It has become an indispensable part of modern medicine. The calls often come in the middle of the night, and technicians from Tissue Banks International are sent scrambling to hospitals, coroners’ offices and funeral parlors to “recover” medically useful body parts from the dead.
Ghoulish as the work sounds, it has become an indispensable part of modern medicine.
Corneas, tendons and bones from cadavers are routinely used to repair torn ligaments, bad backs, burned skin and a host of other ailments. The demand is so high that suppliers are hard-pressed to meet it.
“There is a huge shortage of donated tissue, especially for those us of us who demand high-quality tissue,” says Dr. Kevin Stone, a San Francisco sports medicine surgeon.
The tissue recovery business goes largely unnoticed until a shocking scandal shakes the industry every few years.
Arrested on suspicion of illegally selling donated tissue
Two years ago, the UCLA director of willed body parts was arrested on suspicion of illegally selling donated tissue. He was never charged, but UCLA shut down its program and the entire industry came under scrutiny.
More recently, a New Jersey company was accused of taking body parts without families’ consent and, again, a scandal hangs over the industry.
TBI represents the industry’s lawful side. This nonprofit tissue processor located in a nondescript office park 15 miles north of the Golden Gate Bridge makes about 300 products that surgeons use.
“This is the best technology going for a lot of surgeons,” says James Forsell, who runs TBI’s processing center.
Forsell has been working in the donated body parts industry for 20 years. As president of the American Association of Tissue Banks, he points out that the New Jersey company was not accredited by the organization.
“This is the worst thing that could have happened”
“This is the worst thing that could have happened,” a teary-eyed Forsell says.
Many of TBI’s workers are foreign physicians awaiting their California medical licenses. The bank was launched by San Francisco’s California Pacific Medical Center in 1986 and processes about 600 cadavers a year. It takes in about $20 million in revenue from the 300 different products it produces.
Body parts donated to TBI must be removed from a refrigerated corpse within 24 hours of death — 12 hours if not refrigerated.
They arrive at TBI in blue packaging about the size of a pillow, packed in dry ice in plastic foam coolers.
Technicians in hospital gowns, goggles and masks working in sterile rooms began ridding the tissue of all living matter.
Marrow is blown from the bone with a high-pressure water spray
Marrow is blown from the bone with a high-pressure water spray and fat cut from muscle with scalpels, scissors and other instruments. The goal is to turn the tissue into inorganic material that can be stored on hospital shelves until needed.
“It’s labor intensive,” Forsell says of this first step. “It’s pretty meticulous work.”
Some tissue, such as spinal bone, is then carved and shaped by an industrial-sized table saw programmed by computer to cut specific shapes popular in back operations.
After the tissue and bone is devoid of living material and cut to the desired shapes and sizes, it is freeze-dried and bottled and shipped to another company to be irradiated.
Most banks briefly zap the tissue with radiation to kill any lingering viruses. Others use a chemical bath, a process preferred by some doctors because they believe it does less damage to the tissue, says Stone, who served as a doctor for the U.S. ski team.
25 percent of operations on the anterior cruciate ligament of the knee now use donated tissue
He says his confidence in the sterilization of donated tissue has increased dramatically over the past five years. About 25 percent of operations on the anterior cruciate ligament of the knee now use donated tissue, he says, and the preferred material comes from healthy, young donors.
Before the technicians can begin operating on a cadaver, TBI administrators review the donor’s medical and social history.
People are disqualified if they were recently released from prison or led a high-risk lifestyle.
The operating team also gives the cadaver a physical exam, looking for piercings, prior injuries and any other signs that the donor is less than optimal for processing.
Ensure a clean history and often the attending physician is consulted
The blood is immediately shipped out to be tested for HIV, hepatitis and other infectious diseases. The medical charts are checked to ensure a clean history and often the attending physician is consulted.
Once TBI begins processing the tissue, the same paperwork goes to the company’s medical director, who reviews it yet again. It seems redundant, but it is necessary to ensure that patients are getting safe tissue, Forsell says.
“The real safety,” he says, “is in the monotonous details of going through the charts and the paperwork.”
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