A deep understanding of human anatomy is essential for medical professionals and serves as a critical milestone in both pre-graduate and post-graduate programs, including during the study and training phases and for medical research purposes (1). One effective way to learn and practice is through donated human body dissection, which remains an excellent method to achieve a high-fidelity and realistic three-dimensional comprehension of human anatomy (2, 3). Recent studies have also highlighted the importance of improving legal and ethical frameworks surrounding body donation, as these regulations vary significantly across European countries, impacting the availability of donated bodies for medical education and research (4).

Nonetheless, in Italy, a shortage of donated bodies has been observed compared to the growing number of medical students (5–7). To facilitate anatomy studies and address the challenges of limited donated body availability, various types of artificial models or other technological aids have been explored as substitutes in recent years. Many universities are currently using synthetic models for their students due to their ease of management and availability. Artificial models can, therefore, be useful in supplementing anatomical studies on donated human bodies, especially at the undergraduate level, where topics are approached with less complexity (8). Each synthetic model can usually provide a specific type of simulating procedure; for instance, there are models designed for basic life support, as well as others tailored to various anatomical systems such as the cardiovascular, musculoskeletal, and nervous systems. These models offer valuable hands-on experiences, aiding students in developing a comprehensive understanding of different aspects of human anatomy. However, despite the continuous technological advancements in synthetic models, traditional human body dissection remains unmatched in terms of educational effectiveness (9). Indeed, while the use of artificial models can still be effective and beneficial, especially in undergraduate courses where exercises are generally less complex, the use of donated human body dissection often becomes inevitable for postgraduate training (10). In undergraduate settings, anatomy based on donated human bodies allows students to develop not only a solid understanding of human structure but also essential professional and ethical values, such as respect for the human body, empathy, and awareness of death as part of clinical reality. These humanistic aspects are a fundamental part of the educational impact of body donation, which goes far beyond the purely technical learning dimension. While institutional models may vary, this integrated approach aligns with a growing recognition of the ethical and pedagogical relevance of human dissection in shaping responsible future physicians.

Nevertheless, once the different possible applications of various options are established, there is no doubt that the study, training, and research using donated-to-science human bodies remain the gold standard in all medical fields (11).

A potential alternative solution to address the shortage of donated human bodies to science at certain anatomical centers could involve adopting external donation programs, where donated human bodies or specific anatomical parts are sourced from foreign countries (e.g., the United States) (12). In this context, another relevant aspect to consider is the ecological sustainability of the dissection process and how it might be made more environmentally responsible. Given the growing concerns surrounding global climate change, there is increasing awareness of the environmental consequences of human activities. This has led to a broader recognition of the need to reflect on the ecological impact of various choices, including the materials we use and the decisions we make (13). As sustainability becomes an increasingly important consideration, it seems worthwhile to explore how the dissection of donated human bodies could be approached in a more environmentally friendly manner.

One area that warrants further exploration is the environmental impact associated with the life cycle of donated human bodies, including transportation, preservation, and the dissection itself. These factors can contribute to the overall carbon footprint of anatomical education. While the scientific value of body donation is clear, it would be useful to investigate whether there are opportunities to reduce its ecological footprint.

Moreover, these considerations align with the broader discourse surrounding the environmental footprint of medical education and could help foster a more inclusive discussion about the future of anatomical studies. Such a dialogue might encourage the development of practices that integrate sustainability without compromising the quality of education. Drawing inspiration from the well-known Latin expression, “Hic mors gaudet succurrere vitae,” an updated version that reflects contemporary concerns may be proposed: “Hic mors gaudet succurrere vitae et planetae.” This revised phrase could symbolize not only the intersection of the human life cycle and education but also the potential importance of environmental responsibility in contemporary anatomical practices, an aspect that will be investigated in this study.

This study aimed to evaluate the carbon dioxide equivalent (CO₂e) emissions linked to the use of donated human bodies from a local Italian donation program, compared to a hypothetical scenario where the same bodies would be obtained through an international donation program.

