez-Aybar et al.,
2004). The Turkish study noted that while 49% of
the respondents (Turkish anatomists) were planning
to donate their organs and 16% were planning for
body donations, 64% did not intend to donate their
bodies. The survey respondents cited many reasons
for not donating their body. For example, they did
not want to be dissected by colleagues, their families
objected, they were psychologically not ready, they
were worried about disrespectful behaviors towards
cadavers or they were constrained by religious
beliefs (Sehirli et al., 2004).
A notable example of an anatomical professional
who is planning to donate his body is the artist and
anatomist Gunther von Hagens, who became famous
through his expositions of plastinated bodies, ‘‘Body
Worlds.’’ In an interview by the German tabloid Bild
he informed the readers that he has a degenerative
disorder (Parkinson’s disease) and that he wants to
donate his body to the exhibition and be plastinated
by his wife (Bild, 2011; Erlanger, 2011).
Obviously, given that only a small number of the
Dutch population (0.1%) is registered as whole body
donors, the probability of finding one or more body
donors in a sample equal in size to our sample of
anatomical professionals is small. The probability of
finding a body donor in our sample may also be
decreased by the fact that many of our respondents
have not yet reached the advanced age (as determined
in the study Fennell and Jones, 1992; Richardson and
Hurwitz, 1995; Bolt et al., 2010; McClea and Stringer,
2010) at which the decision to become a body donor is
usually made. However, our sample is not representative of the general population. Anatomical professionals are fully aware of the assets of body donation and
they have direct access to information about the body
donation procedure. For this reason, we explored
whether Dutch anatomical professionals were willing
to donate their body to anatomical science.
MATERIALS AND METHODS
At the 171st scientific meeting of the Dutch Anatomical Society (NAV) in Lunteren, the Netherlands,
held on 9–10 January 2009, 60 survey questionnaires were handed out to the meeting participants.
Institutional ethical approval was given in advance
by the chairperson of the NAV. The NAV, founded in
1930, is a society of scientists and professionals who
are employed either by one of the eight Dutch anatomical institutes (Academic Medical Center Amsterdam, Erasmus Medical Center Rotterdam, Leiden
University Medical Center, Maastricht University
Medical Center, Radboud University Nijmegen Medical Center, University Medical Center Groningen,
University Medical Center Utrecht, and VU University
Medical Center Amsterdam) or by one of the two anatomical institutes (Ghent University and Hasselt
University) located in Flanders, the Dutch-speaking
part of Belgium. The annual scientific meeting is
organized by the NAV with the goal of promoting the
Anatomist on the Dissecting Table?
3
were either married (55.6%) or had an official registration of cohabitation contract (18.5%). A small
number of the respondents (18.5%) were single and
a few (7.4%) were divorced. Two-thirds (66.7%) of
the respondents had children and the average
number of children was 2.4. Only 29.6% of the
respondents described themselves as a member of a
Christian church or religious community: Catholic
(13.0%), Protestant (11.1%), Evangelical (1.9%),
anthroposophy (1.9%), and Buddhism (1.9%).
Education and Profession
The majority (87%) of the respondents completed
school at the tertiary level and the remainder (13%)
completed secondary education. Among the respondents, there were 29 anatomists, 7 prosectors, 7
PhD students in anatomy, 5 anatomy teachers, 2
research technicians, 1 biologist, 1 curator, 1 secretary, and 1 pathologist. The mean work experience
in the anatomical field was 14.8 years, with a range
of 1–40 years of experience.
(Un)Willingness to Donate
Fig. 1.
Age and sex distribution respondents.
exchange of information pertaining to all aspects of
anatomical science. Respondents were requested to
return the completed questionnaire by either dropping
it into an appropriate box at the meeting or by sending
it in by post afterwards using a postage-paid envelope.
The survey data were entered into the software program SPSS, version 15.0 for statistical analysis.
The questionnaire asked respondents to provide
certain details about themselves, such as their age,
sex, nationality, religion, profession, marital status,
education, and work experience in anatomy. The
survey items are included in the appendix to this
article. Using open-ended questions, we asked the
respondents to write down the reason for their willingness or unwillingness to donate their own body to
medical science. Some of the participants responded
to this query by offering one reason, others wrote
down two reasons. The reasons given were organized into categories.
RESULTS
Donor Characteristics
The questionnaire was completed by 54 respondents
and 2 questionnaires were returned blank (n ¼ 54).
