PHOENIX — Standing in front of a group of prospective body donors, Garland Shreves grabs the head of a plastic human skeleton model and pops it off the body.
“We may take this right off the top of your shoulders,” he explains to the audience of 16 who have come to Shreves’ Phoenix company – Research for Life – for a Saturday morning seminar and tour about body donation.
Shreves explains to the audience that his company dissects, dismembers and ships body parts all over the world. The body parts aren’t for transplant. Body donation businesses aren’t about organ transplants.
Rather, body donation businesses use the body parts of corpses to sell to medical device companies and other entities, although the companies don’t like the word “sell.” The unused body parts are cremated and returned to the family at no cost.
That cost-saving can be an incentive for families, too.
Approximately 4,000 people – about 7% of the people who die in Arizona each year – are whole body donors, which is roughly five times the national average based on 39 reporting states, the Illinois-based Cremation Association of North America says.
The American Association of Tissue Banks has accredited seven non-transplant human tissue banks in the United States, and four of them, including Research for Life, are headquartered in Arizona.
In addition to the body donation businesses, the state has two medical school programs that accept donated bodies. A research group operated by Banner Health in Sun City has a 32-year-old program that accepts brain and whole body-donations as part of its scientific work looking at diseases of aging.
In Scottsdale, a nonprofit called Alcor Life Extension Foundation has been operating its cryonics facility since 1994.
Alcor preserves the bodies of its members for a fee, with the hope that one day they will be “reanimated” and live again. The foundation moved from California to Arizona to get away from earthquakes and a political climate that at the time was not favorable to cryonics. Arizona has declined to regulate the operation, with the Legislature leaving it out of a 2016 bill that ostensibly regulates body donation companies.
About 58,000 people die in Arizona each year, and 68% of them are cremated, which is higher than the national cremation average of 53.1%. Combine that with a large number of older people who live full- or part-time in the state, and Arizona is attractive to Research for Life and other companies soliciting body donations.
“Arizona has probably one of the largest donor bases for human tissue for medical education and research than probably any other place in the country,” Shreves said.
‘Will I have a head in heaven?’ potential donor asks
During the Saturday morning tour, one older woman wearing a cross around her neck asks whether she will have a head in heaven if it is removed at Research for Life.
Shreves tells her that’s a matter of individual spiritual values – something she’ll have to think about and decide according to her own belief system.
Another woman on the tour says she is a social worker who often encounters clients who have no money for funeral costs. She wants to be able to give them options.
Also on the tour are Steve and Hilary Gilliam, a couple from El Mirage, and their close friend Joanne Frank, who is from Peoria. All are in their 60s and want to make sure they have plans in place before they die. They have also looked into donating their bodies to Midwestern University’s program. They found out about the Research for Life tour in a newspaper advertisement that appeared on the obituary page.
“We’re big into planning, and the three of us have had spouses that died,” said Steve Gilliam, 69, a retired mail carrier. “We’d like to help science in the long run.”
The tour includes the inside of an operating room of sorts called the recovery area, where bodies are taken apart. Alongside a steel table is a gurney of wrapped body parts. Further along in the tour, Shreves leads the tour group inside a walk-in freezer where there are more wrapped body parts in bins with labels for various body parts, including spines, heads and fingertips.
Not ‘back-alley grave robbers’
Shreves was in the funeral home business for 30 years before opening Research for Life 10 years ago. The company, located near Sky Harbor International Airport, asks people to sign up as donors, which means they will give their bodies to Research for Life after they die.
In exchange, Research for Life will pick up the body, sell parts of it to various research and education projects, and return the cremated remains to the family.
Body donation companies are subject to minimal regulation, and some have engaged in illegal and unethical practices that have drawn the attention of law enforcement.
In 2014, state and federal investigators wearing hazmat suits raided a body donation company in Phoenix called Biological Resource Center. The raid came after a two-year cross-country criminal investigation into whether the bodies had been used as donors had intended and whether they had been properly screened for infectious diseases.
The case shed light on an industry that many members of the public knew little about. Some of the public outrage at the time focused on bodies being dismembered after donation – a reaction that Shreves says was misplaced.
People donating their body should be more than aware that it will not stay intact because the consent forms make that clear, he emphasizes.
The tissues and body parts his company uses are never transplanted into a living human, he said.
“I think that the mystique surrounding it is part of the problem, because people don’t understand what it is that we do or why we do it,” Shreves said. “There isn’t anything that we do that isn’t under consent.”
The Research for Life consent form says bodies will be used for “multiple medical education and research activities” by organizations that may include medical device organizations, researchers, “intermediaries” or “others deemed appropriate.”
