On August 24, 2021, 98-year-old David Saunders died from COVID-19 at a hospital near Baton Rouge, Louisiana. Nearly two months later, on October 17, he was publicly dissected in front of hundreds of spectators in a Marriott hotel ballroom in Portland, Oregon.
When news of the event reached the Saunders family, they were shocked. His wife Elsie told one reporter, “As far as I’m concerned, it’s horrible, unethical, and I just don’t have the words to describe it. I have all this paperwork that says his body would be used for science – nothing about this commercialization of his death.” Her words reflect an assumption that many Americans likely hold: the use of human cadavers for scientific purposes is noble, but any hint of commerce renders the practice dirty. In truth, body donation today is a multifaceted enterprise that mixes altruism, the promise of science, and outright profiteering.
How did this violence to David’s body come to pass? Elsie tried to donate his remains to Louisiana State University but was rejected because of his COVID-19 diagnosis. Instead, she worked with a local funeral home, Church Funeral Services, to give the body to Med Ed Labs, a Las Vegas–based company that buys and sells human cadavers for medical and surgical education. The lab sold Saunders’s body to Death Science, a company that normally makes its money providing “eCourses” on forensics and death investigation. Although representatives from these companies have not disclosed the price paid for Saunders’s remains, Med Ed Labs charges an estimated $10,000 for a full cadaver. Death Science charged attendees of Saunders’s autopsy up to $500 a ticket, which were sold through the Oddities and Curiosities Expo website.
Companies like Med Ed Labs benefit from the good will that anatomical donation has engendered in the last seventy-five years. Regulated body donation programs in the United States developed during the twentieth century, marking a significant turn away from the illegal graverobbing used by early American medical schools to find “material” for dissection. Initially, states passed anatomy acts to provide medical schools with unclaimed bodies from the morgue, but this supply could be inconsistent. By the 1950s, poor families relied on mutual aid societies and Social Security to offset the costs of burial, decreasing the number of available remains. Public concerns about the rising cost of funerals also helped shift cultural attitudes toward donation. The 1968 Uniform Anatomical Gift Act, a federal law passed in response to the rise of transplant surgeries, helped standardize who could donate bodies and who could receive them. Today, we celebrate donation as a noble sacrifice, and many companies rely on this to acquire their materials. For example, the company ScienceCare celebrates that “body donors pave the way for the medical community to help future generations live longer, healthier lives.” With the average American funeral costing over $7,000, many families choose donation as a low-cost option. In 2019 alone, an estimated 20,000 people donated their bodies to science.
The reality of donation, though, can be murky. Most individuals imagine donation to a medical school, called anatomical donation or whole body donation. In these instances, cadavers are dissected by medical students, though some institutions, such as the Mayo Clinic, may use bodies for research. Donated remains are cremated or buried after several months, and schools often hold an annual ceremony to honor their donors. For organ donation, there are nonprofit organizations, such as LifeBanc, that specialize in procurement and transport. Organs are surgically removed at the hospital, to keep them sanitary and undamaged; tissues, such as corneas and heart valves, can be removed at a hospital, funeral home, or medical examiner’s office. In these cases, families may still hold a funeral for their deceased because embalmers use special techniques and products to hide the visual evidence of procurement.
A third form of donation, less well known by the public, is to companies that sell, rent, or lease “raw material” to others for profit. These companies, called non-transplant tissue banks, are often non-accredited and mostly unregulated. The employees of these companies – “body brokers” – are middlemen who acquire cadavers, dismember them, and ship the parts to private corporations, researchers, physicians, and hospitals for education and research. These companies provide material to physicians who prefer to do experiments and practice surgical techniques on real human tissue. Although virtual simulation and 3D printing can mimic human tissue, many see these as poor substitutes. For instance, a 2012 study concluded that laparoscopic training on “fresh-frozen cadavers” was better than simulator training. While some of these companies hold themselves to high standards via accreditation from the American Association of Tissue Banks, others use unscrupulous practices. For example, a multiyear series published by Reuters uncovered a 2015 case in which a worker from Southern Nevada Donor Services (now defunct) thawed a human torso in broad daylight outside the company facilities in Las Vegas.