The response rate was high (90%). In 2009, the NAV
had 84 paid members and although our sample is
based on meeting attendance, we believe that the
survey offers a good representation of the NAV members. The age of the respondents ranged from 26 to
66 years, with a mean age of 46. Of the respondents,
63% were male and 37% were female. See Figure 1
for the age and sex distributions of the respondents.
Almost all respondents (90.7%) were Dutch and
the remainder had either Belgian (7.4%) or German
(1.9%) nationality. The majority of the respondents
None of the 54 respondents (0%) was currently
registered as a potential whole body donor at any of
the anatomical institutes. The majority (74.1%) was
not considering donation at all, with the remaining
quarter (25.9%) indicating that they may consider
the possibility of body donation. We also asked
whether the respondents were registered as organ
donors, and exactly half of them confirmed (50%).
The number of respondents who donate blood or
who in the past have donated blood was somewhat
smaller (31.5%). The majority of the respondents
(82%) were neutral to the idea of a family member
considering body donation. Only 2% would advise
against donation and 15% would recommend the
possibility.
Reasons Not to Donate
In response to the open-ended questions ‘‘I do
not want to bequeath my body to science,
because. . .’’ and ‘‘I do not know yet if I want to
bequeath my body to science, because. . .’’ (See
Appendix: q7 and q8), 53 participants gave reasons
for not donating their body and one respondent left
the answer blank. Table 1 shows the categorized
responses to the open-ended questions. Some
respondents gave only one reason whereas others
gave two. The total number of responses (n ¼ 62) is
therefore not equal to the total number of respondents (n ¼ 53). The third column shows the frequencies based on the total number of responses, and the
right-most column shows the distribution based on
the total number of respondents.
The Dutch anatomical professionals had two main
reasons not to donate their body. The first main
reason for their unwillingness includes profession
specific factors. The respondents mentioned seven
times that they did not like the idea of body donation. The respondents spoke in terms of a strange,
unpleasant, and restless idea that their body will
4
Bolt et al.
TABLE 1. Reasons not to Donate Body
Absolute frequency
of responses
(n ¼ 62)
Profession related factors
Unpleasant idea
Inside information
Small Dutch-speaking anatomical
community
Contributed enough to science
Sufficiently enough bodies
Social relations
Take into account relatives wishes
Disagreement with relatives
Other
Prefer to be organ donor
Not well considered
Other preferential body treatment
Too young
Religious beliefs
Total
Relative frequency
of responses
(n ¼ 62)%
Relative frequency
of respondents
(n ¼ 53)%
7
6
5
11.3
9.7
8.1
13.2
11.3
9.4
2
1
3.2
1.6
3.8
1.9
15
5
24.2
8.1
28.3
9.4
7
5
4
3
2
62
11.3
8.1
6.5
4.8
3.2
100
13.2
9.4
7.5
5.7
3.8
117
exist after death; that it will be cut open; or will be
dissected by colleagues. One respondent explained
the difficulties he had with the idea that, if he were
to become a body donor, he would in effect be working in the same place his body would go after his
death. He wrote ‘‘I still have not found peace with
the idea that when you are an anatomist you work in
your future ‘residence after death’. . . although I
deeply respect those who have donated their body.’’
Another respondent expressed the problematic visualization of her own corpse in a fixation bath, and
she explained the unpleasant idea of lying next to a
stranger ‘‘It is an emotional issue. Very irrational,
but the idea of lying in a fixation bath with a second,
strange person, still seems strange. Have yet to say
goodbye to the ‘peaceful image’ of a coffin beneath
the earth in eternal rest.’’
The respondents mentioned six times that they
knew all too well what happens to the body in the
anatomical institute. The respondents pointed to the
inside information that restrains them from becoming a donor. For example, one anatomist explained,
‘‘I am too familiar with the matter. I do not like to
fully know what happens after death in relation to
my own body.’’ Only one of these six respondents
expressed anxiety over the possibility that the body
would be treated in a disrespectful manner. Other
profession specific reasons for not being a body
donor included that respondents felt that they had
already contributed enough to science (two times) or
that body donation was not needed as there are
already enough bodies available (one time).