All bodies included in the analysis, sourced from the local program, were donated to the Centre for Clinical and Surgical Experimental and Molecular Anatomy, Department of Biomedical and Neuromotor Sciences, University of Bologna, one of the Italian reference center for the conservation and use of bodies donated post-mortem for study, training, and scientific research purposes. The United States body donation program was used for comparison. The reference to the United States was chosen due to its frequent use as an external source of human anatomical bodies/parts in countries facing donor shortages, such as Italy. The international transport scenario described in this study was constructed as a hypothetical model, relying on general estimations of distances and associated emission.

A total of 32 donated bodies were included in the study.

In the transportation phase to the Anatomical Centre in Bologna, all donated bodies were ground-transported using refrigerated trucks over an average of 201.19 ± 172.78 km, resulting in a mean CO2 production of 7 ± 6.01 kg (kgCO₂e). The same values were considered for the return journey to their geographical origin, leading to a total average CO2 production of 14 ± 11.84 kgCO2e per body for transportation (Figure 1).

The carbon footprint of the embalming process resulted in total emissions of 22.73 ± 20.36 kgCO₂e per body. This value is derived from the sum of individual contributions: 0.199 kgCO₂e from formaldehyde (1.83%), 2.98 kgCO₂e from phenol (27.8%), 2.59 kgCO₂e from ethanol (33%), and 4.16 kgCO₂e from glycerol (33%). Additionally, the incineration of unused embalming fluid, modeled as hazardous waste with energy recovery, was included in this estimate.

Refrigeration days at −20°C averaged 112.03 ± 139.62 in 1 year, while at + 4°C, the mean was 132.91 ± 120.61. The energy consumption of refrigeration chambers contributed minimally to the total footprint. Based on measured electricity use per day per body (11.232 kWh for −20°C and 12.6 kWh for +4°C), and applying the Italian electricity emission factor (0.39896 kgCO₂e/kWh), the mean carbon footprint for refrigeration over 100 days was estimated at 0.016 ± 0.004 kgCO2e kgCO₂e per body per year.

Considering these factors, the cumulative carbon footprint for a single donated body was calculated at 36.74 ± 22.03 kgCO2e (Figure 2).

In addition, other factors related to educational activities contributed to the overall carbon footprint, including consumables, wastewater treatment, and aeration. The consumables related to a single donated body produced an estimated 64.97 kgCO2e. This estimate assumed the production and final disposal (incineration as hazardous waste) of a mix of plastic materials. Specifically, wastewater treatment produced an estimated 0.023 kgCO2e per body, based on a standard wastewater treatment process. The operation of the HVAC and aeration systems represented the single largest source of emissions. The total annual electricity consumption of 709,632 kWh (including inverter and refrigeration units) translated into 283,112 kgCO₂e per year using the Italian energy mix. When divided by the number of bodies handled annually, the estimated footprint was 8,847.25 kgCO₂e per body (Figure 2).

Taking all these factors into account, the total estimated carbon footprint for a single human body’s activity over 1 year amounted to 8948.99 kgCO₂e.

This footprint was hypothetically compared to an estimate for an identical number of donated bodies, assuming they were sourced from the United States human body donation program. The international transportation from Chicago to Bologna, by aircraft over 7,500 km and refrigerated lorry for 500 km in the US, results in approximately 6.005 kgCO₂e per kg of human body transported. The analysis modeled the international shipment of a human body as air cargo, applying standard emission factors from the Ecoinvent 3.8 database, consistent with the Life Cycle Assessment methodology. These factors allocate emissions per transported kilogram of cargo, without including passenger-related overhead. Given an average human body weight of 75 kg, this translates to approximately 450.375 kgCO₂e for transportation alone for a single human body. International transport from the US produced approximately 450.375 kgCO₂e per body, representing a 3114.3% increase compared to the local program (Figure 1).

