Insider Trading: How Mortuaries, Medicine and Money Have Built a Global Market in Human Cadaver Parts by Naomi Pfeffer - review by Rose George

Rose George

Life After Death?

Insider Trading: How Mortuaries, Medicine and Money Have Built a Global Market in Human Cadaver Parts


Yale University Press 358pp £18.99 order from our bookshop

You may think you are a human being, but in fact you are a warehouse in waiting. You are a shop of products, of bone dowels and bone paste, of membrane and veins, of acellular skin products. Nearly everything you are can be repurposed, and is.

Corpses have always made for rich pickings. Graverobbers and bodysnatchers may seem lurid and historical, but their trade is not: a human corpse has never been more useful or productive than now in the age of biotechnology, though the clients for cadaver stuff, as the stuff from cadavers is known with pleasing pragmatism (there’s no funeral industry whimsy in the cadaver industry), are not gentleman students in bloody aprons but huge bioprocessing companies with names like LifeCell and RTI Biologics. ‘It is safe to hazard’, writes Naomi Pfeffer, ‘that very few of the many millions of American and British people who have volunteered as posthumous organ donors have envisaged skin being peeled off their corpse, processed, sliced, packed in plastic sleeves like American cheese and retailed as a branded dressing of chronic leg ulcers.’

Modern donation campaigns and appeals focus rightly on organ donation: there are never enough organs. But a cadaver can and does offer so much more, and they never ask us for that. Pfeffer has done an admirable job of exposing the unheralded stuff that our bodies can provide, and the huge profits that can be generated from bones, membrane, skin, eyes, veins and brain matter.

Medicine’s search for dead bodies with parts available for harvesting is called bioprospecting. It always comes up against an essential supply problem: there are plenty of dead bodies, but how can they be accessed? Getting consent is time-consuming, unpredictable and expensive. For a long time this was dealt with by not bothering to seek it. In 1921, the embryologist Herbert McLean Evans discovered that rats given ‘a soup of anterior lobes’ grew three times heavier than untreated littermates. This was the beginning of the growth hormone craze, which lasted until synthetic growth hormone was developed. Any gland could yield useful hormones; Evans went so far as to stand beneath some gallows and ‘without bothering to take the dead man’s trousers down or waiting for the attending doctor to hold up his hand to indicate that the heart had stopped beating … used scissors and knife to cut off the scrotum’. Evans defended himself by saying he only cut off the testicles of prisoners who were unclaimed by kinfolk. Later, much cadaver stuff was reaped by allowing the person lawfully in charge of the corpse to authorise harvesting if he or she thought there was no objection. To ascertain this, they simply had to make ‘a reasonable enquiry’. In law, mortuaries became a ‘no-place’, where corpses had no rights. Penalties for misuse of bodies were scanty. The UK Human Tissue Act of 1961 didn’t bother to include any penalties for the theft of body parts because the law did not recognise a right of property in the human body.

Pfeffer’s medico-legal focus is impressive but can be exhausting. Should you be interested in the finer details of when Medicare authorises reimbursement for the repurposing of cadaver stuff, you will be happy. Despite the ‘global’ tag of the subtitle, the focus is Anglo-American, and the book jumps back and forth from one side of the Atlantic to the other, from body part to body part, often with little obvious reason. I was frequently left confused by characters who are mentioned once then reappear several chapters later, with no reminder of who they are.

These are distractions from the main material, which is a shame, because what extraordinary material Pfeffer has uncovered. She describes the work of the technicians, the medical staff and the totally unqualified who slice off skin with a dermatome (like ‘a potato peeler’) or a trephine (‘similar to a biscuit cutter’). In the 1960s, US mortuary technicians on pitiful salaries were paid $2 by the National Pituitary Agency for each pituitary gland they removed (its UK counterpart stored its gland collection in the Protein Hut on Tennis Court Road in Cambridge). In 1976, one in eight British corpses placed in a cemetery was without a pituitary gland. In 2006, the enucleator (a person who collects dead eyes) covering the Corneal Transplant Service for the southeast of England, an unnamed woman who drove around ‘in her own car’, collected 549 eyes from Queen Victoria Hospital in East Grinstead alone, an ‘outstanding record’. One of my notes reads simply ‘Scottish baby thigh TWOC’. Perhaps Pfeffer’s clinical tone is catching, though my note seems callous when I consider the depths of grief provoked by the scandals involving Bristol Children’s Hospital and Alder Hey, in which these institutions were found to have taken thousands of body parts from dead children without consent. Those two were only the worst cases. When the NHS chief medical officer organised a survey in 2000, it was found that British hospitals had retained 54,000 cadaver fragments, 9,800 of them from children below the age of 16.

We like to think that law and practice is now profoundly respectful of our dead, that everything operates carefully and strictly according to the consent of either the dead or dying (‘first-person consent’ or ‘donor designation’) or the next of kin. Yet as recently as 2005 the broadcaster Alastair Cooke’s bones were stolen and sold on to processing companies by a body-harvesting gang that made $4.6 million from illegally taking organs from some 1,077 corpses. The bones, ligaments and tendons of Joseph Pace, another victim, were sold for $5,650 to Regeneration Technologies; his skin was bought by LifeCell for $2,364.

Even when unscrupulous funeral homes are not illegally selling off body parts, there is nothing in US law to prevent a donated corpse from being turned into profit by processing companies. In 2003, there were 70,000 ‘bioavailable’ corpses in the USA. Some 6,057 had their organs explanted, 40,000 had their eyes or corneas extracted and 23,925 were disassembled. In 2004, a square foot of cadaver skin fetched between $250 and $500; a corpse can provide 3.5 square feet of the stuff. Nor are our body parts always put to the noble uses we may imagine: liquid Cymetra, a Lifecell product created from acellular cadaver skin, can be used to strengthen vocal cords but also as a dermal filler. Cadaver Botox.

This may seem tawdry and far from the conventional heroic narrative of organ donation. But cadaver stuff, in various forms, can relieve incontinence, repair burns and generally do good. Every organ donation, I think, is heroic. I was already registered to donate everything. Pfeffer’s diligent research has enlarged my mind but not changed it, even if I do become a bone burger.

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