While not all non-transplant tissue banks operate so carelessly, the experience of the Saunders family demonstrates the “Wild West” nature of many of these operations. There is no central agency that tracks or monitors donated bodies. There are rarely laws in place that can be used against these companies to halt operations. Fines and citations are usually the only punishments. Similarly, there are no legal restrictions on the use of cadavers or body parts in educational seminars held in nonmedical facilities, including hotel ballrooms like the one Saunders was dissected in. Where laws are in place, they are rarely enforced. This stands in stark contrast to other forms of donation, which are very heavily regulated at the federal and state level. Both the 2006 revision of the Uniform Anatomical Gift Act and the 1984 National Organ Transplant Act prohibit the buying and selling of body parts. However, these laws focus specifically on transplant organs, creating loopholes for other forms of donation. In addition, prohibitions on the sale of human remains still allow for brokers to recover their costs, so they use such terms as “fees for service” to get around the law. By and large, these companies conduct their business as an open secret because of these legal ambiguities and a lack of regulatory oversight.
The larger problem, however, is the exploitation of donors, many of whom are poor. Brokers work with hospitals, nursing homes, hospices, and funeral homes to locate donors. They often approach patients during their illness or talk to the family immediately after a death, catching people in a vulnerable moment. For poor families, these companies seem like a godsend: they accept bodies that may be too obese or unhealthy for medical school donation and many offer a no-cost cremation. For example, Richard Saunders (no relation to David) told Reuters that he donated his son Cody’s body to a company because “he couldn’t afford nothin’ else.” In some cases, companies will pay referral fees to funeral homes in exchange for access to patients or their families.
But the Saunders story raises questions regarding how much these families understand about the choice they’ve made. Few companies have their consent forms online (interested donors must register before receiving more information). One available form is clear that bodies may be segmented and disarticulated. However, other companies may be less transparent. In 2019, several families won a lawsuit against Biological Resource Center, Inc. for fraud, claiming they were unaware that the bodies would be “chopped up,” co-mingled, and used in violent experiments like ballistics testing. Such lawsuits raise significant questions about “informed” consent in donation. Who has the responsibility to protect donors and their families?
In early 2021, Bobby Rush (D-IL) and Gus Bilirakis (R-FL) introduced federal legislation to address the problem of body brokers. The Consensual Donation and Research Integrity Act of 2021 would give the Secretary of Health and Human Services oversight over non-transplantable donations, to create a chain of custody for remains and ensure proper handling and disposal. But changes in the law are not enough. We need only look at the funeral industry to see this: Congress passed the 1984 Funeral Rule to create more transparency in funeral pricing, but most Americans remain in the dark about their options. While more regulation is necessary, it is also imperative to educate consumers and change the conversation around death. Many Americans don’t like to discuss death, but our denial actively helps body brokers profit.
For the Saunders family, resolution only came because of public outcry. David’s remains returned to Baton Rouge in early November, where he received a proper funeral. But that should not be the end of this story. We need change. So many people involved in this case were secure in their assumption that what happened was all above board. Even as Church Funeral Services, Med Ed Labs, Death Science, the Marriott, and the Oddities and Curiosities Expo point fingers at one another to distance themselves from the controversy, it is important to remember that this happened because the donation market operates unchecked. I hope that David Saunders’s donation will lead to a greater contribution to science than he ever imagined: real, lasting change to this system.
- Ann Garment, Susan Lederer, Naomi Rogers, and Lisa Boult, “Let the Dead Teach the Dead: The Rise of Body Bequeathal in 20th-Century America,” Academic Medicine 82 (2007): 1000–05. ↑
- Garment, et al., 1002. ↑
- Annie Cheney, Body Brokers: Inside America’s Underground Trade in Human Remains (Broadway Books, 2006), 8. ↑
- Cheney, Body Brokers, 8. ↑
- Joshua L. Slocum, “The Funeral Rule: Where It Came From, Why It Matters, and How to Bring It to the 21st Century,” Wake Forest Journal of Law & Policy 8 (2018): 94. ↑