RESEARCH ON BODY DONATION WILLINGNESS IN CORDOBA- ARGENTINA: MEDICAL AND DENTIST DOCTORS’ ATTITUDE

Medicine and Dentistry are the only careers performing human body dissection and teaching-learning of Anatomy with cadaveric material in our university. Physicians and dentists’ knowledge and opinion on the topic are particularly important because they could be considered as potential procurators due to their contact and influence on patient’s decisions. We surveyed 528 professionals (429 physicians and 99 dentists) collecting some demographic data and questions about organ and whole body donation. Results showed that 94% should donate organs for transplantation, 66% knew about body donation, 66% was interested in further information and 48% should be willing to donate the own body for teaching and research. Main reasons to donate were to support teaching and research, contribute to the science and to be useful. In conclusion, we found that professionals had a very positive attitude in relation to body donation, independently of gender, age, religion, regional origin or specialities, but with significant differences between physicians and dentists. Compared with students, they had better attitude which could be related to a better information and experience. In comparison with the few published articles we found, our results were similar to Ireland and very different to India, improving our expectances about the success of developing a donation program. Organ and body donation are always an act of altruism and social solidarity.


INTRODUCTION
In 2018 we initiated a research project to determine the attitude of different groups in relation to body donation, with the aim in the development of a donation program for the National University of Cordoba. Medicine and Dentistry are the only careers performing human body dissection and teachinglearning of Anatomy with cadaveric material in the National University of Cordoba. Then, we considered important to include a group of medical and dentist doctors to be surveyed about their opinion on the importance of this material for their professional training and their attitude about the donation of their own body for university teaching and research. Their professional knowledge and opinion on the topic are particularly important because they could be considered as potential procurators due to their contact and influence on patient's decisions. The objective of the present article was to request information about the importance assigned by medical and dentist doctors to the corpses for teaching-learning and research in Anatomy and their will to donate organs and the own body.

MATERIAL AND METHOD
Five hundred and twenty eight professionals among medical doctors and dentists, with regular activity in the city of Cordoba were surveyed. The main inclusion condition was living in Cordoba city or, at least, developing regular activity in the city. The importance of this close relation with the city was to be included in the distance from the university determined by a donation program. There were not exclusion conditions related to the university, place or time of graduation, or the area of their working activity, except professors of Anatomy or professionals working in any Chair of Anatomy who were not included. Professionals were surveyed mainly, but not exclusively, at public and private working institutions. The questionnaire was about age, gender, nationality and province of origin, religion, profession, speciality, surgical practice, importance assigned to corpses for teaching-learning of Anatomy, willingness to donate his/her organs for transplantation, knowledge about whole body donation, interest in learning about body donation, willingness to donate the own body and reasons for that. Results were reported in percentages and differences were considered significant if p<0.05.
Chi square test was used for the analysis of the results to evaluate the association of qualitative variables. The statistical software used was INFOSTAT. This study was carried on with the approval and support of the Science and Technology Secretary of the National University of Cordoba (SECYT-UNC).

RESULTS
Of the total 528 professionals 48.30% (255) were women and 51.70% (273) men. The mean age was 41.56±11.36, with the lower in 23 and the higher in 81. We considered 4 age groups: a) 23 to 34 years: 173 (32.77%) professionals, b) 35 to 49 years: 213 (40.34%) professionals, c) 50 to 64 years: 129 (24.43%), d) over 65 years: 12 (2.27%). Five hundred and sixteen of the respondents were argentine (97.73%) while the foreigner professionals were from Bolivia (3), Chile (1), Colombia (1), Mexico (1), Paraguay (1), Peru (2), United States (1) and United Kingdom (1). One did not answer. Argentina professionals were 70.35% (363) from Cordoba. Even if the remaining 29.65% included professionals coming from all the provinces, the higher percentages were from San Juan (4.07%), Salta (3.68%), Jujuy (2.71%), Santa Fe (2.52%) and La Pampa (2.13%). About the religion, most were Catholics (361 -68.37%), followed by those who did not profess any religion (136 -25.71%), non-Catholic Christians (16 -3.03%), Jewish (7 -1.33%) and others (8 -1.52%). There were not Muslims among the surveyed professionals. Four hundred and twenty nine (81.25%) were physicians and ninety nine (18.75%) dentists. Among medical doctors we surveyed professionals on 60 different specialities, while among dentists we identified 12 specialities. To facilitate the understanding and analysis, we considered: a) clinical specialities, b) surgical specialities, c) clinic-surgical specialities, d) other specialities and e) none speciality. (Table 1 summarizes the specialities of surveyed professionals into the different groups). Clinicians were 209 (39.58%), surgeons were 130 (24.62%), professionals with specialities involving both (clinics and surgery) were 91 (17.23%), other specialists were 47 (8.90%) and professionals without speciality were 51 (9.66%). Independently of the speciality, 272 (51.52%) referred to have surgical practice.  p=0.4637) or between those who had or had not surgical practice (p=0.5764) in their attitude towards donation. Religions did not mean a difference (p=0.0555) however people who did not profess any religion were more willing to donate (59.56%) than others. Twenty five per cent (8) of the people who considered corpses -less important‖ for Anatomy teaching were interested in donation of their own body. Only 4 persons were willing to donate the whole body but not organs for transplantation. There was a significant difference (p=˂0.0001) in the interest to donate between people who wanted or did not want to get further information. Among people who wanted to donate 87.45% (223) wished to be more informed, but among those who were not willing to donate 46.07% (123) should like to get information. Main reasons to donate were to support teaching and research 118 (46.27%), to contribute to the science 16 (6.27%), to be useful 15 (5.88%) and 47 (18.43%) did not answer (Table 2 summarizes all reasons to donate). Among a long list of not well founded motives, the main causes not to donate were the family 30 (11.28%), lack of information 27 (10.15%), cremation choice 20 (7.52%), religion 14 (5.26%) and 44 (16.54%) who did not respond (Table 3 summarizes  Comparing physicians and dentists, we found medical doctors were significantly older (p=˂0.0001) instead age average was only 1.10 years higher. There was also significant difference in: A) religion professing (p=0.0086) as physicians had a higher percentage of nonprofessing (28.67% / 13.13%) and dentists had a higher rate of Catholics (77.78% / 66.20%); B) speciality groups (p=˂0.0001) as physicians had a bigger group of -other specialities‖ (10.49% / 2.02%) and dentists were more in the group of -none speciality‖ (22.22% / 6.76%); C) surgical practice (p=˂0.0001) as the answer was positive for 78.79% of dentists and 45.22% of physicians; D) willingness to donate organs for transplantation (p=0.0045) was higher in medical doctors (94.64%) than dentists (88.89%); E) knowledge about the possibility to donate the own body (p=0.0419) was higher in physicians (68.30%) than in dentists (57.58%); F) the will to donate the own body (p=0.0298) as medical doctors were more willing (50.35%) than dentists (39.39%). There were no statistical differences by gender (p=0.2471), in the geographical origin of the surveyed professionals (p=0.2048), in the importance assigned to corpses for teachinglearning of Anatomy (p=0.2746) and the interest in getting more information (p=0.2557). www.anatclinar.com.ar