The respondents listed five times that they would
not donate their body because of the ‘‘small Dutchspeaking anatomical community.’’ In other words,
respondents felt unease at donating their body
because they knew almost everyone working in the
various anatomical institutes. Others noted that they
wanted to safeguard the dividing line between work
and home, and that this would not be possible lying
down on a table in front of a ‘‘known’’ person. Two
respondents were worried about their colleagues and
one of them wrote, ‘‘I do not want to harm my colleagues. The anatomical work is mentally taxing if it
concerns the body of a well-known person. If I was
not involved I would do it.’’ Another respondent conveyed, ‘‘It is unethical as an anatomist to donate
yourself: which prosector would you dare to harm?’’
The second main reason for the unwillingness of
anatomical professionals to donate their own body
included social relations. Respondents mentioned 14
times that they wanted to take into account the
wishes of family and friends before making such a
decision. They brought up the consequences of body
donation for the bereaved. For instance, one respondent emphasized the symbolic significance of
the corpse at a funeral, ‘‘I do not want to donate my
body because I do not want to spoil the symbolic
value of my ‘remains’ at a funeral for my bereaved.’’
Other respondents explained that they wanted to
give their relatives the choice of what happens with
their body after death. They wanted to give their
family several possibilities, including the possibility
of organizing a normal funeral or cremation, of having a place to visit after death, of giving the
bereaved more time for bereavement, of preventing
relatives’ concerns of what happens with their body
and of following the family practice of burial. In line
with this category, the respondents mentioned five
times that they were motivated not to donate their
body because there is disagreement with relatives
over body donation. That is, they have not registered
as body donor because spouses or other family
members object.
Next to professional and social environment, there
were other reasons for the unwillingness of anatomical professionals to register as a body donor. It was
mentioned seven times that organ donor registration
restrained the respondent from becoming a whole
body donor. The respondents indicated their preference for organ donation, for example, by expressing
the wish to help living people, ‘‘I prefer to donate my
Anatomist on the Dissecting Table?
5
Fig. 2. Reasons not to register as body donor and social characteristics.
organs to living people, to improve their lives.’’
Another respondent noted that he considered organ
donation more useful, ‘‘I am an organ donor and I
would rather consider donating my brains to the
brain tissue bank. In my opinion, this is currently
more needed and it personally appeals more to me.
That is real science. Body donation to science is
actually more a donation to education.’’ Respondents
also mentioned five times that they would rather
treat the corpse differently. They said that rather
than donating their bodies, they would like to be buried in the earth without a coffin, be recycled in a natural way, or remain intact as much as possible.
Not all of the respondents had already given the
option of body donation a thought. Consequently,
the respondents mentioned five times that they had
not yet sufficiently considered body donation. Reasons that were given less often include, respondents
who considered themselves to be too young to think
about their final destination (three times), and
respondents who had constraints due to religious
beliefs (two times).
Figure 2 superimposes the reasons not to register
as a body donor by the most typical social characteristics of the anatomical professionals. The respondents aged 50 and over most often cited the reasons
that they have contributed enough to science and
that there are enough bodies available. Young, single
female anatomical professionals without children typically disliked the idea of body donation and mentioned
the small anatomical community as their main reason
not to register. Married male anatomical professionals
with children mentioned that most often social reasons
related to their relatives’ wishes and disapprovals as
the reason not to become a body donor.
DISCUSSION
The need for Dutch body donors is not pressing,
since there are adequate numbers of body donors
available (Wijbenga et al., 2010). This contrasts with
the inadequate numbers of bodies for dissection
reported in other countries such as Turkey (Sehirli et
al., 2004). While the number of body donor registrations has been increasing in the Netherlands for several years (Wijbenga et al., 2010), still only *0.1%
of the Dutch population is actually registered as a
body donor. This article reveals that Dutch anatomical professionals themselves are not likely to register
as whole body donors. None of the respondents to
the survey was registered as body donor and only a
quarter of them would consider the possibility of
body donation for dissection.
Two main explanations for the unwillingness of
anatomical professionals to donate their bodies were
6
Bolt et al.
found in our research. First, profession specific factors impede registration. The Dutch-speaking anatomical community is relatively small. There are only
10 anatomical institutes in the Netherland and Flanders, whereas there are, for example, 36 medical
faculties in Turkey (Sehirli et al., 2004) and 38 medical faculties in Spain (SAE 2010). Consequently,
some respondents do not want to end up on a
dissecting table after death, not only for personal
reasons, but also to avoid causing problems for
their colleagues. Additionally, protecting the privacy of body donors would be difficult if people
working in the dissecting rooms donated their
bodies. In the rare case that medical students know
the deceased, measures can be taken to prevent a
confrontation with the corpse of the known person.
However, for people who work in the dissecting
room on a daily basis, such measures would make
their job impossible.
