By Karla Basa
Every year, thousands of Americans will their bodies to science, choosing a path that, ideally, leads to the clinical dignity of the medical school or research lab, where the deceased aid in the discovery of cures to life-threatening diseases or uncover the wonders of human anatomy. Every year, thousands of Americans entrust the care of their loved ones to trusted professionals in the funeral industry so that the honor of the deceased may be preserved. Few donors and family members, however, are aware that these bodies are often exploited for the sake of science, progress, and profit. Corpses are hacked to pieces and shipped abroad to be used in land mine tests while organs, bones, and tissues are stolen without the consent of family members or the deceased. Nor do many suspect that bodies are valuable commodities in an underground black market in which cadavers are worth more in pieces than as a whole.
Required for education, transplant, and research, human tissues are increasing in demand. However, there is a deficiency in the amount of available tissues and organs. Federal laws such as the Uniform Anatomical Gift Act and National Organ Transplant Act prohibit the sale and purchase of human tissues and organs, but their vagueness in some sections allows room for interpretation, resulting in laws that are essentially obsolete. The rising demand for human tissues in combination with soft regulatory laws have created a thriving market for the purchase and sale of these parts; as such, body brokers resort to illegal and unethical means to procure human parts for sale to inquiring parties, prompting a call for reformations in current laws regulating the transplantation and distribution of human parts as well as direct intervention by medical professionals involved.
Recent advancements in science and technology have led to a greater demand for transplantable organs and human tissues for research and medicine. New surgical techniques are continuously developed, and the use of cadavers is essential to instruction in these new procedures. Technological advancements and new medicinal products have also enabled biomedical labs to conduct research on muscles, bones, tendons, and skin in addition to donated organs. Furthermore, medical schools and biology classes across the nation utilize cadavers to familiarize students with the human anatomy (Kittredge). Statistics are now suggesting that the demand will only increase due to elevating diabetes rates, an aging population, and improved surgical techniques (Zwillich). However, With so many uses and needs for human bodies and body parts, it becomes increasingly difficult to accommodate the overwhelming demand.
Currently in the United States, the amount of donated bodies, tissues, and organs is not sufficient to meet the demand. According to the Center for Organ Recovery and Education, there are currently over 80,000 people waiting on the organ transplant list. While there is an average of six transplants performed daily, 16 people die each day due to the scarcity in available organs for transplantation (Weber et al.). The problem is that there are not enough people willing to donate. In national polls, 60-80% of people surveyed indicated that they might be willing to sign an organ donor card. However, the national percentage of people who have actually signed an organ donor card is under 20% (Weber et al.). Researchers in need of tissues and organs often find that the distribution of available specimens is unreliable. A central catalogue or agency that allocates cadavers does not exist, so researchers are left to find their own means of obtaining tissues and organs. State anatomical boards and nonprofit donation programs, such as Willed Body programs, sometimes allow scientists access to bodies not used by students, and organ procurement organizations arrange for researchers to obtain organs if a transplant recipient could not be found first, but these methods are not always consistent. Ultimately, we cannot predict when a body will become available, and with an unpredictable supply of bodies, scientists, especially those in need of specific parts, sometimes turn to for-profit companies who work with the funeral industry (Waltz).
From as early as the 1800s, the illegal body trade has long been a profitable proposition. In the 19th century, the United States saw a sharp rise in the number of medical schools that needed cadavers for dissection. With the rising demand, medical schools began collecting unclaimed bodies from the streets and poorhouses. Medical schools went so far as to hire body snatchers to rob graves as in the case of two Irishmen, William Burke and William Hare, who in the 1820s allegedly murdered 16 people. By the 1950s, advancements in science encouraged people to donate bodies for the first time. According to Michael Sappol, a medical historian at the National Library of Medicine, vaccines for polio and rabies, anesthesia for childbirth, and antibiotics convinced the public that science could be a boon for society (Waltz). However, as the demand outpaced the rise in donations, even scrupulous handlers of cadavers were lured into making a handsome profit.
Today, body brokering has become a highly lucrative black market business. Modern day body snatchers provide bones, tendons, and body parts in addition to transplantable organs to tissue banks, research facilities, and other buyers. While federal law prohibits most sales of body parts, it is not illegal to charge fees for handling, procuring, storing, and processing human tissue (Armour). Thus, body brokers are able to amass substantial fortunes from the selling of body parts. In the black market, delivery of an intact cadaver costs as little as $1,000, but research specialists seeking out specific tissues and organs pay larger fees. A head can cost $500 in processing fees, a torso can fetch $5,000, spines for $3,500, a knee $650, and a cornea for $400. Over the course of a year, one particular body broker, the director of the cadaver laboratory at the University of Texas Medical Branch at Galveston made more than $400,000 in the body trade (Broder).
