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Insider Trading

Insider Trading: How Mortuaries, Medicine and Money Have Built a Global Market in Human Cadaver Parts

Naomi Pfeffer
Yale University Press
372 pp.
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Donating parts of one’s body, either when alive (e.g., blood, kidneys, or eggs) or after death (e.g., eyes, skin, lung, or heart), is an acceptable and commonplace occurrence in many countries around the world and has been so in both the United States and the United Kingdom for well over a century. But what happens to these tissues and organs after death? How are they obtained and distributed? Who has the right to donate or harvest parts from a cadaver? Do potential donors understand how their donations will be taken and used? Do recipients know what they are receiving?

These are some of the questions Naomi Pfeffer tackles in Insider Trading. Focusing on three organs in particular—the skin, the eyes, and the pituitary glands—Pfeffer delves into the history and practices of tissue procurement and the varied uses of human parts. She also explores the differences in legislation, guidelines, and policies surrounding tissue donations in the United States and the United Kingdom.

Burns and eye damage sustained in combat during World War I propelled the initial collection of skin, as well as eye and corneal harvesting. During the same period, the belief that growth hormone could help people of short stature obtain a more socially acceptable height drove the harvesting of hundreds of thousands of pituitary glands from human cadavers. But as the collection of these tissues began to gain traction, so, too, did questionable procurement practices. In chapter 29, Pfeffer describes a particularly egregious example, in which medical examiners’ assistants in Texas were paid $50 for each next-of-kin agreement they obtained, while county supervisors accepted bids for the right to extract parts from cadavers.

Through trial and error, surgeons and scientists were uncovering the immunology of tissue grafting for much of the 20th century while society was beginning to debate the ethics of acquiring and transplanting human body parts. This ultimately led to the establishment of legal precedents both to ensure that tissues were available and to protect personal rights. The rights of the next of kin  were at times upheld, while at other times, they were denied. In 1985, for example, a mother sued the Georgia Lions Eye Bank after her baby died of sudden infant death syndrome and the child’s corneas were collected without her knowledge or consent. The state court initially ruled in favor of the mother. This decision, however, was overturned by the U.S. Supreme Court, which ruled that there was no constitutionally protected right to a decedent’s body in the state of Georgia.

Cadaver parts, reveals Pfeffer, have become a viable business and are now used for everything from life-saving organ transplants to hip replacements to cosmetic reconstructions. Tissue banks are increasingly adopting a more commercial approach, with some now even offering “off-the-shelf” organs that can be ordered from catalogs.

Pfeffer’s well-researched and enlightening book also includes extensive reference material for those interested in further study. It should be read by transplant recipients, donors and donor families, and legislators.

About the author

The reviewer is at the American Society for Radiation Oncology, Arlington, VA 22202, USA.