Body Snatch­ers

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

Kyiv Post - - Front Page - BY VLAD LAVROV, KATE WILL­SON, MARTINA KELLER, THOMAS MAIER AND GER­ARD RYLE

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.”

‘Our mis­for­tune’

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.

Awk­ward si­lence

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.

Smoked salmon

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.”

Few pro­tec­tions

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)

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