Body Brokers Page 13

  But Nelson’s clients apparently never raised alarm bells. Nor did Allen Tyler’s clients. After using Nelson, Mitek went on to buy shoulders and knees from Michael Brown’s company. They did what they have always done. They bought body parts wherever they could get them. When one broker folded up shop, they found another willing broker. And the business carried on.

  chapter 7

  The Bone Machine

  For the most part, all bodies undisturbed after death decay in the same way. The rate of decay can vary dramatically according to variables in temperature, humidity, place, and cause of death. But the decay is relentless. As soon as the heart stops pumping, blood settles in the lowermost part of the corpse. The body cools. The muscles relax and then stiffen—first the eyes, then the neck, then the jaw go into rigor mortis. The rest of the body follows part by part.

  By the third day, a green tinge has spread across the torso and down the thighs. Bacteria now devour the flesh. Their foul gas inflates the body, drives the bowel from the rectum, and forces bloody liquid from the nose and mouth. The skin blisters, loosens, and peels.

  By the third week, the heart, liver, and kidney begin to rupture and liquefy. Soon, there is nothing left but bones.

  Early one morning in September 2001, a young man in Utah shot himself. His father found him, lying in his room, a .22-caliber handgun by his side. The young man had been out late the night before. His father had heard him stumble in at around 1:30 in the morning. But no one heard the shot. The medical examiner ruled his death a suicide.

  By the time his father found him, the young man had been dead for almost nineteen hours. The process of decay had begun. While the young man lay dead in his bedroom, Clostridium sordelli bacteria probably broke from his bowel through his intestinal wall and began circulating through his body.

  At the medical examiner’s office, an official approached the young man’s parents about donating their son’s tissue for transplant. The parents agreed and signed the paperwork. Their son, now officially Donor 58600, was transferred to the local tissue bank.

  Once Bart Wheatley of Intermountain Donor Services got the body, he set about locating a buyer. Donor 58600 was well past the twelve-hour time limit that a donor body can remain without refrigeration if its tissue is meant to be transplanted. Wheatley knew right off the bat that several regular customers would turn him down, including the processor that had the right of first refusal on all of Intermountain’s musculoskeletal tissue. It wasn’t even worth making the call.

  But for every corpse—no matter how far gone—there is a willing buyer. Wheatley called CryoLife, a tissue processor in Georgia that paid handsomely. He got a guy on the phone named Matt and gave him all the details. Matt told him to send the tissue of Donor 58600 along. By nightfall, it was packed on ice and on a plane to Atlanta. Cryolife paid $10,500 for the tissue.

  A couple of months later, a section of Donor 58600’s knee would wind up in St. Cloud, Minnesota.

  On the seventh of November 2001, a twenty-three-year-old man named Brian Lykins was admitted to St. Cloud Hospital in Minnesota for what was to be routine knee surgery. Lykins was young, full of hope for the future, a creative man who taught himself to play the piano by listening to tapes of classical music. Lykins had recently moved home to Minnesota to be closer to his family and was taking classes in electrical engineering at a local college.

  Though he was in perfect health, an operation to remove a bone chip in his knee had left Lykins with a quarter-sized divot in his knee. To prevent arthritis in the future and return his knee to its normal state, his surgeon, Dr. Mulawka, suggested that he have another procedure to fill in the gap. Dr. Mulawka explained that he would use a piece of bone donated from a cadaver to repair the hole. He assured Brian and his parents that there was nothing to worry about. It was common to use donated tissue in healthy patients. The tissue, he said, had been tested and was free of disease.

  Because Brian was young and healthy, complications from the procedure were highly unlikely. Dr. Mulawka warned that, at worst, Brian might become slightly sick from the postoperative medications and possibly experience more pain than he had after his first surgery—such reactions were common, but they usually resolved quickly and were followed by a speedy recovery.

