The shadowy trade in body parts has been exposed in the wake of accusations that UCLA staff have illegally sold cadavers donated to science. Stephen Phillips reports
It's the modern-day incarnation of Burke and Hare. Staff at the Medical School at the University of California, Los Angeles, have been accused of illicit trafficking in cadavers donated to science. The story, picked up by media worldwide, has provided a glimpse into the shadowy market in body parts.
Henry Reid, the head of UCLA's willed body programme, the world's oldest such scheme, has been charged with profiting from the sale of parts from up to 800 corpses meant for research. The Los Angeles Times has reported seeing invoices with UCLA's letterhead that document the sales of 496 cadavers for $704,600 (£380,000).
Reid, 54, allegedly gave Ernest Nelson, 46, the run of the freezer at UCLA's David Geffen School of Medicine, where he cut up bodies to order from 1998 until earlier this year. Unsuspecting patrons included pharmaceutical giant Johnson & Johnson. Nelson, who has been charged with receiving stolen body parts, proclaims his innocence. He says he operated with the blessing of university officials.
UCLA has tendered profuse apologies to outraged relatives, but a class-action lawsuit has been filed on behalf of loved ones who, the relatives say, hardly consented to being hacked up and parcelled out to the highest bidder when they bequeathed their remains to advance medical knowledge.
It also emerged this month that cadavers intended for the dissecting table at Tulane University in New Orleans wound up being blown apart by the US army in landmine experiments. The university sold the seven bodies for $1,000 each to a broker, who delivered them to the military for nearly $30,000, according to Harper's Magazine .
Tulane officials say that the university's fees covered only the cost of preserving the bodies, that they had assumed that the bodies, surplus to needs, were destined for a medical school and that they were as shocked as everyone else by their fate. Tulane has since dispensed with the broker's services, staff say.
But experts worry about how the scandals, particularly the apparent breach of trust at UCLA, could affect organ donations for transplant operations.
"It's going to reduce willingness to donate organ and tissue... people are going to die," warns Kenneth Iserson, professor of emergency medicine and director of the bioethics programme at the University of Arizona.
In fact, organ donations are all above board and tightly regulated, says Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics.
The same cannot be said of cadaver donations. There is little supervision of procedures, donors frequently sign boilerplate agreements that do not spell out the uses to which their remains might be put, and cremation covers up unscrupulous operators' tracks, observers say.
Demand for corpses is insatiable. Dissections performed by medical students are a small part of the story. Bodies are harvested for anything from skin grafts for burn victims and replacement heart valves to collagen for pouty lips and cartilage to repair knees. The US market for transplantable body parts is worth more than $200 million and will only grow as society ages, Caplan says.
Cadavers are also needed for tests of medical instruments and for injury prevention studies. Using bodies to test protective gear such as fire-retardant clothing may scandalise and turn some stomachs, but it saves lives, says Iserson, the author of Death to Dust: What Happens to Dead Bodies? Crash-test dummies are only so good in gauging the safety of things such as seatbelts or airbags, he adds. "The bottom line is that you have to see how tests pan out on a human body. It's nicely done. They wrap the bodies in muslin and treat them respectfully."
Less well treated, perhaps, are those cadavers employed by the US military, which has long used them for its artillery impact studies, Iserson says.
The provision of cadavers for research falls into a legal grey area that is exploited by enterprising middlemen, frequently former morticians with ties to morgues. US law forbids the sale of bodies, but it says nothing about the charging of exorbitant "service" fees. It's a racket, Caplan says.
"They charge high fees because of the messy nature of the work. It's a direct descendent of the grave-robbing of the 18th century."
With bodies worth less than the sum of their parts, so-called disarticulators ply a lucrative trade. "The mark-ups on bones, tendons and tissues are scandalously high," Caplan says. A human jaw can fetch $1,000, and an earbone three times that, he says.
He suggests that holding buyers accountable for verifying the legitimacy of suppliers might stamp out illicit trafficking. He also thinks that donor consent forms should divulge the uses a cadaver could be put to and allow the donor to opt in or out.
But reform has been frustrated by squeamishness. "It's macabre," Caplan says. "As someone who's been trying to pry this box open, there are many people who just want to sit on it and say 'yuck'."
There's also reticence in the medical community. Michael Sappol, curator-historian at the National Library of Medicine and author of A Traffic of Dead Bodies: Anatomy and Embodied Social Identity in Nineteenth-Century America , says anatomists were resistant to his inquiries into the state of anatomical donations. "There's a culture of discretion dating back to the years of no legal sources of bodies, when there were body-snatching gangs, networks of informants and student body-snatching competitions," he says.
Until the 1950s, educational institutions relied on unclaimed bodies from hospitals and prisons and on executed criminals for anatomical studies, Sappol says. This source still accounts for 5 per cent to 15 per cent of bodies used today, he says.
"In the 1950s, however, the whole thing pivoted," he says. "Antibiotics came in, medicine achieved unprecedented prestige and contributing your body became a noble thing."
By then, death had also shed much of the cultural baggage that led people to plunge their savings into ensuring that they got a respectable burial and saw lavish funerals and mausoleums as status symbols, Sappol says.
But what hasn't disappeared is the belief that human remains should be handled with dignity and in accordance with the philanthropic intent of donors.
Undignified handling led to complaints about UCLA's programme in 1993, when it was alleged that human ashes mixed with used medical implements had washed up off the southern California coast after having been dumped in garbage drums in the Pacific Ocean. Lawyers also objected to a practice called "canoeing", whereby, to save on the costs of disposal, cadavers are stuffed with medical waste from animals and other human bodies before being cremated.
This was the situation Reid was hired to straighten out in 1997. It's since been revealed that he owed more than $100,000 in back taxes and that he declared bankruptcy for the third time shortly after being appointed.
Unwittingly hiring a bankrupt for a post that provided an opportunity for black-market enrichment may have proved UCLA's undoing. Reid's alleged scheme appears to have coincided with swingeing court-ordered repayments to settle his debts.
THE UK PICTURE
In the light of the Alder Hey scandal, where organs were taken from dead children and used in medical research without parents' consent, the UK law on body parts is being tightened. The human tissue bill, now going through Parliament, will outlaw the sale of human bodies or body parts or the storing of them without a licence from a new regulatory organisation. Scientists have complained that the proposed legislation is too draconian and could harm legitimate medical research.