Cadavers – Part 1

ANATOMY CLASS: Everyone that you will be dissecting willfully donated their bodies when they were alive, or their families donated after they passed away.

This is an anatomy class at Georgetown University School of Medicine.

ANATOMY CLASS: It is not a morbid curiosity to learn what is inside of us, or to work with a dead person.

A professor is briefing a classroom full of anxious students in blue scrubs. They are about to embark on a rite of passage: Their first dissection of a human cadaver.

ANATOMY CLASS: If you hit the perfect layer, then it just pulls right back. See how there’s kind of that little bit of white there? That connective tissue?

We learn about how human bodies work by studying dead ones. And not just in the classroom. Researchers use cadavers to study chronic illnesses; medical device makers use them to test out new tools; the military blows them up to measure its explosives.

Science, education, and technology all rely on a steady stream of cadavers. And a lucrative, for-profit industry has arisen to fill the demand.

GOODWIN: Last year alone, we placed more than 45,000 specimens for research, training and education in 50 countries worldwide.

For the Freakonomics Radio Network, this is The Economics of Everyday Things. I’m Zachary Crockett. Today, part one of a special two-part story: Cadavers.

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To understand how cadavers became a commodity, you have to go back a few hundred years, to a time when the study of anatomy was still considered a taboo.

LAWRENCE: In Western history, modern anatomy really begins in the 14th century. It is the first time that humans have access to other humans to dissect.

That’s Susan Lawrence. She’s a professor and head of the history department at the University of Tennessee, Knoxville. She studies the history of cadavers — she has a book coming out on the topic with her fellow historian Susan Lederer. Lawrence says that in the Late Middle Ages being dissected was considered the ultimate punishment.

LAWRENCE: The only bodies available were the bodies of executed murderers or other felons. A lot of people believed in the literal physical resurrection of the body. The idea that the body would be dismembered was particularly abhorrent. This would terrorize or deter other criminals from committing these heinous acts.

The dissections of those criminals were public spectacles with little educational value. But as interest in anatomy grew over the next few centuries, scholars began to realize that watching a demonstration wasn’t enough. They needed to do hands-on training.

 LAWRENCE: So they started setting up cadaver labs, or places where students could come to dissect. And it’s at this point wherein the supply of bodies of executed criminals is not enough to deal with the number of students who want to do dissection and to really learn anatomy.

In other words, they needed more bodies. And, to get them?

LAWRENCE: That’s when grave robbing really takes off. You know, it’s the stuff of horror shows. It’s the stuff of Frankenstein. There were basically gangs of men who would target the graves of the poor because they would not have been guarded very well. They would just dig one little hole. You didn’t have to unearth the whole grave. You just got down to the head and then pulled the whole body out.

By the early 1800s, robbing graves for cadavers was a big business. Bodies could be unearthed in less than an hour and sold to universities for the equivalent of around a thousand dollars in today’s money. Some doctors and medical students dug up graves themselves.

LAWRENCE: People got away with it for quite some time. Every once in a while somebody would get caught and then there would be, you know, a ruckus. But pretty much people either didn’t know what was happening or they turned a blind eye.

A few suppliers of cadavers even preyed on the living.

LAWRENCE: In Scotland there were two grave robbers who decided that grave robbing was an awful lot of work. And so it would be much easier just to kill people to provide very fresh bodies to the anatomists. And they got away with something like 16 murders over a period of 10 months, among the very poor and the vagrants and the down and outs — people that they thought wouldn’t be missed.

Around this period, American medical schools began teaching anatomy courses for the first time. And they too obtained their cadavers by nefarious means.

 LAWRENCE: They often use the bodies of slaves. And the bodies of poor, free African-Americans. And they, again, didn’t raise a whole lot of political fuss. It was when, you know, the bodies of white people were involved that the community got more incensed

Grave robbers eventually started going after wealthier citizens’ graves. And only then did it become a hot-button political issue in America. The result was a series of state laws that granted medical schools access to unclaimed bodies from prisons, hospitals, and city streets. The decision was driven by economics.

LAWRENCE: If you died on the street or if you died in a public institution the burial would be done with taxpayer money. The medical school has to now pay for the body. And the disposal.

Cadavers were sourced this way for the next century. But in the 1950s, things began to shift. Americans had become less superstitious and more supportive of medicine, thanks to breakthroughs like the first human organ transplants. At the same time, there was a growing distrust in the modern funeral home industry, which had made dying very expensive. The public began to rally around the idea of willingly donating their bodies to science.

There was just one problem. Technically, it was illegal to donate your own body. So, in 1968, legislators enacted a federal framework called The Uniform Anatomical Gift Act.

LAWRENCE: The Uniform Anatomical Gift Act of 1968 was designed to enable organ donation. The whole-body donation part is simply kind of left over from that — that you can donate your body not only for organs, but also for research and for education. So it’s kind of an umbrella act that allows multiple uses of the body.

Versions of this act have since been instituted by nearly every state in America. They generally define a human body as property, and give Americans the right to donate that property to an organization of their choice. But those laws came with an unintended side effect: a new generation of for-profit companies that can obtain and sell cadavers, with very little oversight. That’s coming up.

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Now that it’s legal to donate your body to science, U.S. medical schools have their own body donation programs. If you bequeath your body to Georgetown, for instance, the university will give you a donor card to put in your wallet, and when your time comes you’ll be frozen in a lab and put to use within 30 months. Georgetown receives around 120 donated cadavers every year, and it currently has 4,500 living donors signed up. University donor programs like this are strictly not-for-profit.