  The operation proceeded without incident. No one was surprised when Brian went into recovery in a lot of pain. That was natural after any surgery. But Brian also had a headache and an upset stomach, and he complained to the nurses that he felt hot. When they took his temperature, however, it was normal and his other vital signs looked good. Still, as a precaution, Dr. Mulawka suggested that Brian stay in the hospital overnight. By the time his parents were ready to leave the hospital that evening, Brian was resting comfortably in his room, and the doctor assured everyone that he would be discharged the next day.

  That night, Brian threw up and the pain in his knee got worse. The hospital staff suspected he was having a reaction to the medication, which was being administered through a pain pack inserted in his knee, and the pack was subsequently removed. The next day, Brian was discharged, and by the time he got home, he was feeling much better. His knee was still a little bit sore and he said he felt a little warm, but otherwise, he was starting to feel like himself again. It seemed as if Brian was on the road to recovery.

  Two days later, however, Brian’s condition changed. He began throwing up violently, almost passing out twice on his way to the sink. He complained to his mother that he had that hot feeling again, but when she touched his face, it was perfectly cool. Alarmed, Mrs. Lykins called the hospital and left a message for the doctor. A few minutes later, someone from the hospital called back and told her to change the dosage on one of Brian’s medications. But Brian was feeling unsettlingly sick, so he returned to the hospital to be examined.

  Mrs. Lykins drove Brian to St. Cloud, where he was examined in the emergency room by a nurse and a doctor, both of whom attributed his symptoms to dehydration. They put him on an IV and gave him something to settle his stomach. Still, Brian, whose face had turned a strange shade of gray, wasn’t getting better. He lay in bed, sweating profusely, stripping off his shirt and his blankets. The pain in his knee was unbearable. Twice he doubled over and vomited green liquid.

  Again, the nurse couldn’t find the source of the problem. His knee was not swollen or red. He had no fever. His blood pressure and his heart rate were normal. The doctor ordered a chest X-ray and had blood drawn from Brian. No one knew what to make of his symptoms.

  Around midnight, Mrs. Lykins went out to get some rest in the ER waiting room. Shortly after, a nurse tapped her on the shoulder. Brian’s blood pressure had plummeted unexpectedly. When Mrs. Lykins came into her son’s room, she found a group of doctors working anxiously around him. One of them asked Mrs. Lykins if there was anyone she wanted to contact. Terrified, she called her husband. In the meantime, Brian was transferred to intensive care. His heart was racing and his body was struggling to get enough oxygen. At one point, he sat up in bed and groaned. Then he fell into a coma. By the time his father arrived, Brian’s organs were failing, one by one. His heart was the last to go. At 6:21 A.M., Brian Lykins died—and no one at the hospital could explain why.

  That was before anyone knew about Donor 58600.

  It was several days before the donated cartilage was pinpointed as the cause of Lykins’s death. It was weeks before the journey of Donor 58600 was discovered, weeks before health officials located all of its many pieces, and months before a national investigation by the Centers for Disease Control revealed twenty-five more cases of serious infections in patients who had had similar operations. One of them, a seventeen-year-old boy in Illinois, also received tissue from Donor 58600. The infection nearly destroyed his knee joint.

  It’s likely that none of this would have been discovered if, one day after Lykins died, another knee surgery patient at St. Cloud Hospital hadn’t also died after going under the knife. A few days later, a third person at a different Minn
esota hospital died after knee surgery. These two cases didn’t involve transplant tissue and later turned out to be unrelated to Lykins’s death. But they caused health department officials to take the rare step of declaring a moratorium on elective knee surgery in the state of Minnesota and to launch a major investigation with the CDC.

  Officials hunted everywhere for clues. Fearing the deaths might have been caused by a hospital-acquired infection, they sent out packages of surgical drapes and samples of the iodine solution used to clean Brian’s skin before surgery. They toured the surgical suites, searching for signs of recent construction or problems with ventilation. They scoured surgery records looking for similar incidents—anything that might shed light on what had happened.