While that language appears to give Research for Life a lot of leeway, Shreves said his company sticks solely to research and education. Bodies aren’t used for crash test dummies or ballistics training and aren’t sold to entities that sell bones and skulls to consumers via websites, he said.
One of the reasons Research for Life gives quarterly public tours is to let the public know that the industry is not made up of “back-alley grave robbers,” Shreves said. Donor consent forms from virtually all the body donation companies he’s reviewed uniformly disclose exactly how the bodies will be used, he said.
“Our consent is extremely clear. It quite extensively says tissue will be removed. You are 100% aware of what you agreeing to in our consent,” said Allison Howell, medical client and community relations manager for the for-profit Southwest Institute for Bio-Advancement in Tucson, a 9-year-old body donation company.
The consent form of Science Care, another body donation company, is clear that donated human tissue only can be photographed or documented in video for noncommercial scientific publication, and only if the donor can’t be identified in the photo or video.
The Science Care consent form specifically says bodies could be used as crash-test dummies or ballistics training and that “exposure of the donated tissue to destructive forces may be involved.”
The public is often confused about body donation, particularly the difference between organ donation and whole body donation, said Katrina Hernandez, who is the former vice president of donor services for Science Care, which says it is the largest non-transplant body donation company in the world.
“Awareness has been our biggest challenge,” she said.
The Science Care consent form has 26 disclosures, and within those disclosures is the fact that bodies could be taken apart.
“It says dissection will take place,” Hernandez said. “Number six is that we are for-profit and our clients can be either nonprofit or for-profit. We will make sure they fully understand body donation.”
The online consent form for the nonprofit United Tissue Network in Phoenix says “pictures and/or videos” may be taken of the donor tissue, that the body may be used “in multiple research programs and multiple venues that UTN, in their sole discretion, deems necessary to facilitate the gift,” and that the body could end up with an “intermediary” for “placement.”
Any vendor who wants to record or take photos of the donated tissue must sign a separate camera usage agreement that prohibits posting images or videos on social media sites, said Brittani Mundo, who is United Tissue Network’s donor services manager.
The consent language on intermediaries is referencing other nontransplant anatomical donation organizations such as the Medical Education & Research Institute, which is a Memphis-based nonprofit education and medical skills training organization, she said.
Mundo said United Tissue Network does not work with institutions that use donor bodies for vehicle safety or ballistics testing.
Body parts for sale online
The giant online shopping site eBay began prohibiting the sale of body parts on its site in 2016, but human skulls and other bones may be purchased elsewhere – on Instagram, Facebook and on websites like The Bone Room, Skulls Unlimited, Osteology Warehouse and Zane Wylie Skulls.
Such sales may be ghoulish but are not against the law. The way consumers can protect their own bodies from getting sold online, if they are opposed to that, is to read the consent form, Shreves said.
Zane Wylie of Zane Wylie Skulls, whose name is a pseudonym he uses professionally, said he does artistic carvings using one or two human skulls per year and typically gets them from Oklahoma-based Skulls Unlimited. He also has obtained human skulls from estate sales held by doctors. He’s never obtained a skull from a body donation company, he said in a Facebook message.
None of the human bones sold via The Bone Room is from donated U.S. bodies, owner Diana Mansfield wrote in an email.
“Our material is mainly from India, brought into this country decades ago,” she wrote.
Ohio-based Osteology Warehouse does not receive any human parts from body donation companies, manager Evan Miller wrote in an email.
“All bones are clean, dry and free of any body tissue before we receive them. Everything is internationally shipped from various island communities in compliance with customs codes,” he wrote.
Donors to the United Tissue Network would not end up having their bones photographed and put up for sale on consumer websites, Mundo said.
Science Care CEO Brad O’Connell said his company does not sell to such websites, either.
“We take great pride in vetting our clients to ensure tissue is utilized to improve health care in the world,” he wrote in an email. “We do not supply tissue to clients that provide to the general public. We supply tissue solely for patient and medical advancement and benefit.”
Oklahoma-based Skulls Unlimited International’s bone specimens are “ethically obtained” for sale to educational, medical and research communities and it buys skulls and skeletons from private individuals and institutions every year, its website says. The company did not respond to messages from The Arizona Republic.
Body-part sales could improve medical science, prolong lives, company says
Shreves explains to those on the Saturday morning tour that the gift of their body will help medicine, help train doctors and emergency services personnel, and help perfect treatments.
Some body donation facilities, including Research for Life and Science Care, have operating rooms that can be rented by physicians, medical companies and other health-care personnel for training. During the tour, a group of surgeons is practicing a procedure on a dead person’s shoulder.
