By Martina Keller and Markus Grill
Anatoly Korzhak, a pensioner and former engineer, died in Kiev on August 5, 2004. His body was picked up at 2 a.m. and taken to the forensic medicine institute in the Ukrainian capital. That same night, Korzhak's daughter, Lena Krat, received a telephone call and was asked to come to the institute as soon as possible the following morning, where she was told she would receive further information.
It was the first time Krat was confronted with the death of a close relative. "I was so upset that I couldn't think clearly," she recalls. When she arrived at the institute in the morning, a man there said something to her about skin transplants. He was an employee of a Ukrainian company that works hand-in-hand with forensic medicine experts. She said to the man: "Leave me alone. I don't understand what you're talking about, and I don't want to listen to you."
But the employee was persistent and eventually gave her a form to sign. He told her that if she consented to skin removal, she would be helping pediatric burn victims who needed transplants. Krat signed the form. "It was as if I had been hypnotized," she says.
But now Krat, a mother of two young girls, has learned from SPIEGEL that the Ukrainian company in question sends the body parts to a German company, Tutogen Medical GmbH, which in turn apparently supplies large numbers of such parts to the American tissue market.
In addition to strips of skin, tendons, bones and cartilage are removed from the bodies. "This shocks me," says Krat. "If I had known that so much is cut out, I would never have given my consent."
A Lucrative Industry
The incident in the Ukrainian capital is part of the secretive daily routine of a little-known but highly lucrative branch of the medical industry, in which companies use corpses to make medical spare parts. In doing so, they reuse almost everything the human body has to offer: bones, cartilage, tendons, muscle fascia, skin, corneas, pericardial sacs and heart valves. In the jargon of the profession, all of this is referred to as tissue.
Bones and tendons, the parts that interest Tutogen the most, are subjected to complex processing. The company degreases and cleans bones, cuts, saws or mills them into the desired shapes, then sterilizes, packages and sells the finished product in more than 40 countries around the world. With a prescription, it is even possible to order Tutogen's products through online pharmacies.
The market for tissue products is still small in Germany. When it comes to bones, for example, experts estimate that only about 30,000 transplants a year are used in hospitals nationwide, mainly for use in bone reconstruction for hip surgery and in spinal column surgery.
It's a completely different story in the United States. According to the American Academy of Orthopedic Surgeons, more than a million bone parts are used in transplants every year. In no other country is it possible to make so much money with body parts. If a body were disassembled into its individual parts, then processed and sold, the total proceeds could amount to $250,000 (176,000). For a single corpse! The US tissue industry generates total revenues of about $1 billion a year, says journalist Martina Keller, a co-author of this article and the author of the German book, "Cannibalized: The Human Corpse as a Resource."
Legal and Ethical Questions
This raises the question of just how legal the process of obtaining raw materials is. And are bone products made from corpses even medically necessary? According to Klaus-Peter GŁnther, president of the German Society of Orthopedics and Orthopedic Surgery, they are often "not the first choice" in operations. "For us, the gold standard is still tissue taken directly from the patient in question."
Alternatives are only an option, says GŁnther, when the material from the patient's body is insufficient. Those alternatives include animal bones and artificial replacement parts made of ceramic material, for example -- or human donor bones.
Many hospitals collect and reuse bone fragments removed from patients who have received artificial hips. "For this reason," says GŁnther, "we have not had to resort to dead donors so far."
In the United States, doctors have fewer qualms about using body parts from corpses than their German counterparts -- in such areas as spinal surgery, sports injuries and cosmetic surgery. For instance, doctors used pulverized skin particles to enhance lips and smooth out wrinkles.
Should corpses be butchered to make cosmetic procedures possible? Ingrid Schneider is against the practice. For the past 15 years the Hamburg political scientist, a former member of the Investigative Commission on Law and Ethics in Modern Medicine in the German parliament, has been involved in the subject of recycling body substances. Schneider argues that the body is not a source of raw materials that can be sold at will. Given such concerns, it is not surprising that many people are deeply opposed to allowing the body of a family member to be reused, even for medical purposes.
Even if it is unrealistic to expect that all commercialization of the body could be ruled out in modern medicine, says Schneider, it is important to set boundaries. For that reason, she insists that human tissue ought to be used sparingly -- that is, only when such use is medically necessary and clearly superior to other forms of treatment.
The conviction that the body is much more than an object has also shaped the policies of the World Health Organization (WHO), the European Parliament and the European Council, the EU's body representing the leaders and ministers of the 27-member bloc. All of these bodies condemn the practice of trading in human body parts to turn a profit.
In Germany, the country's organ transplant act regulates the removal of tissue. Only those who have consented to organ and tissue harvesting are considered as donors. If a person dies and is not already a donor, his or her closest relatives can consent to donation. Paragraph 17 of the transplant act explicitly states: "Trading in organs or tissue intended for use in the medical treatment of others is prohibited." Physicians who remove tissue can only be paid suitable compensation for their efforts. The law calls for prison sentences of up to five years for violation of the trading prohibition.
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