Our data also shows that inside information
restrained some anatomical professionals from
becoming a body donor. It may be that their willingness to donate their own body is affected by the
daily exposure to dead bodies. A previous study in
Ireland (Cahill and Ettarh, 2008) found that after
their first dissecting room experience medical students were unwilling to become body donors. The
authors argued that actual exposure to the physical
reality of dissection made students reluctant to
donate their bodies. A follow-up Irish study demonstrated that the age of the medical students modulated the ability of their dissection room experiences
to affect their attitude towards whole body donation. Older medical students are less likely to modify
their pre-established ideas about body donation
after their dissection experience (Perry and Ettarh,
2009). The effects of working intimately with dead
bodies were also discussed in a study among nurses
and other health care professionals involved in
organ retrieval. They expressed their concerns
about the actual practice of organ removal and
wondered if people were aware of what the removal
of organs entails (Lynch, 1990).
The second main constraint found in our research
is the influence of social relations. Some professionals do not want to register because they are worried about the way in which their relatives would or
would not be able to say goodbye to them. Others
say that they do not want to register because close
relatives oppose donation. A lack of family consent is
a recurrent and often problematic theme in donor
recruitment studies (Christmas et al., 2008; Sque et
al., 2008; Thomas et al., 2009). The anatomical professionals themselves will not prevent family members from becoming a body donor and only a small
percent (2%) would advise against body donation by
a family member.
Respondents to the Dutch body donor survey also
indicated that their family influenced their decision
about body donation, but this dynamic seemed to
operate in a reverse fashion (Bolt et al., 2010). Many
body donors were found to propagate the idea of
body donation within their social networks. The
results showed that word-of-mouth advertising
strongly influences the information and decision
making process of whole body donors (Bolt et al.,
2010). A body donor survey conducted in New Zealand also demonstrated the influence of word-ofmouth communication and highlighted that many of
the registered donors had other family members
who had donated their body (McClea and Stringer,
2010).
Another obstacle to body registration for some
respondents was that they preferred to donate their
organs. Seven of the eight anatomical institutes in
the Netherlands refuse to accept the bodies of people who have donated their organs. After organ donation, the body is no longer intact and it will not be
suitable for preservation with the embalming technique. With this in mind, some anatomical institutes
only register people above a certain age in order to
stimulate younger people to register for organ donation. The anatomical institute in Groningen, however,
does accept the so-called total donors, people who
first donate those organs suitable for transplant and
subsequently donate their body for dissection.
In our study, only two respondents indicated that
their decision about body donation was constrained
by religious beliefs. In the Turkish study, only 3.6%
of the respondents objected to body donation
because of their religion. The Spanish study also
showed that the anatomy teachers’ attitude towards
donation was not affected by their religious beliefs
(Arráez-Aybar et al., 2004). This does not imply that
religion has no influence on the supply of body
donors in general. An outcome of the Dutch body
donor survey was that donors were distinctively
less religious than the general Dutch population
(Bolt et al., 2010).
Turkey and Italy are examples of countries with a
strong influence of religion in society and, additionally, countries where the concept of voluntarily body
donation has not yet become rooted (Sehirli et al.,
2004; McHanwell et al., 2008). In both countries anatomical institutes struggle with a dearth of dead
bodies and they mainly depend on unclaimed bodies
to use for dissection. In Turkey, the major source for
unclaimed bodies is mental and state hospitals. The
concept of voluntary body donation is almost
unknown, but anatomical professionals try to
increase the supply of voluntary donations (Sehirli et
al., 2004). In Italy, unclaimed bodies can also be
claimed by religious associations. Consequently, the
actual supply of cadavers is even more limited
(McHanwell et al., 2008). However, also in Italy
more and more anatomical institutes are trying to
shift from relying on unclaimed bodies to relying on
the voluntarily donated bodies of people who made
an explicit declaration of such wishes during their
lifetime (De Caro et al., 2009).
We recommend further research in other countries, for example the United States. Which factors
influence the willingness or unwillingness of anatomists to donate their body? Do profession specific
factors and social relations affect the decision process of U.S. anatomists and those in other countries?
