Corpses are the most valuable part of Durongrit Sawangnet's job. Every day he tirelessly walks in and out of cold storage rooms looking after dozens of dead bodies awaiting dissection.
"We promise to take good care of these bodies, so we have to keep our word," said Durongrit, a staff member at the Soft Cadaver Surgical Training Centre, Chulalongkorn University, as he mopped brown liquid off the floor of the refrigerated repository. Durongrit's responsibility is to make sure everything goes well with the bodies, which have been donated for anatomical study — a medical educational tool known to students as Ajarn Yai, a respectful term literally meaning "the headmaster".
The term ‘cadaver condo’ is used among staff and students at Chulalongkorn University to describe the three-storey body storage unit.
"We also have to make the most of these cadavers because often we fall short," he added.
Durongrit can now breathe a little more easy after the recent news regarding the donation of the body of revered monk Luang Phor Khoon, who died last month, to Khon Kaen University's Faculty of Medicine. The late abbot of Wat Ban Rai in Nakhon Ratchasima province, Luang Phor Khoon's dying wish was to have his mortal remains used to benefit the living even after his departure from the world.
Dr Tanvaa Tansatit, director of the Chulalongkorn Soft Cadaver Surgical Training Centre, believes that Luang Phor Khoon leaving his body to science has had a significant impact on body and organ donations on a national scale.
"People's perspectives towards body donation, especially for the purpose of medical study, has changed tremendously because of Luang Phor Khoon," he said. "His last wish has gained a lot of attention from the public and media, so much so that medical schools are almost unable to handle the increasing number of body donors."
Before the passing of Luang Phor Khoon, according to Dr Tanvaa, the Surgical Training Centre received around 50 to 60 bodies a day. Those numbers have risen to more than a 100.
Students attend a ceremony to pay respect to cadavers before their course begins. Photos courtesy of the Faculty of Medicine, Chulalongkorn University
"We used to have a couple of staff to receive donations. Now we need five," he added.
Statistics from the Department of Anatomy, Chulalongkorn University Faculty of Medicine, reveal a constant rise in the number of donors who leave their bodies to science.
In 2004, there were approximately 4,600 registered body donors — a huge increase when compared to 86 donors 20 years ago. Last year, there were almost 20,000 registered donors — four times higher than a decade ago.
The Department of Anatomy has received, via the Thai Red Cross, bodies for the purpose of medical studies and research for more than 70 years. In 1997, the department applied a new cadaver preservation technique to make "soft cadavers", which is different from the body preservation method used in the past.
Cadaver dissection is a valuable learning method among medical students and lecturers alike.
In the old body preservation process, fluids are first removed from a dead body and are replaced with formaldehyde-based chemical solutions. After that, the body is soaked in saline solutions for at least a year before it is ready for dissection. However, some significant disadvantages of such a preservation method are joint stiffness and tissue rigidity.
But by applying the new technique, which involves the injection of a special type of non-formalin solutions through the arteries without the need to be soaked in saline liquid, the cadaver becomes more flexible and softer compared to the traditional formalin-based preservation approach.
"Cadavers preserved by using the traditional technique are generally used by medical students to gain fundamental knowledge about anatomy, like examining skin layers," explained Dr Tanvaa. "However, soft cadavers are designed for medical students to practice medical procedures and treatments with bodies as close to real humans as possible."
Last year, 281 cadavers were used at the Surgical Training Centre by Chulalongkorn medical students from various faculties, including the Faculty of Medicine, Faculty of Nursing, Faculty of Dentistry and Faculty of Allied Health Science.
Medical practitioners from public and private hospitals nationwide occasionally visit the centre and use cadavers for medical workshops and training.
The Faculty of Medicine at Chulalongkorn University is, however, not the only medical school that processes and turns donated bodies into cadavers. Other public universities such as Mahidol, Khon Kaen and Naresuan universities can handle the process, too.
Teerawit Eakpatcha, a graduate from the Naresuan University in Phitsanulok province, said he studied with cadavers when he was in his second year at the Faculty of Allied Health Sciences.
According to him, he wishes there was a central management system handling cadavers for medical schools countrywide instead of having each university work on their own.
"There should be a centre to take care of the preservation process, as well as the distribution of cadavers to medical schools nationwide," said Teerawit, 27, who now works as a radiation therapist at a public hospital in Bangkok.
"It is an act of sacrifice when people donate their bodies for medical education and therefore these bodies must be handled appropriately.
"Not every university is capable of making cadavers as some medical schools are better equipped than others. A central organisation or association to process and distribute donated bodies to medical schools around the country is desperately needed. This is to prevent the use of cadavers for commercial purposes."
Thawatchai Kaewrakmuk also dissected cadavers when he was a sophomore at the Faculty of Physical Therapy, Huachiew Chalermprakiet University. According to the new graduate, his faculty is the university's only medical school that dissects cadavers. Other health schools such as the Faculty of Pharmacy and Faculty of Nursing study with cadavers but do not dissect them.
"Without cadavers, my understanding of the subject would reduce by half," commented the 23-year-old. "Of course certain knowledge is available from books but it is not like we see the real thing. Knowledge gained from lectures and clinical trials are completely different in terms of depth and comprehensiveness.
"From books, it is only possible to learn theories. But from cadavers, you learn what you can expect to experience when you treat real patients."
"Buddhist philosophy believes that our soul leaves the body when we die. And therefore, what we become in the next life has nothing to do with how your body is treated in this life," Dr Tanvaa noted.
"In this world, in the end everything degenerates. Our bodies do, too. But if you donate your body for medical education, it can still yield positive benefits for years after you die.
"Through your donation, you save people's lives," Dr Tanvaa added. "Medical students learn from dead bodies. And when they become doctors, they know how to treat living people.
"They know how to save patients who are in critical condition or who are likely to become disabled. All this can happen because of your act of kindness."
Five things worth knowing about body donation for anatomy education
1. Bodies that cannot make cadavers are bodies that do not undergo a cadaver preservation process 24 hours after donors pass away (except those kept in a hospital’s mortuary storage), bodies that have undergone extensive operation which subsequently leads to organ loss, bodies suffering cancer that spreads to internal organs and brains, bodies infected with HIV/Aids or hepatitis B and bodies of donors who died from accidents or need biopsy.
2. The Department of Anatomy, Faculty of Medicine, Chulalongkorn University states that body donors must be above 17 years old. It is paramount that relatives of the donor be notified of the donation.
3. Chulalongkorn University Hospital can arrange for transportation to pick up donated bodies in Bangkok and nearby provinces including Samut Prakan, Nonthaburi, Pathum Thani, Samut Sakhon and several districts in Nakhon Pathom. Outside of these provinces, relatives have to bring the bodies to the hospital.
4. Cadavers will be treated with respect by medical staff, lecturers and students. At the Department of Anatomy, there is a ceremony to pay respect to cadavers before dissection starts. Cadavers which are entirely dissected (which usually takes two years) are entitled to royallybestowed cremation.
5. For the case of Chulalongkorn University, a small piece of body flesh is collected from each cadaver and they are put into one coffin for the royally-bestowed cremation. The royally-sponsored cremation will be held at Wat That Thong. The remains (all organs and skeletons) of each cadaver are put into separate coffins and cremated in 21 temples in Bangkok.
