|Year : 2020 | Volume
| Issue : 3 | Page : 125-126
Acceptance of donor bodies and their embalming during COVID-19 period: A challenge to anatomists
Vishram Singh1, Rohini Pakhiddey2
1 Department of Anatomy, Adjunct Visiting Faculty, Kasturba Medical College, Mangalore, Manipal Academy of Higher Eduction, Manipal, Karnataka, India
2 ESIC Dental College and Hospital, New Delhi, India
|Date of Submission||05-Sep-2020|
|Date of Acceptance||07-Sep-2020|
|Date of Web Publication||30-Sep-2020|
Dr. Vishram Singh
Adjunct Visiting Faculty, Department of Anatomy, KMC Manglore, Manipal Academy of Higher Education, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh V, Pakhiddey R. Acceptance of donor bodies and their embalming during COVID-19 period: A challenge to anatomists. J Anat Soc India 2020;69:125-6
|How to cite this URL:|
Singh V, Pakhiddey R. Acceptance of donor bodies and their embalming during COVID-19 period: A challenge to anatomists. J Anat Soc India [serial online] 2020 [cited 2021 Jan 16];69:125-6. Available from: https://www.jasi.org.in/text.asp?2020/69/3/125/296909
The journey of a medical student begins with learning anatomy by cadaveric dissection. It not only helps to acquire knowledge about the anatomy of a human body but also helps in developing surgical skills and other clinical skills required as a physician. With the adoption of the Curriculum-Based Medical Education, there has been a change in the teaching methodologies in medical education. Many medical colleges are now using modern teaching aids such as E-learning, simulation, role play, case study, and virtual dissectors, but nothing can replace the traditional method of teaching by cadaveric dissection.
In the present scenario of COVID-19, when the Ministry of Health and Family Welfare, the Government of India, and the Board of Governors of Medical Council of India have issued guidelines to all the medical institutions to suspend classes for courses such as M. B. B. S., B. Sc., nursing, and other paramedical and allied health sciences, teaching is now being carried out by taking online lectures and practical demonstrations using video software such as Zoom, Google Classroom, Teams, and YouTube. Even in pre-COVID times, there has been a reduction in number of body donations in most parts of the world; hence, many institutions are adopting alternative models, especially for the teaching of gross anatomy. Hence, conducting anatomy dissection classes online has become very challenging for both teachers and students.
The COVID-19 pandemic has taken a toll on body donations for research in many parts of our country. Medical colleges/hospitals are not accepting donated bodies which have dealt a severe blow to the effort of raising awareness on body donations for scientific research.
Numerous guidelines have been produced by organizations and governments during the present novel coronavirus pandemic, which will be of great use to anatomists who facilitate donor programs.
The COVID-19 virus is mainly transmitted through large respiratory droplets by inhalation or contact with mucosal surfaces, but other modes of transmission have been suggested (airborne, fecal-oral, and contact with contaminated surfaces). There is no evidence so far that the virus is transmitted through contact with the skin of a deceased person, but as the virus is known to persist on surfaces for hours or days, depending on the nature of the surface, this mode of transition cannot be ruled out. The risk of transmission likely increases with direct contact with bodily fluids, and certainly increases with invasive handling of the cadaver, as in autopsy procedures, if it produces droplets or aerosols.
No evidence has been found so far of individuals who have become infected from exposure to the bodies of persons who have died from 2 COVID-19 (WHO 2020b). In general, the potential risk of transmission related to the handling of bodies of deceased persons with suspected or confirmed COVID-19 is considered low  (ECDC 2020a). While there is no evidence yet that the COVID-19 virus is specifically inactivated in a preserved body donor, the commonly used preservatives, formaldehyde and ethanol, appear to be efficient against the virus.