DISCUSSION
Instead at the end of the 20th century anatomy dissection was considered as -old fashioned‖ and in some cases excluded from the medical curricula in the belief that new technologies could replace it (Dyer and Thorndike, 2000), importance of corpses and dissection was restored by demonstrating that it was irreplaceable for graduate and postgraduate student's training (Biasutto et al., 2006;Azer and Eizenberg, 2007;Cahill and Ettarh, 2008;Sugand et al., 2010;Dereje, 2014;Narvaez-Hernandez and Murillo-Rabago, 2014;Arráez-Aybar et al., 2014).
Cadaver donation provides 100% of the total corpses used for university teaching in Anatomy in Australia, Austria, Canada, Chile, Czech Republic, Denmark, France, German, Ireland, Japan, Malta, Netherlands, New Zealand, Poland, South Korea, Spain, Sri Lanka, Sweden, Switzerland, Thailand and United Kingdom, and most of the bodies in China, Portugal, South Africa, Taiwan, United States and Uruguay among the participating countries in the study of Habicht et al. (2018).
Most of the articles based on body donation surveyed the attitude of students under different circumstances (Cahill and Ettarh, 2008;Asl et al., 2010;Anyanwu et al., 2014;Saha et al., 2015;Quiroga-Garza et al., 2017;Biasutto et al., 2018;Ciliberti et al., 2018;Biasutto et al.,2019a,b). However, we consider of transcendental importance to know the attitude of professionals whose training and practice include Anatomy playing an important role, and because they could be naturally potential procurators in a donation program. According to Arraez-Aybar et al. (2010) there is evidence to suggest that gross anatomy is considered by medical graduates to be the most relevant basic science discipline for surgical specialties. In our study, it was nearly unanimous that professionals of different specialities and half of them without surgical practice confirmed corpses as corner stone for teaching-learning of Anatomy.
Our study has demonstrated certain differences between medical doctors and dentists in relation to their will to donate as well organs for transplantation as whole body for Anatomy teaching and research. However, we could not find elements to explain it in the collected data; even when religion seemed to established a difference, it did not influenced the willingness to donate (p=0.1513). Probably it was associated to the proportion of professionals in the study or differences in the access to information on this topic. In the literature, most of the studies involving professionals were done surveying Anatomy teachers who were specifically excluded in our study (Arraez-Aybar et al., 2010;Anyanwu and Obikili, 2012;Emue et al., 2012;Quiroga-Garza et al., 2017). We found few references in the literature about studies on medical doctors. Saha et al. (2015) reported a group of 100 physicians, between 35 and 45 years old, 50% male and female and significant differences with our study in the willingness to be organ donors for transplantation (86% -p=0.0023) and/or whole body donors (26% -p=˂0.0001 In conclusion, we found that professionals had a very positive attitude in relation to body donation, independently of gender, age, religion, regional origin or specialities, but with significant differences between physicians and dentists. Compared with students, they had better attitude which could be related to a better information and experience. In comparison with the few published articles we found, our results were similar to Ireland and very different to India, improving our expectances about the success of developing a donation program. Organ and body donation are always an act of altruism and social solidarity.

Funding
This study was supported by the Incentive Program 2018-19 of the SECYT-UNC 33820180100313CB01.

Informed Consent
Survey participants were informed about the scope of the project and, in every case, answer it was strictly voluntary.

Contributions
SNB: Project design, group director, references, spreparation and coordination of the surveys, data registration, statistical analysis and manuscript redaction. OPD: Project design, project vice-director, references, preparation of