Moreover, donated bodies transported from the US are often used as specific body parts rather than whole bodies, potentially further increasing energy consumption and CO2 output. These segments are transported to different locations based on the specific needs of the courses, thereby theoretically increasing the cumulative carbon footprint.

Within the field of medicine, a profound understanding of human anatomy remains not only imperative in pre-lauream education but also across every specialization (14). From ancient times, the exploration of the human body and its physiology has involved the practice of human body dissection. Despite being an ancient science, it continues to hold pivotal importance in the present day (4).

Indeed, the donated human body still represents the gold standard in the study of anatomy today because of its similarity to a living being (11). Moreover, with new technologies, such as the full-body revascularized and ventilated specimen, the donated body can currently be considered suitable for simulating surgeries with high specialist and realistic value (15). Especially in research and the development of new surgical methods and techniques, the donated-to-science human body can be likened to the “first patient,” thereby reducing potential risks or complications in living subjects (16). For the practice of intricate surgical procedures, the importance of human body dissections is unquestionable. While synthetic models may be hypothetically useful in very preliminary anatomical studies, they are not suitable for research on new surgical techniques or the development of new medical devices. Similarly, for students or recent graduates, the human body can represent the perfect “first patient” for surgery, providing both the safest and most reliable simulation (17).

Currently, many universities, including those in Italy, are facing a systematic shortage of donated bodies and reserve their use for moments of indispensable importance (18). Regarding the exploitation of animal models, they are not comparable in terms of efficacy, in addition to the ethical considerations that need to be raised due to the sacrifice of animals. Artificial models are mainly used in broad courses with numerous students, where having a donated human body for each trainee would not be feasible. In this first-phase learning, the synthetic model could serve as a viable option to bring the student closer to the donated human body and be preparatory to a more complex and realistic anatomy, being a halfway between the bi-dimensionality of books and the dissection (9). However, their use is often limited to a narrow and simplified view of anatomy, making them more appropriate for undergraduate courses rather than for actual surgical simulations. Moreover, these models are mostly designed for specific types of learning or particular techniques, such as the Basic Life Support (BLS) training, resulting not as an alternative to donated human bodies but as being complementary (8).

Having assessed that the donated-to-science human body remains the gold standard for educational purposes, in cases of local donor shortages, a possible solution for some anatomic centers could be to apply for an external body donation program. The United States is currently one of the more common origin places for donated bodies. The long journey adds significantly to the carbon footprint; for example, a Chicago to Bologna flight may add 450.375 kgCO₂e per donated body, resulting in more than 3,116,96% of the total carbon footprint of a single human body. A lower but still substantial percentage may be attributed to long-distance national transportation, which is what commonly happens in a national reference center such as the Centre for Clinical and Surgical Experimental and Molecular Anatomy of Bologna (14). Assuming that emissions related to all imports coming from the United States in 2009 were 210.3 Mt. CO2, we estimated that donated bodies would account for 0.000007% of the total. In contrast, the local donation program represents 0.0000006%. Although this may be a small fraction of the total, there is a difference of 0.0000064%, with the emissions from U.S. imports being approximately 11.67 times greater than the local donation program.

To minimize the carbon footprint, the principles of environmental sustainability—known as the 3 R’s: reduce, reuse, and recycle—could be applied. By reducing the need for long-distance transportation (reduce), maximizing the utilization of each donated body through multiple educational, training, and research sessions (reuse), and giving a body already existing in nature a new life and purpose by donating it to science (recycle), sustainable practices within this context could be promoted. As a result, the carbon footprint is primarily associated with the management and transportation of the donated body. For this reason, local donation programs should be prioritized as much as possible to reduce transportation emissions. Moreover, since management is not strictly related to the number of bodies—such as the aeration and refrigeration systems, which are integral to anatomy rooms— having more donors would reduce the carbon footprint per body and provide more students and trainees the opportunity to learn in an extremely realistic setting.