“We owe donors for a variety of therapies that have been invented that add quality of life to people who are living with very serious diseases,” Shreves said. “They have longer life expectancy because of donors.”
He said that to advance medicine, donated bodies will be “disarticulated and dismembered” and that body parts will be removed. The body may be used in whole or in parts, he explained.
“Allowing the donor to be used in parts makes certain that the donor can benefit a variety of medical education and research projects. … We fill a need that I think is personally more important than university programs because of the nature of what we do with donors and the way donors are used.”
One man on the tour group asks about Research for Life’s revenue stream.
“You can’t do what we do without generating revenue,” Shreves replied.
The man wants confirmation that vendors are paying Shreves for the body parts.
“They have to pay us, and there is nothing disgusting or wrong about it,” Shreves said. “There are people in our society who find it distressing that we get paid to recover human tissue. There’s no law against the buying or selling of human tissue. I do find it distasteful to call it that, but it’s semantics.”
Medical schools need bodies for students, offer another donor option
There are ways to donate one’s body to science without using a body donation company.
Arizonans who wish to donate their bodies to medical education may opt for a university program. Two universities in the state – Midwestern in Glendale and the University of Arizona College of Medicine in Tucson – have body donation programs.
Each program emphasizes respect for the donors and students hold memorial services for them, often including poems and testimonials.
The UA program, in existence for 51 years, has a donor memorial garden and each class plants a tree there in memory of the cadavers used that year.
Not every student gets an individual cadaver. Normally at the UA program, it’s about six students to a cadaver, said Kat Alvarado, who directs the UA program.
The donors are anonymous to students, and the only information students receive is the age the person died and their cause of death. Nonetheless, the students typically regard the cadavers as patients, often their first patient, Alvarado said.
“The donors sometimes provide quotes or advice in their paperwork. Some will say, ‘I hope you learn from me.’ We had one that said, ‘I told you I was sick.’ I print those on a poster and post around the lab.”
Both programs pick up bodies at any time of the day within hours of someone dying, from anywhere in Arizona, and they also will file for a death certificate with the state. The transportation is free to UA donors. Midwestern does not charge for transportation within Maricopa County, although it could charge mileage for large distances outside the county.
There are a few other differences between the programs, too.
The UA program, which currently has 7,000 enrollees, must enroll donors while they are still alive, and it does not return cremated remains.
“They have to know and be aware they are signing up for being a cadaver,” Alvarado said.
The Midwestern program, which is three years old, will accept donors after they’ve died, as long as the donor’s next-of-kin or power of attorney signs off on it, which is in accordance with the Arizona Anatomical Gift Act.
Midwestern does return cremated remains to families after students have finished using the body for study. Program leaders say the time between donation and the return of cremains could be about two years.
The Anatomical Board of the State of Florida has a database that lists 127 medical and dental school-based body donation programs across the United States.
Most states have at least one medical or dental school offering such a program, said Bill Rowan, a spokesman for the American Association of Anatomists, an association of about 1,700 anatomists who work in universities, research institutions and private industry.
Citing “unethical and criminal acts performed by some for-profit non-transplant tissue banks,” the anatomists’ association last year issued a statement saying it promotes the donation of bodies, “only to accredited universities and colleges or through a state anatomical program.”
Cadavers are optimal teaching tools for medical school students
Both university body donation programs in Arizona have “exclusionary” factors that could prevent them from accepting a donor. The programs need “whole” intact bodies, so if someone is an organ donor that would in most cases exclude the body from use as a teaching tool, as would someone who had been in a traumatic accident or underwent an autopsy.
Other reasons for excluding someone from the program include a communicable disease such as active tuberculosis, MRSA or HIV – anything that could be transferred to the students.
Most donors to the UA program have some connection to the teaching or medical world – donors include a lot of professors and physicians, she said.
The 700 people enrolled to be donors through the Midwestern program are a diverse group from the community, said Heather Smith, an associate anatomy professor and program director. And if donors want to sign up as organ donors, Smith said that doesn’t preclude enrollment.
While the use of synthetic cadavers in simulation teaching laboratories is popular in medical education, human cadavers are the optimal way to teach anatomy, Smith stressed.
Neither program has any problems finding donors, and they say competition from for-profit body donation companies is not a concern.
“We get calls every single day from people interested in the program,” Alvarado said. “A lot of donors’ parents came through the program. It’s almost like a legacy.”
Body donors can decide: Education, transplant or research?
Another option for Arizonans interested in body donation is the Banner Sun Health Research Institute.
