Contemporary ethical standards and the presence of exhibitors at anatomy conferences

Abstract

Requests over many years from a “for profit” international company to exhibit plastinated human tissues at conferences of the International Federation of Associations of Anatomists (IFAA) have raised concerns amongst the anatomy community. These concerns have centered on the profession associating with companies whose ethical standards do not reflect those held or expected by the IFAA.1 As the IFAA recommends the use of appropriately consented human bodies, the non-commercial use of human tissues, and the practice of dignity and respect toward human bodies used in anatomy education and research, requests of this nature have previously not been approved by the IFAA. A recent decision by the IFAA Executive Committee, supported by input from the IFAA Federative International Committee for Ethics and Medical Humanities (FICEM), to deny this type of exhibition at future IFAA conferences represents a significant action that highlights the importance of ethical standards in anatomy. It also provides a benchmark for ethically-guided decisions around conference exhibitors that signifies the recognition of contemporary ethical standards and their application to future conference organization. In recent decades there has been an expansion of companies that trade in human tissues, which includes whole bodies, body parts, prosected tissues, and plastinated specimens. This industry may provide access to anatomical resources where body donation, access to body donors, and availability of human tissues is problematic.2 However, it is incumbent upon these companies to adhere to contemporary ethical practices, such as those developed and supported by the global community of anatomists as represented by the IFAA.1, 3 This means that companies are required to meet ethical standards should they wish to present their products at meetings of this association. In practice, the requirement of informed consent has consequences for the companies dealing with plastinated human tissues as well as for the users of such tissues. This translates to companies ensuring and documenting the provision of detailed and appropriate informed consent from potential donors, including transparency around considerations such as intended use, destination, and disposition of the donors' tissues. In addition, anatomists and other users or purchasers of these products should request and be provided detailed information on the informed consent process for donors, including consent for international transfer and disposition of these human remains. The information should be clear, explicit, and readily available. These are important issues that reflect appropriate ethical treatment of donors and which also includes ensuring legal requirements are met in countries where institutions may purchase such resources. Most countries will have legislation that addresses issues such as import and export of human tissue, or even whether sale or purchase is permissible, and thus anatomists are obliged to understand what operating “lawfully” involves in their locality. Anatomists who are purchasers or end users should also reflect on whether the information provided on consent and company processes provided meets contemporary ethical standards, and acquire appropriate input and guidance from anatomical organizations if they are unsure. This will likely entail discussion around whether the information available is adequate to make an informed decision, and on the trustworthiness of the documentation provided. In determining whether companies should be allowed to exhibit at conferences or events, organizers should, at a minimum, be cognizant of the following when making decisions around the presence of exhibitors. This includes (a) public information that is available,4, 5 (b) current discussions on this topic, including the history and current practices of the company,6-8 and (c) the existence of guidelines that may inform decision-making1, 3 to ensure decision-making is appropriate for the case or circumstances. In some instances, companies may have a history of unethical and unlawful practice that accompanies product development and distribution,9-11 and this should be taken into account9 with such companies subjected to a heightened level of scrutiny. Furthermore, the international transport and sale of human tissues, both around conferences but also for purposes such as use in anatomy education, also raises several concerns.6 These include whether donors specifically consented for their bodies or body parts to be distributed internationally. For example, there is a paucity of literature detailing whether donors or their families would agree to tissues being distributed globally and thus it remains broadly unknown whether the practice should be supported. There is also a necessity to appropriately differentiate “for profit” companies from legitimate academic donor programs. The sale of human tissues is not viewed as ethically acceptable practice in the anatomy profession,3 and as such the conference participation of entities whose business model involves the commercialization of human tissue should be carefully considered. When reflecting on this issue, it should be noted there are difficulties in identifying precisely what commercialization entails as no concise definition