The collection of brains at Risskov is being shut down

9,479 brains in formalin will not be on the removal vans when Aarhus University Hospital in Risskov moves out of the old buildings next year and relocates to Skejby.

This is the bottom line after a process during which Aarhus University and the Central Denmark Region have assessed and discussed the possibilities for either maintaining or shutting down the collection. The dilemma is that, on the one hand, the collection of brains is unique and probably among the largest in the world. But on the other hand, the collection has led to a very modest number of academic projects since it was founded more than seventy years ago. During the last decade, no more than a dozen or so scientific articles have been published based on the collection of brains, and this carries weight with Kristjar Skajaa, head of the Department of Clinical Medicine, who has been involved in obtaining relevant information and balancing the for and against arguments:

"It would cost several million Danish kroner to move and preserve the collection. But when we compare this cost to the scientific value, the conclusion is that its value is not commensurate with the costs. The research-related benefits have been so limited that the money can be better used elsewhere," says Kristjar Skajaa, and adds that there are no plans to withdraw funds from the Translational Neuropsychiatry Unit, which currently stores and administers the collection of brains.

"This is not about a department saving money. It is a question of due diligence when it comes to comparing the research value with the considerable costs that would be incurred by moving and maintaining the collection for posterity in the new buildings at Skejby," says Kristjar Skajaa.  

State hospitals sent the brains for examination

The collection of brains from psychiatric patients was founded in 1945 as the state hospitals in Denmark began removing brains from deceased patients with diseases such as schizophrenia, depression and dementia, before sending them for examination at what was then the Brain Pathological Institute, which was itself set-up by the Directorate for the Danish State’s Mental Illness Hospitals. 

This was done with the very best intentions, which could be summarised by the logic of the post-mortem: ‘Mortui vivos docent’ or ‘The dead teach the living’. Everything took place under government-controlled conditions, but in a different time and with a different legislation. So that, for example, at the time obtaining permission from patients and their relatives before removing the brains was not a consideration.

The collection continued to grow until 1982 and despite the limited research-interest, it is known in professional circles as a comprehensive collection of brains which have not been exposed to modern medicine. It is therefore not surprising that the clarification process has led to declarations of support for maintaining the collection from other universities in Europe and North America.

Some people will of course be disappointed!

"There will be researchers both locally and abroad who will be disappointed and who disagree with the decision. You cannot shut something down without it affecting anybody. However, this does not alter the disparity between the costs and the modest research-interest, which probably is connected to the inadequate journal material," says Kristjar Skajaa.

She refers to the fact that only around 2,000 of the brains also have accompanying patient files, which are of course characterised by the contemporary understanding of mental illness and registration practice. The remaining brains are accompanied by what are known as neuropathological descriptions.

In connection with the clarification process, the Department of Clinical Medicine ordered an overview of projects involving the collection of brains, which totalled three ongoing and three planned projects.

The sense of modest interest is also confirmed by an inquiry from the dean's office which was sent to the other Danish universities asking whether they would co-finance the collection of brains with a view to joint research in the future. None of the universities were interested in contributing financially.

Brain tissue in paraffin blocks will be preserved

"All in all, this is a decision that has been a long time coming, and one where we have considered the whole spectrum of possibilities. From partial conservation to the unlikely chance of private foundations being willing to pay the moving and operating expenses," explains Kristjar Skajaa on the clarification process that preceded the decision.

In addition to the brains in formalin, the collection also comprises extracted parts of brain tissue embedded in paraffin blocks. These tissue blocks can be used for a wide range of molecular-biological analyses and they will be preserved and moved to Skejby together with the associated digitised neuropathological reports.

The region shuts down the collection with the support of the university

While the university and the region discussed the future of the collection of brains in an uncomplicated collaboration, the parties also had to clarify the legal aspects of the ownership structure.

Even though the University Act states that the university carries out research and is therefore able to assess the scientific value of the collection, it is the region and ultimately the regional council who, in accordance with section 194 of the Danish Health Care Act, have the legal responsibility for research in the healthcare sector. The two parties have therefore decided on a procedure in which the region's administration recommends to the regional council that the collection should be shut down, and Aarhus University supports the decision with a professionally substantiated declaration of support.

If everything goes as expected, the politicians in the regional council will shut down the collection of brains at the meeting of the regional council on 21 June.

Contact

Department Head Kristjar Skajaa
Aarhus University, Department of Clinical Medicine
kristjar.skajaa@clin.au.dk
Telephone: (+45) 7845 9000