In wake of body parts scandal, physicians urged to know cadaver source

The willed body program at the University of California, Los Angeles, is under scrutiny for the second time in nearly a decade, following charges that the director of the program, Henry Reid, allegedly sold hundreds of cadavers and body parts for personal gain.

Ironically, Reid was hired to clean up the program after a container of medical waste and human ashes broke open at sea in 1993, an event that provoked claims that the disposal of donors' remains had been handled improperly since the 1950s.

The UCLA scandal has renewed calls for greater oversight of the human tissue industry, with advocates saying illegal trade in cadaveric material is emblematic of a larger issue.

State and federal laws focus on donations for organ transplantation, leaving room for profiteers dealing with cadaveric material to violate the public trust, tainting legitimate users of human tissue in the process.

Now, some experts say that physicians, who are often the ones using human body parts for research and training, need to play a more active role in monitoring the process.

Todd Olson, PhD, director of anatomical donations at Albert Einstein Medical School of New York and a council member of the American Assn. of Clinical Anatomists, hopes the UCLA scandal will prompt a serious examination of ways to improve the system.

"This is almost a Shakespearean story," he said. "You have at the beginning of the story genuine acts of giving, with people making one of the most precious and valuable donations anyone can make -- your body for the education of someone. On the other end, you have physicians truly interested in becoming better at what they do. Universally, people will say these are wonderful aspects of humanity. In between is where you have a cesspool of profiteering from body parts."

Just how much profiteering is going on is impossible to quantify. Roughly 20,000 bodies are donated to tissue banks each year in addition to the 10,000 given annually to willed body programs. The sale of donated body parts is illegal but there is no limit on what companies may charge for processing the material or transporting it.

Costs can range from $1,000 for a whole body from a public donor program, like the one at UCLA, to $3,000 to $5,000 for one from an independent program such as the Anatomy Gifts Registry.

Prices go even higher for bodies divided up. One surgical training lab director in Florida said he has paid anywhere from $930 to $2,500 for a knee.

When a body is donated to either a medical school's willed body program or an independent tissue bank or donor program, the responsibility for monitoring that body varies from state to state. California, like many states, only regulates tissue for transplantations, so UCLA was primarily responsible for policing its program.

Indeed, in most states it's up to the organization taking the donation to make sure the material is tested for communicable diseases, appropriately stored and distributed for research, educational or commercial uses and then disposed of.

Some experts believe the lack of outside oversight could be fixed by rewriting the Uniform Anatomical Gift Act. Introduced in 1968 the act created national standards for organ donations.

Call for more inclusive standards

Proponents for amending the act want it to set standards for the procurement, use and distribution of all human material.

Karmen Schmidt, PhD, head of the body donation program at Oregon Health & Science University, supports such ideas, since most laws that govern human material were written before the biomedical industry made cadaveric tissue a hot commodity.

"These laws are no longer sufficient," Dr. Schmidt said. "Operating outside the medical institutional venue are a group of companies that are regulated by no one, and there's a lot of money being made."

Joshua Slocum, executive director of the Funeral Consumers Alliance, a nonprofit, educational organization, agrees. The Alliance has asked the National Conference of Commissioners on Uniform State Laws to amend the Uniform Anatomical Gift Act to include the use of all human tissue.

The alliance also wants clarification on the definition of reasonable fees for processing and transportation to prevent padding these costs for inappropriate gain.

"What does professional expertise cost, and when does that become blatant profiteering?" Slocum said. "It's clear there need to be standards where there are not any now."

While new federal and state regulations may be in order, Dr. Olson sees another solution. If those using human parts required vendors to provide documentation on where they got the material, how it will be stored, where it will be used, how it will be disposed of and the costs associated with each of these steps, then 90% of the questionable trade in cadaveric parts would end, he said.

"Is it right for us to ignore this?" Dr. Olson asked. "Are we living up to the standards that we want to promote? I think the answer is no. We hope it will disappear, but it happens again."

He envisions physician organizations insisting on a clear paper trail for the fresh, frozen torsos being used in the seminars they're co-sponsoring. He'd also like to see medical schools collaborate to create a central organization to connect programs that need a cadaver or body part with others who have a surplus.

For the most part, physician efforts, so far, have focused on the living. Cardiothoracic surgeon Robert Sade, MD, a member of the American Medical Association's Council on Ethical and Judicial Affairs who is well-versed on organ donation issues, said CEJA has not dealt with the ethical issues surrounding the use of cadaveric material for research or education.

AMA policy supports having safeguards for the appropriate procurement and use of cadaver organs and tissues in research and education.

"This is something that perhaps we ought to have on our agenda," Dr. Sade said. "It's not now, but perhaps it ought to be."