  No one was prepared for Lykins’s blood results. In the lab, his blood had grown Clostridium sordelli, which is often found in soil and farm animals. It’s rarely found in humans. Health officials were stumped. “All of us were running to the books,” said Dr. Mei Castor, an epidemiologist at the Minnesota Department of Heath. “It is a very rare thing to find.”

  For weeks, the press ran front-page stories about the case. Citizens were outraged. Patients were worried, and the phones were ringing off the hook at the Centers for Disease Control. Hundreds of people called demanding answers about tissue banking.

  In Wisconsin, Bonny Gonyer read about Lykins in her local paper. She had received a tissue transplant in her knee a few months before Brian Lykins had. She, too, had developed a mysterious infection and could barely walk. Luckily, Gonyer’s doctors cultured her blood in time and discovered Clostridium. They told her they didn’t know what had caused the infection, but they gave her intravenous antibiotics. Slowly, Gonyer got better.

  Then, a few months before Lykins died, Gonyer relapsed. Clostridium, which exists as tiny egglike spores, can live dormant in the body and suddenly awaken. This time, doctors blamed the metal screws they’d used. They performed an emergency operation and replaced the screws. But they left the cadaver tissue inside.

  Gonyer was no longer able to kneel or crawl. She needed someone with her at all times, in case she fell. She couldn’t run around or play with her teenage sons. The household tasks she had once done with ease were now exhausting.

  Still, no one—not even Gonyer—suspected the cadaver tissue in her knee. Then Gonyer read the article about Lykins in the paper. When she confronted her surgeon, she learned that her tissue had also come from CryoLife. But the hospital, never suspecting the tissue, hadn’t reported her infection to the company. If they had, it might have saved Brian Lykins’s life.

  The practice of transplanting human tissue began in the late 1940s as an experiment. Several surgeons had reported success transplanting frozen bone. In 1949, George Hyatt, an innovative orthopedic surgeon at the Naval Medical Center in Maryland, convinced the chairman of the orthopedic department at the Naval Hospital to buy a small freezer and let Hyatt and several colleagues use frozen bone transplants. Hyatt began storing bones removed from patients during surgery, which he and his colleagues used to repair fractures in other patients.

  The experiment was a success. Soon Hyatt and his colleagues needed a bigger freezer. They also needed a more consistent supply of bone tissue, so they turned to cadavers. Because the surgeons were implanting the tissue, the bodies had to be fresh and free of disease. The bodies also had to be unembalmed, so those belonging to medical schools weren’t suitable for Hyatt’s purposes.

  Hyatt had a solution. In 1951, he and his colleagues set up a body-donation program. They didn’t limit themselves to bones. They removed many types of tissue, including fascia, veins, skin, and corneas. They also opened a special operating suite to harvest the tissue. By the end of that year, the Naval Tissue Bank had procured tissue from fifteen cadavers. Soon they were supplying tissue to civilian hospitals.

  Hyatt offered the tissue free of charge. In return, he asked only that the surgeons report back with their results. With their input, Dr. Hyatt and his colleagues at the tissue bank constantly refined their approach. Between 1950 and 1980, they pioneered methods—none of which Hyatt bothered to patent—for disinfecting tissue, for freeze-drying it so that it would last longer in transit, and for screening donors for disease.

  The Navy tissue bank soon gave rise to other tissue banks. Many hospitals established their own bone banks. If a surgeon needed bone to repair a joint, for example, he simply went to the freezer, removed a piece of bone, and ground it up or shaped it with his scalpel into the size he needed for a given operation. Many hospitals with burn centers also set up their own skin banks for treating burn victims.

  When the U.S. Navy Tissue Bank finally closed, others took its place. During the 1980s, nonprofit community tissue banks began popping up all around the country. Tissue-bank employees approached the families of people who had died in local hospitals about tissue donation and then made the donated tissue available to local doctors.

