He nodded a couple times in humble acknowledgment, then held up a hand to quiet the room. “You might not feel so kindly toward me when I make this second point,” he said. “The other thing we’ve got to do, to start thinking outside the box, is to get more realistic and more creative about incentives for whole-body donation. Tissue Sciences, like many tissue banks, now covers the cost of cremation for whole-body donors. We harvest and process everything we can, we cremate the remains, and — if the family wishes — we return the ashes to the family. For people who are planning ahead, we offer the opportunity not just to help the sick but also to help their own families, by sparing them the cost of a funeral or cremation. For a grieving family, we lighten the financial burden of death. But that’s too little, too late. We need to expand the incentives we offer families who donate their loved ones…and we need to create substantial financial incentives for individuals considering becoming whole-body donors.”
Several hands went up at the phrase “substantial financial incentives.” He pointed to an attractive young blond woman in the center of the room, who asked, “Are you suggesting we pay prospective donors?”
“You betcha.”
“But isn’t that prohibited by law?”
He beamed. “You betcha,” he said. “Sort of. But not really. The Uniform Anatomical Gift Act and the National Organ Transplant Act do prohibit the buying and selling of human organs and tissues, but there are a couple of gray areas. As all of you who work at tissue banks already know, we’re allowed to recover costs associated with procuring organs and tissues. And defining ‘costs’ can be an exercise in creative writing — just ask any accountant at a Hollywood film studio. The reality is, tissue banks and anatomical-supply companies buy and sell bodies all the time; we just don’t directly, openly pay the body donors or the families who donate. And that, I believe, is the step we must take if we’re to meet the growing need for tissue and tissue-based products.”
More hands shot up, but the blond woman who’d asked the first question fired off a follow-up before anyone else got a chance to. “But isn’t the problem that paying donors — organ donors or whole-body donors — exploits the poor for the sake of the rich?” Her question prompted murmurs of assent throughout the room.
Sinclair shrugged. “Does it? Funny how it’s always people with money and power who say that. Anybody polling the poor about this issue? Case in point: Say some peasant in Pakistan sells a kidney to some rich American for twenty thousand bucks. I pick Pakistan because organ selling is pretty common there. Twenty thousand dollars is twenty years’ worth of income for the average Pakistani. Sure, he’s taking a huge health risk, but are his other options any better? Which is worse, taking a health risk for twenty grand or watching his kids starve to death for nothing?”
Half a dozen hands shot up, and several people tried to interrupt him with objections, but Sinclair plowed ahead.
“Hang on, hang on, everybody gets a turn, but let me finish making my point. I know a dozen bioethicists who say it’s exploitative to buy a kidney from a poor person, but I know three or four who think a mentally competent adult has a basic right to self-determination. Isn’t that one of the fundamental principles of America — life, liberty, and the pursuit of happy, free-market dollars?”
A lot of faces were frowning.
“Fertility clinics pay sperm donors and egg donors. Couples pay surrogate mothers to bear children for them. It’s illegal to buy or sell a baby, but any honest attorney or social worker who’s spent much time in the trenches can tell you it happens.”
He paused for breath, and the hands shot up again.
“Wait, I’m almost done,” he said. “Seriously, we actually can buy bodies legally today, we just can’t call it ‘buying bodies.’ What we’re allowed to call it is ‘sparing you or your family the expense of a funeral.’ Talk about dancing around the truth. The average funeral costs six or seven thousand bucks, so what that means is we’re allowed to buy bodies for six or seven grand, provided we don’t own up to what the transaction really is. What a hypocritical crock. Insurance companies are willing to negotiate what they call ‘life settlements’—cash payments for insurance policies owned by old folks and sick folks. Not the full amount of the policy — that’s why the insurance companies are willing to do it — but at least you don’t have to be dead to collect. A woman with ovarian cancer who’s worth a hundred thousand dollars dead might rather get fifty thousand while she’s still alive. Shouldn’t she have that right? The right to cash in on her mortality? Shouldn’t anyone? People mortgage assets like houses all the time. Why not let them mortgage their bodies? Isn’t the body an asset, a very personal asset? How come, in the whole chain of organ and tissue transplantation — a multibillion-dollar enterprise — the one person who can’t make money off the damn deal is the donor?”
He shrugged again, an olive-branch, peacemaking kind of smile. “These are complicated legal and ethical issues, sure. But we need to grapple with them. And we need to get more honest, more creative, and more aggressive about offering financial incentives for whole-body donation. Otherwise we simply can’t expect to keep pace with the growing need for human tissue.”
“Bullshit.”
The comment came, in a confident, strong voice, from a darkened rear corner of the room. Sinclair looked startled; so did everyone else in the room. The speaker stepped out of the shadows and into a pool of light near the room’s rear door. I was shocked to see that it was Glen Faust of OrthoMedica.
“I think you’re selling people short. I think you’re seriously underestimating the generosity of the human spirit.”
At the podium Sinclair reddened. “I’m just saying we need to find realistic financial strategies for encouraging whole-body donations.”
“No, you’re saying people are greedy or stingy, that they have to be bought. I don’t agree, and I see one other person in the room who I suspect might back me up on this point.” He looked in my direction and pointed at me. “Dr. Brockton, forgive me for putting you on the spot, but have you had difficulty recruiting whole-body donors for your program?”
His question caught me utterly off guard. Price and Rankin had stressed the need to keep a low profile at the conference — the plan we’d agreed on was that I’d introduce myself to Sinclair after his talk and look for ways to bond with him — but it suddenly felt as if a spotlight as bright as the Luxor pyramid’s beacon was shining directly on me.
I stood up slowly, buying a few seconds of time, and cleared my throat. “Well, I reckon I’d have to say no, we haven’t had a lot of difficulty.”
Sinclair eyed me dubiously. “And your name and affiliation?”
“Bill Brockton. I’m the chairman of the Anthropology Department at the University of Tennessee in Knoxville. The program Dr. Faust mentioned is our decomposition-research facility. Most people call it by its nickname, the Body Farm. We study postmortem human decay and the way the rate of decay is affected by factors like temperature, humidity, presence or absence of clothing, and so on. We also do a lot of trainings for crime-scene investigators, teaching them how to find buried bodies, how to search for scattered bones, that sort of thing.”
Sinclair considered this. “And you use donated bodies for this work?”
“We do. Mostly. Some of our specimens are unclaimed bodies from the medical examiner’s system, but the majority are donated bodies. About a thousand people have donated their bodies so far, and we’ve got another sixteen hundred donors on our version of a waiting list.” I heard a few chuckles at my spin on the term “waiting list.”