But, if you don’t want to end up in a classroom, you have another option: you can give your body to one of America’s many for-profit body donation companies, who collect bodies and sell them to third parties.

GOODWIN: We are very transparent about being a for-profit organization. And we are also quick to remind people that funeral homes, crematories — those entities are in most cases also for profit organizations.

That’s Kaylan Goodwin. She’s the vice president of marketing at Science Care.

GOODWIN: We are the world’s largest program that’s dedicated to the facilitation of body donation for scientific purposes.

Science Care opened its doors for business in Arizona 23 years ago. It was started by a funeral insurance salesman who saw an opportunity to be a cadaver middleman. He’d seek out willing donors, then sell their bodies to businesses that had a need for them. The firm grew to around $30 million dollars in annual sales before it was acquired by a private equity firm in 2016. Today, Science Care has seven donation facilities across the country, and it accepts bodies in most states.

GOODWIN: We have as of yesterday, more than 257,000 people registered with us that intend to donate their body to science.

Science Care attracts these donors by marketing body donation as an altruistic act.

​​GOODWIN: So one particular campaign that I’ve worked on this year is the concept of “There’s a hero in us all.” And the idea is helping people understand that we all have this opportunity at the end of our lives to help our bodies go to expand the knowledge and awareness of our inner workings for the benefit of our future generations.

But like other body donation programs, they also offer material incentives.

GOODWIN: All accepted donors in the Science Care program receive free cremation at the end of the program. Anything that’s not collected for active projects, research opportunities, etcetera, is cremated and returned to the designated recipient.

According to Susan Lawrence, companies like Science Care will often say they provide a service — not a product.

LAWRENCE: That’s kind of the umbrella that these for-profit companies are operating under, is that they’re not actually buying and selling body parts. They’re just selling that process. It is the reimbursement costs for the difficulty of securing the body, preparing the body transporting the body, all of those things.

GOODWIN: The body is looked at as a whole, and then matched with those different studies and educational opportunities at the time of their donation. 

But unlike live organ donation, which has strict federal oversight, bodies donated for education or research purposes are largely unregulated. There are no laws against selling them. Sometimes, bodies are sold fully intact to medical schools that have cadaver shortages, either in the U.S. or abroad. But more commonly, the body is cut up into parts — forearms, torsos, heads, knees — and sold to multiple entities.

GOODWIN: It’s able to be separated in a way that honors their life and their decision, but also goes to the fullest extent. We collaborate with medical device manufacturers, research organizations, medical professional associations, pharmaceutical companies, and world-renowned medical teaching and training organizations worldwide.

Cadaver workshops — or so-called wet labs — are a particularly lucrative market for body parts. When medical device manufacturers design a new tool, or when surgeons come up with a new procedure, it needs to be tested — often in bulk, which means the researchers need a specific body part in large quantities. Collectively, body parts from a single donor can generate anywhere from $5,000 to $10,000. A lot of good things come out of these partnerships.

GOODWIN: Science Care donors over the years have aided in cancer research, Alzheimer’s research, the development of new drugs, biomechanical testing that helps us develop new medical devices. The research and development for patient care outside of surgical or emergency training wouldn’t be possible without the gift of body donation.

But many donors aren’t aware that their bodies will be parted out. And the company never says exactly where those parts are going. In 2022, concerns were raised when a box full of human heads from Science Care was stolen from a cargo truck in Denver. Even so, Science Care is one of the most trusted body donation firms in the country. It’s one of only a handful of for-profit companies accredited by the American Association of Tissue Banks — the same organization that regulates live organ donation.

GOODWIN: It’s not a requirement to operate to be accredited through the A.A.T.B. We sought out voluntary accreditation solely to hold ourselves to that higher standard of regulatory compliance.

Goodwin says Science Care sees it as a moral obligation to take care of the cadavers entrusted to it.

GOODWIN: When you look at modern medicine and compare it to the medicine that was being practiced a century ago or even more ago, we really would not be in the position we’re in today without the impact of body donation. So, you know at the end of the day, it’s really difficult to learn about the human body without the human body.

Susan Lawrence is thinking about donating her own body to science someday. But when the time comes, she’d prefer to give it to an educational institution, rather than a for-profit company. She’s looking at a program at the University of Tennessee that runs a body farm, where forensic anthropologists use cadavers to study the decomposition of human remains.

LAWRENCE: It doesn’t bother me at all to think of my body being used for — you know, “How do bodies decay in the back of a car?” or something like that.

But she’s also worried that the future of body donation could be called into question.

LAWRENCE: It’s a delicate social contract that I think could be easily broken if there were enough scandals and abuse of body parts.

In a market as unregulated as human cadavers, that fear may have some merit. Next week, in Part 2 of this story, we talk to a man who spent more than a decade in the underbelly of the trade. And he says the cadaver market can get pretty wild.

GUYETT: I didn’t have to have any type of medical degree, or licensing to take possession of a human body. They’re not paying for a fine cut. You know, we use Home Depot tools, stuff like that. I don’t say there’s zero regulation, but yeah, but there is really no regulation.

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For The Economics of Everyday Things, I’m Zachary Crockett. This episode was produced by Sarah Lilley, and mixed by Jeremy Johnston. We had help from Lyric Bowditch and Daniel Moritz-Rabson.

GUYETT: After a while, you just get numb, you know? You get this request and you don’t think twice about it, and then somebody else hears it over the phone, they’re like, “What the hell?”