  As the amount of available tissue grew, so did its uses. Surgeons routinely used cadaver ligaments and tendons to treat sports injuries. They discovered they could use cadaver menisci to replace torn menisci in the living. They cut cadaver tibia into new shapes to replace herniated discs in the spine. They ground up cadaver bones into chips to help rebuild fractured jaws and to support dental implants.

  Soon, for-profit companies joined the fray. Entrepreneurs saw the growing demand for tissue. They also saw that none of the basic techniques of the field had been patented. They set themselves up as “processors,” middlemen who bought tissue from the nonprofits and cleaned it. Each company used a different process to rid the tissue of bacteria, many of which they copied directly from Hyatt. Some used gamma radiation. Some used antibiotics or disinfectant cocktails. Then they packaged the tissue and distributed it to hospitals. In 1984, CryoLife became the first big processing company on the scene. Osteotech followed in 1986. Both are now very profitable companies.

  By the early 1990s, tissue banking was becoming an industry. Profit-driven processors patented their cleansing cocktails and created “product lines” from human bone, transforming it into highly lucrative, ready-made products like bone paste and screws, chips, and dowels. They wrapped these ready-made products in glossy packaging and marketed them to hospitals just as they would any other medical device.

  Still, there was no oversight by the U.S. government. Without regulation, some companies did as they pleased, cutting corners on safety to increase their profits. By the time Brian Lykins died, CryoLife had stopped culturing its tissue before immersing it in an antibiotic rinse. Pretesting is an important step in tissue processing. A company like CryoLife, which used a special antibiotic rinse, needed to establish the amount of bacteria on the tissue before it could decide how to treat it. What’s more, the rinse could have created false negatives; if there had been bacteria on it at some point, the company might not have known. A 1997 memo from the company’s quality-assurance officer suggested the company stop the testing step as a cost-saving measure.

  It took the death of Brian Lykins to bring about real change. In May 2003, Senator Susan Collins of Maine held a senate hearing demanding that the FDA finalize regulations that it had proposed years before to ensure tissue safety.

  In 1993, the FDA issued an interim rule, implemented five years later, which required tissue banks to screen donors for risk factors and to test their tissue for HIV, hepatitis, and certain communicable diseases. Finally, in 2004, the agency also began to require tissue banks to report deviations in manufacturing and to follow specific safety practices.

  Still, no one has proposed legislation that goes beyond the monitoring of tissue safety. There has been no movement toward regulating the business as a whole. The Uniform Anatomical Gift Act of 1987 prohibits the buying and selling of tissue, but this law is not enforced. Unlike organ-procurement groups, tissue banks are not required to be nonprofits. No one audits their finances. And although tissue banks receive donations from the public, they still aren’t requi
red to disclose anything to donors.

  Current regulations don’t address conflicts of interest, either. There’s nothing preventing a funeral director or the owner of a crematorium, like Michael Brown, from opening his own transplant tissue bank and soliciting bodies from grieving families so he can sell the tissue for cold, hard cash. Competition for bodies has led tissue companies to collaborate with funeral directors and brokers from the underground trade. Together, they are funneling bodies into the transplant pipeline, an endeavor with far more dangerous consequences than that of someone like Michael Brown.

  One day, I called up a funeral director I know named A. Gray Budelman. “I’ve got to talk to you,” he said as soon as he heard my voice.

  Budelman and I were friendly in the funny way that a reporter is friendly with a good source. I had interviewed him once about the funeral business, and finding him to be an engaging conversationalist, I called him every so often to chat.

  Budelman has a history in the cadaver trade. In the 1980s, he transported surplus corpses from a medical school in North Carolina to other medical schools in the Northeast. “I used to bring them up driving. A hundred at a time,” he told me. “I used a tractor-trailer.” Budelman knew John Vincent Scalia—“Johnny,” as he called him. He also knew Richard Santore, but unlike Santore, he had never threatened to strangle me.

  But Budelman did like to shock me. Once, when I visited him in his wood-paneled New Jersey office, I found him sitting at his desk, poring over the obituaries. “These are my financial pages,” he explained.

  “Really?” I asked.