exists to guide decision-makers around this topic. Legitimate body donor programs already undertake transfer to institutions and countries where local supply is limited,8 and some likely receive compensation for costs incurred. This is by definition a commercial activity, however this process is very different to “for profit” companies that are trading exclusively in human tissues as their sole business.12 Determining whether commercial transactions involving human tissues are more or less ethical illuminates the difficulties surrounding decision-making in such instances. Broadly, where the requirement for human tissues exist, anatomists are preferentially encouraged to engage with institutions that are not solely commercially-driven entities in order to maintain ethical standards within the global anatomy community. This should include consideration around conference organization. Within the anatomy community, anatomists should reflect on whether engagement and association with “for profit” companies trading in human tissues represents the “ethical future” of the profession. Anatomists should also take steps to ensure that alternatives to these companies are developed and promoted, and that support is made available to assist and encourage companies to transform and align with the ethical values of the profession. Appropriate community-centered decision-making, that includes the views of the global community of anatomists, should generate outcomes that include a balance of legal considerations, contemporary ethical standards, and appropriate social license.13, 14 This is particularly true for decisions which have the potential to cause controversy. In this instance the purchase and transfer of human tissues is a sensitive topic, and anatomy associations are encouraged to participate in open and transparent dialog with their members to acquire perspectives and support for the position they adopt. This may include obtaining perspectives from experts on ethical standards and issues to provide information that is relevant to contemporary ethics in anatomy, in order to ensure communities are aware of potential issues. While the operations of international companies who trade in human tissues may not necessarily contravene any specific laws and are thus “legal,” this does not necessarily mean such operations are ethical or should be immune from ethical scrutiny. It is essential for all anatomists and anatomy associations to ensure that persons operating within the profession are held to account around ethical standards and practice, including those who participate at anatomy conferences and events. Only in doing so can the anatomy profession ensure that ethical standards are promoted, developed, and maintained. The recent recommendation by the Executive Committee of the IFAA to deny an international company the opportunity to exhibit at the 2024 IFAA conference in Korea is one of which anatomists and member associations should be made aware. It is hoped this will lead to ethical standards around the attendance of exhibitors being considered and enacted when conferences and other educational events are organized. Jon Cornwall: Writing – original draft; writing – review and editing; conceptualization. Sabine Hildebrandt: Writing – original draft; writing – review and editing; conceptualization. Brendon Billings: Writing – original draft; writing – review and editing; conceptualization. Beverley Kramer: Conceptualization; writing – original draft; writing – review and editing. Jon Cornwall, Ph.D., is currently Education Adviser in the Centre for Early Learning in Medicine at the Otago Medical School, University of Otago, Dunedin, New Zealand. He is interested in body donation and the use of human tissue in education, research, and health care, and is one of three academics guiding the “Bioethics Unicorns” initiative that seeks to promote ethics and professionalism education in anatomy. He is a member of the Federative International Committee for Ethics in the Medical Humanities (FICEM) for the International Federation of Associations of Anatomists (IFAA). Sabine Hildebrandt, M.D., is an associate professor of pediatrics in the Division of General Pediatrics, Department of Pediatrics at Boston Children's Hospital and a lecturer on global health and social medicine at Harvard Medical School in Boston, Massachusetts. She teaches anatomy, and her research interests are the history and ethics of anatomy, with a focus on the history of anatomy in National Socialist Germany. Sabine is one of three academics guiding the “Bioethics Unicorns” initiative that seeks to promote ethics and professionalism in anatomy. Brendon Billings, B.Sc., B.Sc. (Hons), M.Sc., Ph.D., is a senior lecturer and the curator of collections in the School of Anatomical Sciences at the University of the Witwatersrand, Johannesburg, South Africa. While lecturing in morphological anatomy and biological anthropology, his research specialty is comparative neuroscience. Beverley Kramer, B.Sc., B.Sc. (Hons), Ph.D., is an emeritus professor in the School of Anatomical Sciences, Faculty of Health Sciences at the University of the Witwatersrand, Johannesburg, South Africa. She is currently President of the International Federation of Associations of Anatomists (IFAA). Her research interests include developmental biology and growth, as well as anatomical education.