Corpses are in high demand internationally. Body parts are harvested for a host of medical and cosmetic surgeries. Ukraine is at the center of this trade, which is dogged by repeated allegations that human tissue has been removed without proper consent an
On Feb. 24, Ukrainian authorities made an alarming discovery: bones and other human tissues crammed into coolers in a grimy white minibus.
Investigators grew even more intrigued when they found, amid the body parts, envelopes stuffed with cash and autopsy results written in English.
What the Security Service had disrupted was not the work of a serial killer but part of an international pipeline of ingredients for medical and dental products that are routinely implanted into people around the world.
The seized documents suggested that the remains of dead Ukrainians were destined for a factory in
Germany belonging to the subsidiary of a U.S. medical products company, Florida-based RTI Biologics.
RTI is one of a growing industry of companies that make profits by turning mortal remains into everything from dental implants to bladder slings to wrinkle cures.
The industry has flourished even as its practices have roused concerns about how tissues are obtained and how well grieving families and transplant patients are informed about the realities and risks of the business.
In the U.S. alone, the biggest market and the biggest supplier, an estimated two million products derived from human tissue are sold each year, a figure that has doubled over the past decade.
It is an industry that promotes treatments and products that literally allow the blind to see (through cornea transplants) and the lame to walk (by recycling tendons and ligaments for use in knee repairs). It’s also an industry fueled by powerful appetites for bottom-line profits and fresh human bodies.
In Ukraine, for example, the Security Service believes that bodies passing through a morgue in the Mykolaiv oblast, the gritty shipbuilding region located near the Black Sea, may have been feeding the trade, leaving behind what investigators described as potentially dozens of “human sock puppets” — corpses stripped of their reusable parts.
Industry officials argue that such alleged abuses are rare, and that the industry operates safely and responsibly.
For its part, RTI didn’t respond to repeated requests for comment or to a detailed list of questions provided a month before this publication.
In public statements the company says it “honors the gift of tissue donation by treating the tissue with respect, by finding new ways to use the tissue to help patients and by helping as many patients as possible from each donation.”
Despite its growth, the tissue trade has largely escaped public scrutiny. This is thanks in part to less-than-aggressive official oversight — and to popular appeal for the idea of allowing the dead to help the living survive and thrive.
An eight-month, 11-country investigation by the International Consortium of Investigative Journalists (ICIJ) has found, however, that the tissue industry’s good intentions sometimes are in conflict with the rush to make money from the dead.
Inadequate safeguards are in place to ensure all tissue used by the industry is obtained legally and ethically, ICIJ discovered from hundreds of interviews and thousands of pages of public documents obtained through records requests in six countries.
Despite concerns by doctors that the lightly regulated trade could allow diseased tissues to infect transplant recipients with hepatitis, HIV and other pathogens, authorities have done little to deal with the risks.
In contrast to tightly-monitored systems for tracking intact organs such as hearts and lungs, authorities in the U.S. and many other countries have no way to accurately trace where recycled skin and other tissues come from and where they go.
At the same time, critics say, the tissue-donation system can deepen the pain of grieving families, keeping them in the dark or misleading them about what will happen to the bodies of their loved ones.
Those left behind, like the parents of 19-year-old Ukrainian Serhiy Malysh, who committed suicide in 2008, are left to cope with a grim reality.
At Serhiy’s funeral, his parents discovered deep cuts on his wrists. Yet they knew he had hanged himself.
They later learned that his body parts had been recycled and shipped off as “anatomical material.”
“They make money with our misfortune,” Serhiy’s father said.
During the transformational journey tissue undergoes — from dead human to medical device — some patients don’t even know that they are the final destination.
Doctors don’t always tell them that the products used in their breast reconstructions, penis implants and other procedures were reclaimed from the recently departed.
Nor are authorities always aware of where tissues come from or where they go.
The lack of proper tracking means that by the time problems are discovered some of the manufactured goods can’t be found. When the U.S. Centers for Disease Control and Prevention assists in the recall of products made from potentially tainted tissues, transplant doctors frequently aren’t much help.
“Oftentimes there’s an awkward silence. They say: ‘ We don’t know where it went,’” said Dr. Matthew Kuehnert, the CDC’S director of blood and biologics.
“We have barcodes for our [breakfast] cereals, but we don’t have barcodes for our human tissues,” Kuehnert said. “Every patient who has tissue implanted should know. It’s so obvious. It should be a basic patient right. It is not. That’s ridiculous.”
Since 2002 the U.S. Food and Drug Administration (FDA) has documented at least 1,352 infections in the U.S. that followed human tissue transplants, according to an ICIJ analysis of FDA data. These infections were linked to the deaths of 40 people, the data shows.