What effect does the exposure to dead bodies in the
dissecting room have? More comparative data would
Anatomist on the Dissecting Table?
improve our insight into the motivations of anatomists worldwide. In the United States among a population of over 300 million people, there are about
20,000 body donations per year (Gunderman,
2008). Unlike other countries, in the U.S., there are,
alongside the traditional academic-housed body
donation programs, legal entrepreneurial ventures
supplying U.S. medical schools, medical training centers, and medical device companies with human
corpses and remains (Anteby and Hyman, 2008). A
comparative study found that the entrepreneurial
programs attract donors more likely to have died
from cancer and donors with a relatively short
bequest interval (Anteby and Hyman, 2008). In a
recent Dutch study, last-minute donations were
found to influence actuarial prediction in an anatomical body donation program. Last-minute registrations were significantly more likely to be males than
females (Wijbenga et al., 2010).
While none of the anatomical professionals in our
study was registered as a whole body donor, the
number of registered organ donors (50%) is considerably larger than in the Dutch population at large
(28%). The respondents’ willingness to donate their
organs demonstrates that many of them do have a
positive attitude towards donation. Their unwillingness to donate their body to science stems from the
conditions in their professional and social environment, which makes them less likely to become a
whole body donor in the future.
ACKNOWLEDGMENTS
The authors would like to thank the participants of
the 171st scientific meeting of the Dutch Anatomical
Society (NAV) in 2009.
REFERENCES
Anteby M, Hyman M. 2008. Entrepreneurial ventures and wholebody donations: A regional perspective from the United States.
Soc Sci Med 66:963–969.
Arráez-Aybar LA, Castaño-Collado G, Casado-Morales MI. 2004.
Dissection from the Spanish anatomist’s perspective: Aims, attitudes, and related aspects. Anat Rec B New Anat 281:15–20.
Bild. 2011. Dr. Tod bereitet seine eigene plastination vor. URL:
http://www.bild.de/BILD/news/2011/01/02/dr-tod-gunther-vonhagens/dr-tod-weint-um-sein-leben.html [accessed Jan. 2011].
Bolt S, Venbrux E, Eisinga R, Kuks JB, Veening JG, Gerrits PO.
2010. Motivation for body donation to science: More than an
altruistic act. Ann Anat 192:70–74.
Boulware LE, Ratner LE, Cooper LA, LaVeist TA, Powe NR. 2004.
Whole body donation for medical science: a population-based
study. Clin Anat 17:570–577.
7
Cahill KC, Ettarh RR. 2008. Student attitudes to whole body donation are influenced by dissection. Anat Sci Educ 1:212–216.
Christmas AB, Burris GW, Bogart TA, Sing RF. 2008. Organ donation: Family members NOT honoring patient wishes. J Trauma
65:1095–1097.
De Caro R, Macchi V, Porzionato A. 2009. Promotion of body donation and use of cadavers in anatomical education at the University of Padova. Anat Sci Edu 2:91–92.
Erlanger ,S. 2011. Exhibitor of bodies intends to contribute his own.
The New York Times. URL: http://www.nytimes.com/2011/01/
06/world/europe/06corpses.html [accessed Jan. 2011].
Fennell S, Jones DG. 1992. The bequest of human bodies for dissection: A case study in the Otago Medical School. N Z Med J
105:472–474.
Gunderman RB. 2008. Giving ourselves: The ethics of anatomical
donation. Anat Sci Educ 1:217–219.
Leiden van HA, Heemskerk MB, Diepstraten-Goddijn B, HaasseKromwijk BJ. 2009. NTS Jaarverslag 2009. URL: http://
www.transplantatiestichting.nl/cms/mediaobject.php?file¼ Jaarverslag_2009_NTS.pdf [accessed Jan. 2011].
Lynch A. 1990. Respect for the dead human body: A question of
body, mind, spirit, psyche. Transplant Proc 22:1016–1018.
McClea K, Stringer MD. 2010. The profile of body donors at the
Otago School of Medical Sciences–has it changed? N Z Med J
123:9–17.
McHanwell S, Brenner E, Chirculescu AR, Drukker J, Mameren Hv,
Mazzotti G, Pais D, Paulsen F, Plaisant O, Caillaud MM, Laforet E,
Riederer BM, Sanudo JR, Bueno-Lopez JL, Donate-Oliver F,
Sprumont P, Theofilovski-Parapid G, Moxham BJ. 2008. The
legal and ethical framework governing body donation in Europe–
A review of current practice and recommendations for good
practice. Eur J Anat 12:1–24.
Ministry of Health, Welfare and Sport. 2000. The organ donation
act. URL: http://english.minvws.nl/en/folderszzoude_directies/
csz/the_organ_donation_act.asp [accessed April 2011].
