Recent headlines in tabloid and mainstream media outlets refer to “ghoulish” and “macabre” activities allegedly occurring over several years in the Eastern United States.
(See Safety, ethics questioned in tissue transplant industry; Body snatchers of New York; Body-part scandal hits Bay State.)<?xml:namespace prefix = o ns = “urn:schemas-microsoft-com:office:office” />
It is reported that many funeral homes may have been involved, perhaps unwittingly, in the criminal mishandling of human body parts. One of the alleged victims of “body snatching” and mutilation is the famed BBC and PBS broadcaster Alistair Cooke, who died at his New York home in 2004 at the age of 95
Funeral directors and their professional associations are reeling emotionally from the negative publicity of media sensationalism. Some are responding ethically also to the news that even one of their member colleagues might have engaged in such egregious misconduct as is alleged in the brewing scandal.
On Feb. 22, a 122-count indictment was served in <?xml:namespace prefix = st1 ns = “urn:schemas-microsoft-com:office:smarttags” />Brooklyn, N.Y. against affiliates of Biomedical Tissue Services Ltd., based in Fort Lee, N.J.
Four defendants are accused of grave robbery and grand larceny involving the unlawful dissection of potentially hundreds of corpses from which were taken for transplantation or research thousands of body parts: skin, bone, tendons, ligaments, heart valves, blood vessels. Charges include the falsification of medical records and forging donation consent documents.
Indictments were filed against two dissectors along with Joseph Nicelli, an embalmer and licensed funeral director, and his former business partner Michael Mastromarino. “Dr. Mike” had been an oral surgeon but lost his license to practice dentistry in 2000 due to professional misconduct.
Mastromarino’s tissue-recovery company solicited bodies from funeral homes in at least New York, New Jersey and Pennsylvania. BTS may have paid fees of $700 to $1,000 per corpse and sold from each one up to $7,000 of material to legitimate bone and tissue processors in many states.
It is believed that the procurers failed to do requisite medical screening of “donors.” If so, might this protocol omission result in transmission, to transplant recipients or researchers, of HIV, hepatitis, syphilis, and other infectious agents? Subsequent processing protocol and methods make that scenario unlikely, yet the fears being fueled are understandable and not entirely unreasonable.
From bone and tissue processors, to whom BTS sold its goods, body parts are distributed internationally to clinical and research programs. According to the American Association of Tissue Banks, approximately 1 million Americans benefit from transplants each year, ranging from corneas to skin or bone grafts.
Orthodontic and orthopedic surgeons use a paste and implants made from processed bone. Much biomedical research depends on the ready availability of human body parts recovered from BTS and hundreds of other procurement organizations. It is a billion-dollar-per-year industry that begins, in most cases, with a sacrificial gift.
Because of the donation basis for human bone, tissue and organs, first codified by Congress in the 1968 Uniform Anatomical Gift Act, it is a fiduciary enterprise that remains dependent on the altruistic good will of people and maintenance of the public trust. National norms dictate that bodies and/or body parts must be given freely and voluntarily.
Only “reasonable” fees are to be generated by those who then recover, process, distribute and transplant them. Researchers ought to pay nothing or only what is “reasonable” for transfer of cadaveric specimens. They should handle, and ultimately dispose of, all human remains in a respectful manner and in keeping with state statutes.
Funeral directors usually do not have much to do with any of this except for what happens after donation and procurement of body parts. The relationship between procurement personnel and morticians has not always been amicable. The latter are required to “clean up” after the former. Preparation of the body for funerary viewing may be delayed and made more complicated by the organ and tissue recovery process. Good collegial communication and cooperation is necessary if the decedent donor’s family is to be accommodated in their bereavement. In most cases, all goes well, and the various professionals involved with post-mortem practices are making notable efforts to work harmoniously for the common good.
Although the Biomedical Tissue Services defendants allegedly both solicited and removed body parts on funeral home premises, that is uncommon. One industry analyst estimates that much less than 5 percent of recovery operations take place in funeral home preparation rooms rented for that purpose. Even eye enucleation is rarely done by morticians anymore, and few of them are indicating any desire to get involved in solicitation or consenting of organ and tissue donors.
Like the American public in general, most funeral directors likely support the concept of donation, as does overtly the National Funeral Directors Association. But what it means to be supportive, in terms of active or passive involvement, is a matter for professional discernment and deliberation at the present time.
In particular, the New Jersey State Funeral Directors Association, located in BTS’s home state, has become ethically proactive under the leadership of Executive Director Wilson Beebe Jr. and his associate Maryann Carroll.
A special task force was convened in New Jersey in late 2005, shortly after initial reports of a body brokering scandal. The group is comprised of funeral directors, association leaders and representatives from the organ and tissue industry.
Ethics dialogue is facilitated by a clergyman bioethicist from the Center for Practical Bioethics toward the end of drafting and disseminating a guidelines document for NJSFDA members. The membership will be surveyed, also, for attitudes toward and involvement with donation and recovery activities.
At issue, in part, is whether or not funeral homes should enter into direct business relationships with anatomical procurement organizations, and/or which ones. An informative ethics workshop relevant to funeral directors is being planned for the association’s annual meeting in September.
The New Jersey task force is looking at potential gaps in anatomical recovery regulation and oversight on the state and federal level. Its members have consulted with public officials and legislative staff in a coordinated effort to identify and close regulatory gaps—which may be, however, less a matter of insufficient rules than of public funds allocated (especially by the Food and Drug Administration) for ensuring accountability and sanctions.
Preliminary research indicates that if there is a need for more laws and regulations, it probably is in regard to the proliferating entities brokering bodies specifically for research utilizations.
A proactive and ethically responsive approach of this sort, rather than one emotionally reactive, is needed so as to enable funeral directors to participate responsibly in practices achieving benefits for individuals and society. It hopefully will help prevent future scandals involving funeral homes, human bodies and professional violations of the public trust.
Tarris Rosell is program associate with the Center for Practical Bioethics in Kansas City, Mo., and associate professor teaching ethics at Central Baptist Theological Seminary in Kansas City, Kan.