Guidelines for reporting original anatomical studies—Quality and ethics

In their recent article, Tomaszewski et al. suggest “Guidelines for reporting original anatomical studies” to facilitatemeta-analyses and systematic reviews (Tomaszewski et al., 2017). We applaud this effort to improve reporting of anatomical studies and to advance evidence-based anatomy. However, we suggest a revision of the section on ethics that concerns cadaveric specimens. The suggested final list of 29 items of an “Anatomical Quality Assurance Checklist,” produced via a Delphi Procedure involving 12 anonymous anatomical experts, does include an “Ethics” section under “Methodology” (item 16). This section asks authors of anatomical studies to “Provide the details of compliance with ethical guidelines” including details of review board approval. The checklist explicitly “endorses the Helsinki Declaration and its later amendments” and finally requests that “details of written, informed consent should be clearly stated. ” This section on ethics covers research on living research subjects, but as the Helsinki Declaration does not concern research on bodies of deceased persons, it remains unclear whether Tomaszewski et al. have considered the use of the latter in this ethics section, even if they explicitly include “cadaveric” as one of the possible study types under item 5 (study design and fundamentals). It also remains unclear whether item 8 (subjects) is meant to cover body donors or other tissue sources as well as living research subjects. In contrast to theHelsinki Declaration, the “Recommendations of good practice for the donation and study of human bodies and tissues for anatomical examination” issued by the IFAA (International Federation of Associations of Anatomists, 2012; Jones, 2016) do explicitly cover research on donated bodies and should be referred to as the only formal ethical standard available in this field and endorsed by the accepted organization of the international community of anatomists. Reference to these recommendations would cover questions of willed body donation based on informed consent of the deceased during their lifetime, following their free decision and documented inwriting. It has been shown that reporting of cadaveric studies indeed has its shortcomings, with the majority of papers lacking information about their sources of cadaveric material and their compliance with ethical guidelines (G€ urses et al., 2016; Winkelmann et al., 2016). It was therefore suggested that the following standard information be reported in all cadaveric studies: “What are the biological characteristics of the specimens (sex, age at death, preservation method)? /Was there written consent of donors during their lifetime? /Which institution provided the specimens? /Which was the legal/ethical basis for the availability of specimens (e.g., local laws or guidelines, approval by review boards)? ” (Winkelmann et al., 2016). We encourage incorporation of this standard information, together with a reference to the IFAA Recommendations, into the AQUA quality assurance checklist. We acknowledge that there are countries which have not yet been able to establish body donation programs, mainly for cultural or religious reasons (Gangata et al., 2010; Riederer, 2016). Anatomical research from such countries should therefore not be generally rejected, if it is legal by local standards. However, as the above suggested standard information implies, transparency should be achieved regarding these local standards and the exact source of bodies or tissues, be they from unclaimed bodies, bodies in pathology or forensic departments, tissues surgically removed from living patients, or other sources. However, we strongly recommend that research on executed prisoners be prohibited. Anatomists should not benefit from such a controversial legal practice (Hildebrandt, 2008), even if it may still be legal to do so in some places. In addition, the suggestion to acknowledge donors in the acknowledgment section of an article (Benninger, 2013) is also relevant. Such an acknowledgment does not necessarily improve the information standard needed for evidence-based anatomy, but it should be included in the suggested checklist, as it improves the ethical standard of anatomical papers. Finally, we suggest that an ethics domain be added to the “Anatomical Quality Assessment Tool” published by the same authors in the same issue of Clinical Anatomy (Henry et al., 2017), which does not cover ethical aspects at all. While it might be argued that ethical considerations do not contribute to the quality of anatomical research in the sense of enabling meta-analyses and pooling of data, we would strongly caution against the omission of any ethical considerations in the assessment of the “quality” of an anatomical study. It is fully