Organ donors, both living and deceased, play a vital and lifesaving role in modern medicine. Whole-body donors play a role just as vital, enabling scientific research and the training of new physicians. However, the legislation and government oversight involved in organ donation does not currently exist for whole-body donations. Within this regulatory vacuum, an industry of body brokers has arisen nationwide to commercialize the sale of human remains. The results have been ugly: investigative reporting has uncovered countless instances of unsafe practices, abuse of human remains, and exploitation of donors’ families. The existence and prevalence of such widespread malpractice clearly displays that regulation and federal oversight is necessary to ensure that this industry operates both ethically and safely.
Cadavers are irreplaceable in both the training of new medical students and medical research. Companies that make medical products also rely heavily on human tissue. Many medical schools operate their own donation programs, which provide the majority of cadavers needed for their education and research. However, many other bodies are obtained from body brokers. These body brokers, also known as non-transplant tissue banks, serve as middlemen between the recently deceased and the market for cadavers. They solicit donations from patients or their families, dismember or otherwise process the bodies as required, and sell what remains to the highest bidders. Each part has a price: a foot may sell for $250, a head might fetch $1,000. For these businesses, bodies are raw materials to be harvested and sold to other institutions for further use.
These sales skirt the border of legality; since the 1984 National Organ Transplant Act outlawed the sale of human tissue, body brokers have characterized their charges as fees for services. Despite this, the various roundabout fees that link prices to body parts, on top of shipping and handling, make it abundantly clear that great profit is being made by selling body parts. For example, Science Care, the largest whole-body donation company in the world, regularly reports earnings in the millions of dollars. Listed in the assets of Science Care in 2016 were over 100,000 body donation pledges.
Exports of these body parts are even more lucrative: German cosmetic surgeons and Chinese orthopedic researchers alike practice their craft on American heads and knees. The United States is unique among developed countries in its lack of regulation—body brokers are subject to regulation in only ten states. In other countries, religious tradition and tighter regulations have prevented such industries from taking hold. The current unregulated free-for-all of body brokerage that takes place across the US is troublingly reminiscent of body snatching in the 19th century, a practice where physicians and students resorted to nightly grave robbing in order to obtain cadavers.
Indeed, not much has changed since the early 2000s, when the first investigative report on body brokers came out. One particularly troubling report from Reuters in 2013 detailed the misuse of the body of 74-year-old Alzheimer’s patient Doris Stauffer, which had been donated to the Biological Resource Center, a now-defunct Arizona-based tissue bank. Her family members had previously signed paperwork authorizing the use of her body for medical research and disallowing military and non-medical applications. They had hoped that her brain would be used for Alzheimer’s research. Instead, it was sold to researchers funded by the US Army, becoming “part of an Army experiment to measure damage caused by roadside bombs.” Though US Army policy prohibits the use of cadavers without explicit authorization from the donor’s family, they and many other customers rely on brokers to accurately ascertain and represent donor wishes.
Lack of regulation has allowed many other abuses to abound. Brokers have even gone so far as to ship cadavers and body parts ridden with infectious disease such as tuberculosis, hepatitis, and HIV to unwitting customers. There is no licensing required to start such a business; anyone can handle human remains, dissecting out parts to order. Additionally, anyone can legally buy these parts: in 2016, a Reuters reporter obtained a human cervical spine and two heads for $300 each—shipping not included. Ultimately, to prevent future cases of such gross misconduct, regulation of this industry must proceed on all fronts.
Regulating how organizations contact family members to solicit donations is a crucial first step. Tissue banks must do more to ensure that donors and their family are providing fully informed consent when authorizing a donation. Many families are unaware that the organizations to which they donate proceed to sell the donated body parts for profit. Regulation must also combat the exploitative strategies used for sourcing donations. Body brokers often offer free or discounted cremations to incentivize families to donate the body of a recently deceased relative. Many brokers work closely with funeral homes, which provide a consistent source of potential donors, and pay a referral fee per body obtained. In this way, brokers exploit families who otherwise lack the financial means to provide for cremation.
Body brokers must additionally be subject to high standards and regular inspection to ensure safe handling of specimens. Human tissue can pose significant health risks to those preparing donated bodies, as well as the educators and researchers using them. The standards that exist in the industry are entirely self-imposed, thereby allowing non-compliant organizations to easily slip through the cracks. Currently, the New York State Department of Health imposes the strictest regulations, mandating reports, inspections, and licenses for brokers doing business in the state. Yet, even with this regulation in place, officials in New York are generally unable to give anything more than a slap on the wrist for offenses due to a lack of enforcement and precedent in other states. Federal legislation must standardize the documentation and testing of human tissue to ensure adequate safety measures.
A prescient example was signed into Colorado law this past May: A bill entitled “Human Remains Disposition Sale Businesses“ now prevents individuals from simultaneously holding interests in non-transplant tissue banks and funeral establishments or crematories, and additionally mandates registration of tissue banks and standards for record-keeping and disclosure to regulators. Using this measure as a template, the federal government needs to pass similar blanket legislation to help put an end to many of the nationwide abuses that have plagued the industry since its inception.
Finally, in governing the distribution of human tissue, legislation would do well to follow the extensively regulated model set by organ donation. The United Network for Organ Sharing, with oversight from the Health Resources and Services Administration and other government agencies, maintains the nationwide transplant list that matches donors to recipients, registers data for every transplant that occurs, makes policy decisions, and ensures that regulations are followed at all levels. Setting aside agency resources at the federal level would allow for better implementation and coordination of changes. Likewise, a centralized registry, as is used for organ donation, would help to efficiently allocate cadavers among the parties that require them, prioritizing medical schools and researchers.
Organ donation is already tightly regulated and nationally coordinated; similar oversight for whole-body donation would benefit donor families, medical schools, and researchers alike. Until the industry receives oversight accordingly, brokers will continue to exploit patients and their loved ones at their most vulnerable. Body donation is among the most final acts of altruism one can perform, a gift given with the hopes of improving the lives of others. Treating these donations with anything less than the utmost respect does a grave disservice to donors and their families.
Photo: Blossom Plant