One of the weaknesses of the tissue-monitoring system is the secrecy and complexity that comes with the crossborder exchange of body parts.
The Ukrainians export cadaver parts to the Germans; the Germans export finished products to South Korea and the U.S.; the South Koreans to Mexico; the U.S. to more than 30 countries. 271 active FDA registered banks recover traditional tissues. Of those, 28 are foreign; and of those, 20 are in Ukraine.
Distributors of manufactured products can be found in the European Union, China, Canada, Thailand, India, South Africa, Brazil, Australia and New Zealand. Some are subsidiaries of multinational medical corporations.
The international nature of the industry, critics claim, makes it easy to move products from place to place without much scrutiny.
“If I buy something from Rwanda, then put a Belgian label on it, I can import it into the U.S. When you enter into the official system, everyone is so trusting,” said Dr. Martin Zizi, professor of neurophysiology at the Free University of Brussels.
Once a product is in the European Union, it can be shipped to the U.S. with few questions asked.
“They assume you’ve done
the quality check,” Zizi said. “We are more careful with fruit and vegetables than with body parts.”
The International Center for Investigative Journalists' investigation got a quick reply from Interpol secretary general Ron Noble. In Los Angeles on July 17, Nobel pledged to track illicit trade in human tissue.
Piece of the action
Inside the marketplace for human tissue, the opportunities for profits are immense. A single, disease-free body can spin off cash flows of $80,000 to $200,000 for the various non-profit and for-profit players involved in recovering tissues and using them to manufacture medical and dental products, according to documents and experts in the field.
It’s illegal in the U.S., as in most other countries, to buy or sell human tissue. However, it’s permissible to pay service fees that ostensibly cover the costs of finding, storing and processing human tissues.
Almost everyone gets a piece of the action.
Ground-level body wranglers in the U.S. can get as much as $10,000 for each corpse they secure through their contacts at hospitals, mortuaries and morgues. Funeral homes can act as middlemen to identify potential donors. Public hospitals can get paid for the use of tissue-recovery rooms.
And medical products multinationals like RTI? They do well, too. Last year RTI earned $11.6 million in pretax profits on revenues of $169 million.
Phillip Guyett, who ran a tissue recovery business in several U.S. states before he was convicted of falsifying death records, said executives with companies that bought tissues from him treated him to $400 meals and swanky hotel stays. They promised: “We can make you a rich man.” It got to the point, he said, that he began looking at the dead “with dollar signs attached to their parts.” Guyett never worked directly for RTI.
Human skin takes on the color of smoked salmon when it is professionally removed in rectangular shapes from a cadaver. A good yield is about six square feet.
After being mashed up to remove moisture, some is destined to protect burn victims from life-threatening bacterial infections or, once further refined, for breast reconstructions after cancer.
The use of human tissue “has really revolutionized what we can do in breast reconstruction surgery,” explains Dr. Ron Israeli, a plastic surgeon in Great Neck, N.Y.
“Since we started using it in about 2005, it’s really become a standard technique.”
A significant number of recovered tissues are transformed into products whose shelf names give little clue to their actual origin.
They are used in the dental and beauty industries, for everything from plumping up lips to smoothing out wrinkles.
Cadaver bone — harvested from the dead and replaced with PVC piping for burial — is sculpted like pieces of hardwood into screws and anchors for dozens of orthopedic and dental applications.
Or the bone is ground down and mixed with chemicals to form strong surgical glues that are advertised as being better than the artificial variety.
“At the basic level what we are doing to the body, it’s a very physical — and I imagine some would say a very grotesque — thing,” said Chris Truitt, a former RTI employee in Wisconsin.
“We are pulling out arm bones. We are pulling out leg bones. We are cutting the chest open to pull the heart out to get at the valves. We are pulling veins out from the inside of skin.”
Whole tendons, scrubbed cleaned and rendered safe for transplant, are used to return injured athletes to the field of play.
There’s also a brisk trade in corneas, both within countries and internationally.
Because of the ban on selling the tissue itself, the U.S. companies that first commercialized the trade adopted the same methods as the blood collection business.
The for-profit companies set up nonprofit offshoots to collect the tissue — in much the same way the Red Cross collects blood that’s later turned into products by commercial entities.
Nobody charges for the tissue itself, which under normal circumstances is freely donated by the dead (via donor registries) or by their families.
Rather, tissue banks and other organizations involved in the process receive ill-defined “reasonable payments” to compensate them for obtaining and handling the tissue.
“The common lingo is to talk about procurement from donors as ‘harvesting,’ and the subsequent transfers via the bone bank as ‘buying’ and ‘selling,’ ” wrote Klaus Høyer, from the University of Copenhagen’s Department of Public Health, who talked to industry officials, donors and recipients for an article published in the journal BioSocieties.