Adopting the One Health approach could further address these challenges. One Health is a collaborative, multisectoral, and transdisciplinary strategy that recognizes the interconnection between human health, animal health, and environmental health. In the context of anatomical education, this approach emphasizes integrating training and research with ethical donation practices, ensuring health and safety standards, and promoting environmental sustainability. By fostering local body donation programs, we not only enhance educational and research opportunities but also reduce environmental impacts, aligning with ethical considerations and safety protocols. This holistic perspective supports the advancement of medical science while safeguarding ecological balance and public health (Figure 3).

To promote body donation and raise awareness of the expanding body donation program in Italy and beyond, particularly within the general public, various strategies could be implemented, including the co-creative use of graphic medicine and novels. (19, 20).

Nonetheless, while the U.S. body donation program primarily involves single body parts to meet specific training requests, considering the donation of whole bodies could further reduce the carbon footprint and enhance the re-use of each body (21). It is important to note that the return of remains to families, which is common in many U.S. academic donor programs, was not included in our model due to the lack of consistent data. This omission likely results in an underestimation of the true environmental impact of internationally sourced donations.

A recent study provides valuable insights into the geographical impact of human gift registries, particularly in the context of centralized resources for anatomy education. The article offers a detailed model for understanding how the geographical distribution of body donations influences the logistics of human anatomy programs. By examining the distances traveled by body donations, the study highlights the potential for localized donation systems to reduce transportation-related environmental impacts, further confirming the results of the present paper. The findings are highly relevant to our study as they underscore the importance of considering geographical factors when assessing the sustainability of body donation programs (22).

This study introduces a preliminary ecological analysis of the body donation process. This topic, if further explored, could potentially be discussed in best practices consensus documents for the dissection room quality system and in human body donation programs’ best practices and recommended standards (23, 24).

Recent discussions on sustainability in medical education have highlighted the potential benefits, according to the present study, of localizing anatomical body donation programs. A recent study emphasizes the importance of considering environmental sustainability within anatomy education, suggesting that reducing the carbon footprint of anatomical studies could be achieved through more localized approaches (25). Furthermore, while the international transport of human bodies could raise ethical concerns, some authors point out that these practices might require further ethical considerations and the development of guidelines to ensure respectful management (26). In this context, our study may support the notion that promoting local body donation programs could not only reduce environmental impact but also help address these ethical considerations by minimizing the need for international transportation.

However, it is crucial to consider the limitations of this study, given its retrospective nature and the fact that the donated human bodies involved are related to a single specific Italian center. In particular, the study relies on data from a single Higher Education Institution Dissection Room. The focus of the study was on this specific context, but the importance of incorporating broader data at a national or EU level in future research would be valuable. Expanding the scope of data would provide a more comprehensive understanding of body donation practices across different regions. Moreover, due to the complexity of the whole process, some parameters were estimated by considering the worst-case scenario (e.g., aeration), which may not be fully representative of everyday practice.

A key limitation of this study is the lack of primary data on donated bodies sourced from the United States Body Donation Program, with data being estimated hypothetically to construct a generalized model. Even within this context, the comparison with the U.S. body donation process can still offer valuable insights, particularly in terms of screening LCA. This remains an important aspect to consider when interpreting the findings. Nevertheless, this study could lay the foundation for future research and introduce an important concept that may stimulate further discussion and studies on environmental awareness.

The donated human body remains the gold standard for educational and training purposes in medicine, as it already exists in nature. Since the majority of the CO2 emissions are related to the management and transportation of the donated bodies, a national and local awareness-raising campaign should be supported to help reduce its carbon footprint. The phrase “Hic mors gaudet succurrere vitae et planetae” (This is the place where death delights in helping the living and planet) could be even truer with a greater number of donated bodies sourced from local areas. To conclude, human body donation should be considered not only a philanthropic choice but also an eco-friendly one.