Who then are the suppliers in this gruesome trade? Trusted professionals in the medical and funeral industry are the perpetrators behind the black market business. One of the most publicized scandals that brought the body brokering business into the national spotlight was that of the Willed Body program at the University of California, Los Angeles. Henry Reid, director of the program at UCLA, and a suspected associate, Ernest V. Nelson, were arrested in 2004 for the purchase and sale of human parts. Using scalpels, scissors, and electric saws, Nelson, a former autopsy technician, sliced off hands, knees, and other body parts, packing them in coolers for shipment to one of 80 clients, including a subsidiary of Johnson & Johnson . Between 1998 and 2003, Nelson removed the parts of 496 cadavers and in exchange for cashier’s checks totaling $704, 600 (Murr). In the profit-driven black market, it is not uncommon for medical professionals to make business partnerships with funeral industry employees.
For instance, four Brooklyn men were indicted on charges of participating in a body parts ring that stole body parts from corpses at funeral homes within the New York area. A former dentist, Michael Mastromarino, the director of a body brokering company, Biomedical Tissue Services, solicited funeral homes in the area to supply him with body parts such as tendons, skin, and bones. He enlisted the help of an embalmer, Joseph Nicelli, who also owned Daniel George & Son Funeral Home and two other associates, Lee Cruceta and Christopher Aldorasi, who both aided in the dismemberment of bodies. Corpses brought in for embalming were secretly disseminated: bones were taken discretely and replaced with PVC pipes, organs were removed and refrigerated, and the body was quickly sewn back before funeral ceremonies (Armour).
In the cadaveric trade, brokers go to far lengths to keep their supplies fresh and plentiful, heavily marketing their services in funeral homes, sometimes offering families a free cremation for the donation of a body, a tactic they refer to as “the dangle of the dollar.” Once the corpse is delivered, a skilled technician dismembers the body and sells the parts to university researchers and surgical equipment companies. After usage, body parts are sometimes returned to brokers who cremate the remains and deliver them to families, but they often lose track of the identity and distribute the wrong ashes (Cheney 48). After cremation, it becomes difficult to discern human ashes from one another (Kluger). Body brokers, it seems, habitually prioritize their business and profit over the interest of family members who have a strong desire to preserve the dignity of their loved ones whether they donate the body to science or simply lay them to rest.
While there is little controversy in the medical community over the use of donated bodies in teaching and research, most find the cavalier way in which cadavers are handled by brokers and universities to be both medically and professionally unethical. In a 2004 case, the Tulane University willed-body program was criticized for handing over 9 bodies to the National Anatomical Service, a body brokerage company, which in turn sold the bodies for $37,000 to the US army. The bodies were used to test the durability of anti-land mine boots, several of which were destroyed in the explosions. When her mother died three years ago, after a lengthy battle with kidney and heart problems, Leigh Ajan took comfort in knowing that her mother’s body, which was willed to Tulane University, might help researchers find cures for those diseases. In response to the Tulane scandal, Ajan asserts: “If my mother had known that her body could be sold like it was nothing, she never would have donated it” (Mangan). Researchers rely heavily on the public for donations, but the public’s growing distrust in medical professionals is worsened by cases like the Tulane University scandal. As a result, the public is becoming increasingly wary and unwilling to participate in willed-body programs. As Arthur L. Caplan, the director of the Center for Bioethics at the University of Pennsylvania School of Medicine states: “One of the worst things you can do to dishonor someone is to desecrate his body. The perception that people are mishandling body parts is toxic to future gifts” (Mangan). However, body brokers like Augie Perna, the founder of Innovations in Medical Education and Training (IMET) which organizes surgical seminars, maintain that the body is merely “flesh and bones” — a simple article of trade in their business (Cheney 47). Brokers are largely unrepentant of their work and feel that once deceased, a person loses social significance — they become less a person and more an object — and as a commodity of the business, they are treated as such. However, more than the moral degeneration of body brokers is stake as cases of post-transplantation death continue.
In several instances, transplantation of diseased organs from tissue banks supplied by body brokers have led to death, spurning a widespread health concern for transplant patients. In a 2001 case, a 23-year-old man died from infection after undergoing reconstructive knee surgery in which he received a bacterially infected transplant. A second man in a separate incident was admitted for septic arthritis after receiving an allograft from the same donor tissue as the knee replacement. Both transplants were furnished by Cryolife Inc, the largest processor of human cadaveric tissue in America (McCarthy). By forging documents, body brokers frequently omit important medical histories or alter causes of death to make donors ideal for submission to tissue banks. When funeral home employees stripped the body of famed British broadcaster Allistair Cooke, they altered his forms so that the cause of death was natural as opposed to cancer (Armour). The alteration of documents is a common practice and there is very little oversight in dealing with funeral home employees and body brokers which allows them to manipulate the system in their favor.