The Banner program must register donors while they are still alive, as they need to do yearly medical examinations that are important in studying the progress of diseases, said Dr. Thomas G. Beach, senior scientist and director of the program. The medical exams can last about six hours and includes a general neurological examination and a specialized dementia and movement disorders testing.
“We really like to get the earliest signs of Alzheimer’s and Parkinson’s, and those both actually start in the brain up to 20 years before anyone notices any symptoms,” he said.
Like other programs, the Banner research institute transports bodies free of charge and pays for cremation. Donors also receive a free chapel service. The program will provide families with something other programs don’t offer – a detailed autopsy report.
“That is one of the main reasons they sign up to the program. It usually takes a few months,” Beach said. “People think that modern medical care knows everything about you when you die, but there have been published studies that show in say about 20% of autopsies, there is something major discovered that wasn’t discovered in life.”
The program has about 700 enrolled members, has accepted nearly 2,000 body donations and is limited to residents of Maricopa County. It also acts as a tissue bank and ships out tissue to researchers in 38 states and 20 countries.
The research program’s consent form makes it clear that, like body donation companies, the Sun City program is going to take apart the bodies. The facility offers free monthly tours, which include visiting its morgue, freezer area and research areas.
“Most people who donate their bodies do it out of a sense of altruism. They really want that last act of theirs to be meaningful. It’s really a noble thing to do,” Beach said.
” On the other hand, it’s not for everyone. We don’t try to convince people to do it,” Beach said. “People should think about what they want their body to be used for – education, transplant or research.”
Altruism, finances top reasons people donate bodies, company says
Outside of the medical schools and the Sun City program, the body donation industry in Arizona began with for-profit Science Care in 2000, which is registering about 100 Arizonans per week as body donors.
The company said the number of pre-registered donors jumped 18% between 2017 and 2018, and that interest continues to grow.
The most common reason that people donate is altruism and the second most common reason is financial, Science Care officials say. People don’t want their families to have to worry about the cost of cremation and about making arrangements, Hernandez said.
“Some people don’t want to be a cadaver for a bunch of students to play science on. They want to do something more impacting. They want to impact diabetes, heart disease, things of that nature. … Science Care works with, I’m pretty confident to say, every prestigious medical program in the world, both international and domestic.”
Science Care plants a tree in memory of every donor in national forests throughout the country. Families receive a certificate commemorating the planting on the one-year anniversary of the donation.
After Science Care’s entry into the Arizona market, other companies have followed, including the Southwest Institute for Bio-Advancement in Tucson. The owners are Tucson residents who had been in the funeral industry for 20 years, said Howell, the company’s medical client and community relations manager.
The company receives about 500 to 600 body donations per year from across Arizona, Howell said.
“We market to the entire state of Arizona – doctors, nurses, medical organizations. A lot is word of mouth, families who have had good experiences with us,” Howell said.
“One of our key points is we really give families a custom service. If they need to coordinate a (funeral) viewing, we make it really easy because we are smaller.”
‘It was a good pitch,’ but frozen heads in a bin were a deal-breaker
At the end of the Research for Life tour, Steve and Hilary Gilliam and their friend Joanne Frank seem positive about signing up, although they decide to go out for lunch after to talk it out.
During lunch, Steve Gilliam’s enthusiasm begins to wane. He can’t shake the image of frozen, wrapped heads inside a bin in a the Research for Life freezer. It was like a meat market where butchered humans were the commodity, he said.
“What they are going to do is chop me up, freeze me, bag me, label me and sell my body parts,” Gilliam said four days after the tour. “Basically all that will be left to cremate will be a cupful of guts.”
Body donation is a good idea for people who don’t plan ahead, or who don’t have the money for cremation, he said. But Gilliam wants to be buried with his parents at a veterans’ cemetery in Dallas, and he has decided he wants his whole body to be cremated. Both he and his wife decided to pass on Research for Life.
“It was a good pitch, but he didn’t give us coffee and cookies for nothing,” he said.
Gilliam’s friend, retired retail manager Joanne Frank, is still considering signing up. She was impressed that the body parts go to helping advance medical procedures and wasn’t bothered by the graphic details of the tour.
“It’s a great place for what they do,” she said.
She is still finalizing her end-of-life plans and weighing her options.
Most people who take the public tours end up enrolling, Shreves said. As she’s leaving, the woman who worried about going to heaven without a head says she’s going to sign up.
Shreves himself has not enrolled. Because his wife and kids work for Research for Life, it would be too traumatic for them to dissect him, he said, explaining that his son is the company’s lab manager.
“If I had it my way, I’d be just stuck in a sheet and rolled directly into the ground,” he said. “I don’t need anything fancy.”
Follow Stephanie Innes on Twitter at @stephanieinnes.