Med Examiner's Office Has Secret Body-Parts Deal
By Tom Mashberg
Originally published in the Boston Herald, May 20, 2002
The cash-strapped state Medical Examiner's Office has a secret contract with a company that harvests body parts from donors without telling their next-of-kin the remains are often used for lucrative cosmetic surgery, documents reviewed by the Herald show.
The contract, with New England Eye & Tissue Transplant Bank, has since 1996 guaranteed equipment, staff and cash to the notoriously undermanned M.E.'s office—despite two outside audits since 2000 calling the arrangement a "conflict of interest."
In exchange, NEETTB has immediate access to the names of deceased who are prime candidates for tissue donations.
The father of a 20-year-old East Falmouth man who died in a car crash in April 2001 said yesterday he was disturbed he had not been informed of the commercial aspects of donations when phoned by the New England Tissue Bank.
"If I'd known that, I would have insisted he not be used for someone's profit," said Norman Sizelove, a computer programmer who lost his eldest son, Robert, to an automobile accident on Route 151.
"I remember the call," he said. "It wasn't a good time. I just listened. There was some kind of legal spiel about using the tissue for transplantation, or for medical research, but nothing about for-profit use. We told them 'yes.' It seems that they left a few facts out."
Under the six-year-old secret arrangement, paid employees of the tissue bank, stationed at the M.E.'s office, fill out the highly sensitive "case report" intake forms used when sudden or suspicious deaths must be reported to the state.
They immediately fax the forms to the tissue bank's Boston headquarters, using equipment given to the M.E.'s office by the tissue bank as part of the contract.
The forms, which are subject to state privacy regulations, are considered evidence under state law. They are replete with Social Security and family telephone numbers, and intimate details about the deceased.
Tissue bank staffers promptly call grieving next-of-kin to request organ or tissue donation. The calls must be made within 12 hours because of decomposition, and in some cases have come before the next-of-kin knew of the death.
The staffers read from consent forms which make no mention of the for-profit uses for a donor's body parts—including breast, lip and penis enlargements, as well as non-cosmetic elective procedures.
The tissue-recovery industry has become a billion-dollar business in the past decade. Companies can earn $200,000 from one cadaver, industry analysts say.
In fact, the standard one-page form used by New England Eye & Tissue Transplant Bank says nothing of for-profit uses for donated tissue, bone and teeth.
The closest it comes is this clause: "If the organs or tissues I/We have donated for transplantation and therapy cannot be used for those purposes, I/We agree that those tissues may be used for: Medical research (yes/no); Education (yes/no)."
Minutes of an Oct. 10, 2001, staff meeting at NEETTB show that the nonprofit's relationship with a variety of for-profit processors of human parts is a strategic focal point for the Boston-based business.
The minutes say Tissue Banks International (TBI), the multinational Baltimore-based parent of NEETTB, "has made providing skin to Collagenesis a priority."
Collagenesis is a Beverly-based medical company that turns cadaver skin into collagen and other plastic-surgery-related products.
"Each Donor will be evaluated on a case-by-case basis with the goal of sending Collagenesis a minimum of 2 to 3 Donors a week," the NEETTB minutes read.
Perry L. Lange, vice president of LifeNet of Virginia, a pioneering nonprofit tissue bank, said his company makes informed consent of donors and families a business priority, and strains to avoid any appearance of conflict of interest.
He said many donors imagine their skin and body parts will go solely to help burn victims and others in dire need, and should be fully informed that there are multiple uses beyond the philanthropic.
While not commenting specifically on NEETTB, Lange said it was vital that the industry as a whole avoid any implication that it would set quotas on delivery of donor tissue to the for-profits.
"We very strongly believe the actual process of obtaining consent, and of tissue recovery, must be handled by a not-for-profit with no ties to a for-profit," he said. "Donors must be given the opportunity to say 'no' to for-profit uses of body parts free of any pressure or possible ulterior motive."
The presence of NEETTB employees inside the Massachusetts Medical Examiner's Office dates to an August 1996 contract between Chief Medical Examiner Richard J. Evans and Gerald J. Cole, executive vice president of TBI.
Under the deal, TBI agreed to pay the M.E.'s office a lump sum of $100,000, as well as $4,000 per month, to allow NEETTB to place an on-site donation coordinator, as well as four or five "case-taking specialists," inside the office.
An executive summary memorializing the deal, also reviewed by the Herald, reads: "The case-taking specialists are responsible for collecting case data (from police, medical and fire personnel) and generating official case reports… .
"The transplant agencies benefit from more timely referrals of potential donors … and, most importantly, increased numbers of organ and tissue donors from medical examiner's cases," it reads.
A letter sent to the M.E. staff by Evans, dating from the same time, says he or his designated subordinate must be consulted before any coroner or assistant medical examiner seeks to deny an organ or tissue donation in a specific case.
"This agency will make all agency resources available to maximize organ/tissue donation whenever possible," Evans writes.
The M.E.'s office is under the jurisdiction of the Executive Office of Public Safety. Officials there referred calls Friday to a state police lieutenant who is assigned to the M.E.'s office. That official did not return a message left on Friday.
Similar arrangements between medical examiner's offices and tissue banks in other states, notably California, have led to lawsuits and mandated state or federal reforms so donor families are fully apprised of where cadaver parts go before donations are approved.
Lange said the presence of tissue bank workers inside M.E.'s offices is "not common but not rare." He added there is "potential conflict of interest" in the arrangement.
The National Association of Medical Examiners was more emphatic. In an October 2000 audit of the state M.E.'s office, it wrote: "This results in a clear conflict of interest." A separate audit of the office by Dallas Associates, a management consulting group, issued the same verdict in March 2001.
In 2000, after articles in the Orange County Register exposed the connection between nonprofit and for-profit tissue recovery companies there, and the lax regulation of non-organ donations, the federal government stepped up efforts to regulate the industry.
Some nonprofit tissue recovery companies have halted sending cadaver skin to companies that manufacture collagen for cosmetic purposes. In 2001, the American Association of Tissue Banks, an industry trade and accreditation group, vowed that the for-profit uses of body parts would be made known to donors or their kin when tissue solicitations were made.
"Most agencies are now up-front with families," said Lange. "If you can find a case where they are not that is a violation of standards."