Perry GF, Ettarh RR. 2009. Age modulates attitudes to whole
body donation among medical students. Anat Sci Educ 2:167–
172.
Richardson R, Hurwitz B. 1995. Donors’ attitudes towards body donation for dissection. Lancet 346:277–279.
Rijksoverheid. 2011a. Orgaandonatie. URL:http://www.rijksoverheid.nl/onderwerpen/orgaandonatie. [accessed Jan. 2011].
Rijksoverheid. 2011b. Wet op de Lijkbezorging. URL: http://
www.rijksoverheid.nl/documenten-en-publicaties/vragen-en-ant
woorden/wat-is-de-wet-op-de-lijkbezorging%5B2%5D.html. [accessed
April 2011].
SAE. 2010. Spanish Anatomical Society. URL:http://
www.sociedadanatomica.es/miembros/Universidades [accessed
Dec. 2010].
Sehirli ÜS, Saka E, Sarikaya Ö. 2004. Attitudes of Turkish anatomists toward cadaver donation. Clin Anat 17:677–681.
Sque M, Long T, Payne S, Allardyce D. 2008. Why relatives do not
donate organs for transplants: ‘Sacrifice’ or ‘gift of life’? J Adv
Nurs 61:134–144.
Thomas SL, Milnes S, Komesaroff PA. 2009. Understanding organ
donation in the collaborative era: A qualitative study of staff and
family experiences. Int Med J 39:588–594.
Wijbenga BS, Koning RH, Kooistra-Akse BJ, Bolt S, Kuks JB, van
Zanten-Timmer G, Veening JG, Gerrits PO. 2010. ’Last-minute’
donations influence actuarial prediction in an anatomical body
donation program. Ann Anat 192:2–6.
8
Bolt et al.
APPENDIX TABLE: SURVEY ITEMS ANATOMICAL PROFESSIONALS
1. What is your profession?
2. How many years work experience do you have
in the anatomical field?
3. Are you registered at an anatomical institute to
bequeath your body to science after death?
4. Are you registered at your own anatomical
institute or at another institute?
5. I want to bequeath my body to science
because. . .
6. You have not yet registered yourself as body
donor. Would you consider the possibility in the
future?
7. I do not want to bequeath my body to science,
because. . .
8. I do not know yet if I want to bequeath my
body to science, because. . .
9. What advice would you give to a family
member if he or she would consider
bequeathing his/her body to science?
10. Are you registered as organ donor?
11. Are you a blood donor or have you been a
blood donor in the past?
12. Are you a man or a woman?
13. In what year were you born?
14. Do you have children? We also mean any
step-, foster-, and adopted children.
15. How many children do you have?
16. What is your official marital status?
17. What is your highest level of education?
18. In the Netherlands, there are many different
ethnic groups. To which ethnic group do you
feel you belong?
19. Do you consider yourself member of a church,
religious community, or philosophical
community?
20. Which church, religious community, or
philosophical community?
1. Anatomist, 2. prosector, 3. PhD student in
anatomy, 4. other (please specify)
(specify number of years)
1. Yes (continue to q4), 2. no (continue to q6)
1. At my own institute, 2. at another institute
(Please specify and subsequently continue to
q9)
1. Yes (continue to q8), 2. no (continue to q7)
(Please specify and subsequently continue to
q9)
(Please specify)
1. I would highly advise against this, 2. I would
advise against this, 3. I would remain neutral,
4. I would advise this, 5. I would highly advise
this
1. Yes, 2. no
1. Yes, 2. no
1. Man, 2. woman
19. . .
1. Yes (continue to q15), 2. no (continue to
q16)
Number of children–
1. Married, 2. divorced, 3. widow/widower,
4. single, 5. official registration of cohabitation
contract
1. No education completed, 2. primary school,
vglo, 3. lbo, huishoudschool, vbo, 4. mavo, ulo,
mulo, 5. havo, mms, 6. vwo, hbs, atheneum,
gymnasium, 7. kort mbo, 8. volledig mbo,
9. hbo, kandidaatsexamen, 10. university or
post-academic
1. Dutch, 2. Turkish, 3. Moroccan,
4. Surinamese, 5. Antillean, 6. other
(please specify)
1. Yes (continue to q20), 2. no (you have
completed the survey)
1. (Roman) Catholic, 2. Protestant, 3. Judaism,
4. Islam, 5. Humanism, 6. other Christian
church (please specify), 7. other non-Christian
church (please specify)