In Reply We could only briefly highlight key ethical issues pertaining to the use of exome sequence data obtained from individuals who have donated their bodies for teaching anatomy to medical students in our Viewpoint, which Dr Cornwall and colleagues have described in more detail.
Although not required, our program is fully compliant with the International Federation of Associations of Anatomists' guidelines and incorporated guidance from our institutional review board regarding both the use of DNA from cadavers and the reporting of an educational initiative. Part of our intent was to generate interest and discussion in this area, for which, as Cornwall and colleagues point out, only a paucity of ethical guidelines and thought exists. The consent for total body donation to the Humanity Gifts Registry of the Commonwealth of Pennsylvania1 allows for use for anatomical study, research, or both. However, it also states that “no reports will be provided to the family.” We are thus precluded from returning results based on incidental or secondary findings. Indeed, a genetic disease in the donor with implications for relatives may be found through the discovery of anatomical and pathological findings during dissection without any genetic analysis. Our program is also not conducted under clinical grade standards and regulatory requirements, which would require substantial additional resources to be a diagnostic program. Even with DNA sequencing performed for clinical care, a consensus does not yet exist on which incidental or secondary findings should be returned to patients, practical guidance is limited, and national and international standards are lacking.2 Despite these deficiencies, such testing is growing substantially.
Gerhard GS, Paynton B, Popoff SN. Cadaver Exome Sequencing for Teaching First-Year Medical Students—Reply. JAMA. 2016;316(1):103. doi:10.1001/jama.2016.4760