National / Science & Health

Body donations surge amid changing views of death in Japan

by Reito Kaneko

Kyodo

In what experts say is a shift in attitudes toward death in rapidly graying Japan, donations of bodies for anatomical training have increased dramatically in recent years.

Some 296,000 people had offered to donate their bodies to universities as of March 31 last year, compared with about 68,000 in 1985, and the figure has been climbing by 8,000 annually in recent years, according to Tokushi Kaibo Zenkoku Rengokai, an association set up in 1985 to encourage the practice, known as kentai in Japanese.

Availability is so high that some universities have stopped accepting donations.

Junko Hirota, 55, an acupuncture and moxibustion therapist, registered her body a few years ago. Her decision dates to when she observed the dissection of a body at Tokyo Medical and Dental University in her 30s as part of her acupuncture training.

Experiencing firsthand how much could be learned about the human body from dissections got her thinking later in life about how her own body could become “a textbook” for others.

“Receiving my body donor registration card gave me a feeling of relief,” she said. “I feel that when I die, my body will be like an exoskeleton shed by a cicada. I’d be honored just to be in people’s memories.”

Hirota, who lives alone, described the decision as part of her “preparations for death” — an issue gaining attention amid the nation’s falling birthrate and graying population, which has seen more seniors living on their own, especially in rural areas.

The trend has even given rise to a newly minted term for preparing for death — shuukatsu, a homonym for the widely used term for job-hunting.

Decades ago, the cadavers used for dissection were mainly from people who had died without relatives or unidentified bodies. University officials in charge of obtaining bodies for dissection would make the rounds at nursing homes or care facilities.

One of the reasons why few people stepped forward to donate or why few families gave consent, as required by law, was a taboo influenced by Japan’s Buddhist heritage against damaging bodies after death.

But attitudes toward death are changing, according to George Matsumura, a professor of anatomy at Kyorin University and an executive director at the kentai association. One reason driving this may be the plethora of natural disasters in Japan, he said.

Witnessing the death of family or friends in the 2011 Great East Japan Earthquake and tsunami, for example, “made people more conscious of wanting to decide how they end their own lives,” Matsumura said.

Signing up to donate a body is relatively simple: You register with a university and receive a body donation card to complete the process.

After death, family members or those close to the deceased must contact the chosen university, which will come to claim the body. The body is then embalmed and placed in cold storage for about three weeks. Normally, dissection classes, performed only by licensed doctors, take from three to seven months.

After use, the body is cremated. But depending on the university, it can take as long as three years to return the ashes to the family due to the large number of bodies on hand.

If no family members retrieve the remains, they can be kept in a repository at the university if the registrant stated that desire.

In explaining the idea behind the kentai program, Tatsuo Sakai, a professor of anatomy at Juntendo University and an executive of the association, stressed the importance of taking a hands-on approach to teaching anatomy.

“Students learn what they can’t from textbooks. It is usually their first encounter with a dead body, which makes an impact after they graduate, become doctors and attend to patients” Sakai said.

Nevertheless, interest in body donations is beginning to outstrip demand.

According to the aforementioned Tokushi Kaibo association, the advisory council for promoting body donations, about 15 universities including Hokkaido University and Kumamoto University have stopped accepting offers due to lack of capacity.

Even if they continue, many universities will only accept those 60 or older or residents who live in their neighborhoods, effectively shutting the door to many donors.

Around 4,000 bodies are dissected annually at 98 universities, according to Sakai.

The Health, Labor and Welfare Ministry’s 2018 budget included a fund that allows universities to use bodies not only for education, but also for training, which lets surgeons hone their skills for especially difficult procedures, such as those involving endoscopy.

“(Surgical training) could lead to a much greater demand for body donations,” said Matsumura.

There has even been a debate to broaden the scope of those allowed to perform dissections, including physical therapists, but it will require a change in the law in which only doctors perform dissections in schools.

Another kentai registrant, Katsuhiko Takemura, 77, became a donor a couple of years ago but started to think seriously about death while he was hospitalized due to pneumonia for over two months when he was about 60. While hospitalized, he remembered one of his closest friends’ death.

Takemura’s perception of death started to form in his 40s while working as a director and staff reporter for a television company.

He had met legendary explorer Naomi Uemura, who became the first person to climb Alaska’s Denali (then known as Mount McKinley) in a winter solo ascent in February 1984 but never returned to base camp.

Takemura had gone to the Antarctic with Uemura before the Denali ascent to film a documentary of Uemura’s long-held dream of a solo dog-sled run across Antarctica and stayed with him for a year.

“He had a great impact on the society at the time, but after death he became nothing. I started to think how I want to treat my body after death then,” said Takemura, who has gotten consent to donate from his wife.

The death of Akiyuki Nosaka in 2015, a novelist best known for his award-winning book, “Grave of the Fireflies,” and who was also a friend, influenced Takemura’s decision.

“I was shocked when I saw his bones after cremation. This very talkative person was nothing but bones. It made me feel that I want to contribute something, even after death. I decided to help medical students or surgical doctors by answering their questions with my body” he said.

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