“These expressions were used freely in interviews; however, I did not hear this terminology used in front of patients.”
A U.S.-government funded study of the families of U.S. tissue donors, published in 2010, indicates many may not understand the role that for-profit companies play in the tissue donation system.
Seventy-three percent of families who took part in the study said it was “not acceptable for donated tissue to be bought and sold, for any purpose.”
There is an inherent risk in transplanting human tissues. Among other things, it has led to life-threatening bacterial infections, and the spread of HIV, Hepatitis C and rabies in tissue recipients, according to the CDC.
Modern blood and organ collection is bar-coded and strongly regulated — reforms prompted by high-profile disasters that had been caused by the poor screening of donors. Products made from skin and other tissues, however, have few specific laws of their own.
In the U.S., the agency that regulates the industry is the Food and Drug Administration, the same agency that’s charged with protecting the nation’s food supply, medicines and cosmetics.
The FDA, which declined repeated requests for on-record interviews, has no authority over health care facilities that implant the material. And the agency doesn’t specifically track infections.
It does keep track of registered tissue banks, and sometimes conducts an inspection. It also has the power to shut them down.
The FDA largely relies on standards that are set by an industry body, the American Association of Tissue Banks (AATB). The association refused repeated requests over four months for on-record interviews. It told ICIJ during a background interview last week that the “vast majority” of banks recovering traditional tissues such as skin and bone are accredited by the AATB. Yet an analysis of AATB accredited banks and FDA registration data
Recycling corpses is big business
The business of recycling dead humans has grown so large you can buy stock in publicly traded companies that rely on corpses for their raw materials, a new investigation by the International Consortium of Investigative Journalists has found.
“Skin and bone donated by relatives of the dead is turned into everything from bladder slings to surgical screws to material used in dentistry or plastic surgery,” according to Gerard Ryle, the director of ICIJ, which is a project of The Center for Public Integrity.
Distributors of the merchandise can be found in the European Union, China, Canada, Thailand, India, South Africa, Brazil, Australia and New Zealand. Some are subsidiaries of billion-dollar multinational medical corporations.
ICIJ’s eight-month, 11-country investigation found patients aren’t always told that the product they are getting originated from a corpse. This leads to an even more complex issue – how does the industry source the raw material it uses for its products?
Among our key findings: • Consent: There have been repeated allegations in the Ukraine that human tissue was removed from the dead without proper consent. Some of that tissue may have reached other countries, via Germany, and may now be implanted in hospital patients. • Safety: Surgeons are not always required to tell patients they are receiving products made of human tissue, making it less likely a patient would associate subsequent infection with that product. • Tracking: The U.S. is the world's biggest trader of products from human tissue, but authorities don’t seem to know how much tissue is imported, where it comes from, or where it subsequently goes. The lack of proper tracking means that by the time problems are discovered some of the manufactured goods can’t be found. When the U.S. Centers for Disease Control and Prevention assists in the recall of products made from potentially tainted tissues, transplant doctors frequently aren’t much help. “Oftentimes there’s an awkward silence. They say: ‘We don’t know where it went,’” said Dr. Matthew Kuehnert, the CDC’s director of blood and biologics. The international nature of the industry, critics claim, makes it easy to move products from place to place without much scrutiny.
«We are more careful with fruit and vegetables than with body parts,” said Dr. Martin Zizi, professor of neurophysiology at the Free University of Brussels.
The ICIJ’s investigation relied on more than 200 interviews with industry insiders, government officials, surgeons, lawyers, ethicists and convicted felons, as well as thousands of court documents, regulatory reports, criminal investigation findings, corporate records and internal company memos.
The ICIJ also conducted analysis on registered tissue banks, imports, inspections, adverse events, and deviation reports filed with the Food and Drug Administration, the U.S. agency that polices the trade.
The Mykolaiv regional forensic medicine bureau, where the Security Service of Ukraine is investigating whether employees tricked relatives of dead people into signing consent forms to recover their tissue. Seized documents suggested that the tissue was to be shipped to Germany. (Kostyantyn Chernichkin)
Different mesh sizes double or even triple the size of recovered skin – and therefore the surface it can cover. This is crucial in severely-burnt patients with very limited good skin left (Mar Cabra/ICIJ)
Lyubov Frolova's son died in December and his bones were allegedly taken without her consent. She says, "I have nothing against donation, but it should be done lawfully" (Kostyantyn Chernichkin)
After it is processed, human skin looks similar to thin layers of smoked salmon. Here, it is being meshed before application on a burns patient at Queen Astrid Military Hospital in Brussels, Belgium (Mar Cabra/ICIJ)