Exploitative cases like the Tulane University scandal and the tragic deaths of several transplantation patients have revealed substantial inadequacies in the current regulation of tissue donation and transplantation. Current U.S. law prohibits the sale and purchase of body parts, but does not explicitly specify a limit on processing or handling fees (Armour). The FDA regulates tissues used for transplant and requires disease screenings and medical histories of the donors, but the parameters are not consistently enforced, as evidenced by the occasional diseased transplantation. Currently, there are no federal laws or agencies that regulate the sale of human tissue intended for research or teaching (Waltz). State laws govern the trade, but are based on vague wording from the Uniform Anatomical Gift Act of 1968. According to the act, the law requires consent from the family or the donor to utilize the body for science, but the unspecific wording in several sections allows room for interpretation. For instance, tissue banks are able to recoup “reasonable” costs for shipping and handling, but the law does not clearly define what is considered reasonable. Donated bodies must be used for science, but “science” is an undefined catch-all category (Waltz). The National Organ Transplant Act seeks to regulate the donation process by establishing a donor’s list in addition to districts which oversee distribution, but the law still fails to address the tissue shortage in the U.S. Inefficiencies in legislation necessitate further reinforcement and revision of current laws.
Several steps have already been taken to address issues surrounding the illicit cadaver trade. The FDA has mandated new regulatory procedures and measures for tissue banks processing bone, ligaments, skin, tendons, and reproductive tissue. Banks must now register with the FDA and provide a list of cells and tissues produced in the lab to aid in the tracking of grafts that may potentially cause infection. The FDA is also considering the implementation of new criteria and requirements for the screening of tissue donors (Ault). A new legislative bill known as Schumer’s Bill, if passed, will prevent funeral employees from relocating bodies without the family’s consent. The bill also provides for FDA inspections of the funeral home in addition to mandatory auditing of organs and consent forms (Armour).
However, policy makers and medical professionals find that addressing the complex issue of the organ shortage in the US is more difficult to attend to. Although there have been several proposals for solutions, there are still problems inherent in the proposed policies. In order to increase the number of donors, medical professionals suggest providing a financial incentive. Monetary rewards will encourage more participants for donation, keeping money within the hands of donors and family members and away from greedy profiteers of the cadaver trade. Critics argue however, that the provision of a financial incentive will only serve to legitimize the black market trade not eliminate it. Instead, the donors themselves will become the new body brokers, soliciting their organs for profit (Beard et al.). Other proposed solutions explore the notion of presumed consent as a means to reduce the shortage. According to the current process, an explicit consent form must be signed to donate a body to science (Zwillich). Under the new provision, all persons are eligible donors unless he or she “explicitly” refuses. However, it then becomes difficult to define what exactly constitutes an “explicit” refusal (Beard et al.).
Other medical professionals argue that increased government regulation of the organ transplantation and donation process will only complicate matters further. The direct involvement of researchers and physicians in the recruitment of donors and the regulation process will best address the shortage issue and curtail the black market trade in human parts (Waltz). Vocational incentives, it is argued, will be far more effective than financial incentives because it appeals to one’s sense of compassion while avoiding the involvement of money, which can complicate the situation further (Weber et al.). Too much governmental involvement can also delay the transplantation process, thus medical professionals feel that they must take it upon themselves to regulate the trade. Experts say that organizations who utilize cadavers should require total transparency from suppliers. These groups should demand documentation on how handlers store and transport bodies, how much money is received, along with an associated list of medical histories. Some also suggest that funding agencies and institutional review boards require more extensive explanations from researchers regarding their purposes prior to acquiring research samples (Waltz).
The demand for human organs and tissues is at an all time high, and with lenient regulatory laws, body brokers have found a highly profitable business in the cadaver trade. In order to maximize returns, brokers often resort to illegal means to keep human parts in constant supply. The careless way in which cadavers have been handled by brokers have caused some ethical and medical concerns which have prompted a need for reform and better enforcement of regulatory laws. However, solutions to the issue are not straightforward or simple. While experts argue for more government involvement in the organ donation and transplantation process, other professionals advocate the opposite: more independent regulation and less governmental interference. Perhaps a combination of both federally mandated and independent regulation will best address the organ shortage issue and the unethical market of the cadaver trade.
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