In general, the safety precautions applied in the basic handling of any human cadaver should cover the risk of a COVID-19 infection. As in any given case, any cadaver should be treated as potentially infectious. In the absence of a test for COVID-19, this also applies to the risk of a COVID-19 infection. All the staff who are responsible for the collection, transportation and preparation of bodies which are infected or suspected of being infected with COVID-19, must be trained specifically for their tasks. They should be well trained in donning and doffing of personal protective equipment (PPE). They should also be trained to use Infection Prevention and Control practices while handling the bodies. The staff should be trained in performing the last rites in a dignified way. The staff must be trained in, and apply, standard precautions for hand hygiene. The staff handling the bodies should take care of proper disinfection of instruments, washing them with detergent, and sterilizing in autoclave. All the instruments should be sterilised chemically with 70% alcohol, diguanide or 2% glutaraldehyde or 1 % hypochlorite. The area of the body receiving unit and of the embalming room and adjacent environment should also be disinfected using chemicals such as 70%–90% ethanol, hypochlorite based products (0.1%), and hydrogen peroxide (0.5%). Any tubes, drains, and catheters on the dead body must be removed with caution; any puncture holes or wounds on the dead body should be disinfected with 1% hypochlorite and dressed with impermeable material; oral and nasal orifices should be plugged. Extreme cautions should be undertaken while using sharp objects, IV catheters, etc., All medical waste should be handled by the following biomedical waste management rules. All surfaces of the isolation area should be wiped with 1% sodium hypochlorite solution giving a contact time of 30 min and then allowed to dry.
Embalming of bodies infected by the novel coronavirus is not recommended by the WHO, but this is in the context of advice for funeral homes. In the case of anatomy departments, embalming cannot be avoided, especially for cosmetic embalming and for transportation of bodies. The reason provided by the WHO  and the New South Wales Health authority for not recommending embalming is in order to minimize manipulation of the body and thus the possible generation of aerosol. The Department of Health of South Africa (2020) asserts that embalming of a body infected with the novel coronavirus does not pose a risk. However, forced inflation of the lungs, which may occur during fixation, may generate aerosol  (RCP, 2020b). Thus, any aerosol-generating procedures and splashes of contaminated fluids should be avoided during embalming. The use of PPE, as described above, applies during all embalming procedures.
Body donation is voluntary, and there is no compulsion. In this period of COVID-19 pandemic, we can deny acceptance of a donated body even if the body is COVID-19 negative, considering the risk of community transmission via the staff who are handling the body in hospital or the relatives accompanying the body, as there are chances of them being asymptomatic COVID-19 carriers.
Due to lack of clear cut guidelines regarding the acceptance or non-acceptance of a non COVID body, we may accept the donated body, provided the deceased is COVID negative, doesn't come from a containment zone, has no suspected history and is fulfilling other criteria for body donation.
Keeping in view of the risks associated with handling of dead bodies and the necessity of cadaveric dissection on donated bodies, every medical teaching institution should formulate the best practice guidelines for handling body donation and embalming procedures during the novel coronavirus pandemic.
| References|| |
Khan AN, Baig S, Zain S. Importance of cadaveric dissection in learning gross anatomy. Pak J Med Dent 2014;4:31-5.
Aruna V. Teaching learning methods in medical education-merits and demerits. Int J Res Rev 2019;6:215-21.
Government of India. Covid-19: Guidelines on Dead Body Management. 1st
ed.. New Delhi, India: Government of India, Ministry of Health and Family Welfare, Directorate General of Health Services (EMR Division); 2020.
Hindson, J. COVID-19: Faecal – Oral transmission? Nat Rev Gastroenterol Hepatol 2020;17:259.
World Health Organization (WHO). Infection Prevention and Control of Epidemic-and Pandemic Prone Acute Respiratory Infections in Health Care. Geneva: World Health Organization; 2014.
Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect 2020;104:246-51.
Finegan O, Fonseca S, Guyomarc'h P, Morcillo Mendez MD, Rodriguez Gonzalez J, Tidball-Binz M, et al
. International Committee of the Red Cross (ICRC): General Guidance for the management of the dead related to COVID-19. Forensic Sci Int 2020;2:129-37.
Shidham VB, Frisch NK, Layfield LJ. Severe acute respiratory syndrome coronavirus 2 (the cause of COVID 19) in different types of clinical specimens and implications for cytopathology specimen: An editorial review with recommendations. Cytojournal 2020;17:7.
World Health Organization (WHO). Infection Prevention and Control for the Safe Management of a Dead Body in the Context of COVID-19. -1. Interim Guidance. World Health Organization; 24 March, 2020.
Royal College of Pathologists. Briefing on COVID-19: Autopsy Practice Relating to Possible Cases of COVID-19 (2019-nCov, Novel Coronavirus from China 2019/2020); 2020a.