Science sits without a body – Newspaper Kommersant No. 51 (7496) of 03/25/2023

Russian private educational projects that organize cadaver courses for doctors (training in applied anatomy on bodies) have encountered a shortage of biomaterial. As Kommersant was told in several such companies, the main supplier of corpses for scientific tasks, the United States, stopped selling them to Russia. Due to sanctions, the price of cadaver has increased by 80–100%, and the cost of courses for doctors by 20–30%. The delivery is debugged as part of a parallel import. However, in the universities subordinate to the Ministry of Health, “Kommersant” was assured that they did not experience a shortage of cadaveric material, and there would be no need to introduce an import substitution system, since “we have everything of our own.”

The shortage in Russia of cadavers – corpses with which doctors manipulate for educational purposes, was confirmed to Kommersant by two private companies organizing such courses. The head of the educational project KinesioCourse, rehabilitation doctor Mikhail Kasatkin explains that over the past few years, medical universities, private medical companies, educational and information projects have been purchasing cadaveric material abroad due to the peculiarities of legislative regulation of this area in Russia.

As Mr. Kasatkin explained, Russians can bequeath their bodies to science, but only to a state institution of higher education.

“A person must notarize such a decision in the presence of a representative of this university. But how does the university know that he has died and that his body can be taken away? And besides, any donation program has bOgreater legal force than this application for donation,” continues Mikhail Kasatkin. As a result, universities, as a rule, receive “refuseniks” – bodies that end up in judicial morgues. Mr. Kasatkin points out that students can only work with such cadaveric material for a few hours over two or three days until the body is buried.

Thanks to the donation law and the absence of a ban on the export of bodies, the United States was the main supplier of cadavers to Russia. However, after the introduction of anti-Russian sanctions, American companies stopped working directly with Russian ones, says Oleg Kolesov, commercial director of the Moscadaver educational project. “It seemed to us that this was a purely political decision. All the medical companies that worked with us, not only on biomaterials, refused to renew contracts, leaving them not terminated, but frozen,” he says. The issue, according to him, was resolved through “the possibility of parallel imports.” Kommersant’s interlocutors refused to name market prices. Mr. Kolesov specified that the price of cadaver increased by 80-120% on average. At the same time, the cost of courses increased by 20–30% (the price of a cadaver course for gynecologists starts from 60 thousand rubles, for neurosurgeons – from 75 thousand rubles, for cosmetologists – from 100 thousand rubles). All this, emphasizes Oleg Kolesov, will affect the final consumers of medical services – patients.

Mikhail Kasatkin argues that Russian companies that are trying to establish supplies under parallel imports also face refusals, as colleagues in other countries do not want to spoil relations with American partners.

The KinesioCourse project team, he specified, stockpiled “fresh-frozen cadaveric material for a year and a half.” Most of these projects in Russia are moving, according to Mr. Kasatkin, to plastinates, a specially prepared cadaveric material that can be used repeatedly. The downside is that it is impossible to “open it, separate the tendons, see how the human body works from the inside.” Describing the scale of the need for cadaveric material, Mikhail Kasatkin says that, for example, for cosmetologists, on average, more than 300 heads are needed per year, for plastic surgeons – about 140 torsos.

The clinical study of cadaveric material, explains Mikhail Kasatkin, gives a more accurate understanding of manual techniques, invasive methods of influence, and physiotherapeutic methods.

“We are constantly learning something new about human anatomy,” he notes. “So, in 2023, it is a myth that a person has a quadriceps femoris muscle, or quadriceps. Because statistically on the cadaver material it is shown that we actually have five, and some even have six heads of this quadriceps. Roughly speaking, the anatomy that we still teach at universities is incorrect. And for osteopaths, rehabilitologists, physiotherapists, surgeons, neurologists, it is critically important to understand what and where a person has in order to avoid mistakes in treatment.”

“Some initiative groups” tried to contact responsible government agencies and wrote letters asking them to expand the possibilities of using Russian biomaterial, says Oleg Kolesov, but have not yet received a response: “I assume that, since this is a federal law, it is difficult to change it.”

Medical lawyer Irina Gritsenko notes that the regulatory framework in the field of transferring the body, organs and tissues of a deceased person to an organization for use in training students and doctors in Russia is “under development”.

Art. 68 law “On the Fundamentals of Protecting the Health of Citizens” regulates that the body, organs and tissues of a deceased person can be used for medical, scientific and educational purposes if there is a written declaration of will of the person made during his lifetime and notarized in the prescribed manner; and also if the body is not claimed after the death of a person due to the absence of his spouse, relatives, legal representatives or other persons who have assumed the obligation to carry out the burial. The conditions for the transfer of an unclaimed body, Mrs. Gritsenko continues, are compliance with the deadlines established by the law “On Burial and Funeral Business” (three days from the date of determining the cause of his death); the presence of a request from a medical or educational organization; the presence of permission for such transfer, issued by the body or person who ordered the forensic medical examination of the body. “As my colleagues, forensic experts, note, problems most often arise at the stage of issuing permission for the transfer of an unclaimed body by the police,” says Irina Gritsenko.

The procedure for transferring the body itself, she clarifies, is established in resolution Government dated July 21, 2012 No. 750. In paragraph 3 it is said that the unclaimed body, organs and tissues of a deceased person upon the occurrence of the circumstances provided for in paragraph 1 of Art. 12 federal law “On Burial and Funeral Business”, can be transferred for use in medical, scientific and educational purposes to educational, scientific, and medical organizations. Irina Gritsenko draws attention to the fact that this can only happen on a gratuitous basis. “The maximum period of use of an unclaimed body, organs and tissues of a deceased person cannot exceed ten years. The term for the use of the body, organs and tissues of the deceased on the basis of his will made during his lifetime, as well as the procedure and conditions for transferring them to medical or educational organizations, has not been established by the legislator, ”says the lawyer.

Svetlana Palevskaya, vice-rector of the Samara State Medical University of the Ministry of Health of Russia for vocational education and interregional cooperation, told Kommersant that the university has its own cadaver center, on the basis of which surgical residents are trained and additional vocational education programs for doctors are being implemented. “The sanctions did not affect this process in any way, since Russian cadaveric material is used for training within the framework of Russian legislation,” says Ms. Palevskaya.

The First Vice-Rector of the Kazan State Medical University of the Ministry of Health of Russia, Laysan Mukharyamova, also notes that the university “does not use and has not used foreign cadaveric material.”

The head of the anatomy department of the Volgograd State Medical University of the Ministry of Health of Russia, pathologist Svetlana Kalashnikova assures that “there is no shortage of biomaterial for educational and scientific purposes.” “A well-established procedure and regulatory platform exists and, what is especially important, has been adequately working since the times of the USSR. The medical personnel training system in our country has a number of advantages, including the possibility of teaching students in the “anatomical theater”. In this case, we are not afraid of sanctions, we won’t have to introduce an import substitution system, we have everything of our own,” says Ms. Kalashnikova.

At the Volgograd State Medical University of the Ministry of Health of Russia, classes for students are held directly at the bases of the pathoanatomical departments. “Doctors should not go to private clinics, but to the leading state universities of the Russian Federation, where both sectional courses and advanced training courses using simulation technologies are held as part of the FPE,” the press service of the university told Kommersant. They clarified that the material for classes in the framework of additional vocational education (FVE) programs is used both in Russia and supplied from abroad – and at the moment there are no difficulties with this, and its cost “if it has changed, then slightly.”

Natalya Kostarnova