Who owns your body parts? Everyone's making money in the market for body tissue--except the donors.

• Author: Howley, Kerry

ALISTAIR COOKE'S body lay cold in the embalming room of an East Harlem funeral home, suspended in the brief limbo between death and cremation. A "cutter" soon arrived to make a collection. He sliced open Cooke's legs, sawed the bones from the hip, and took them away. The quintessentially British presenter of Masterpiece Theatre and Alistair Cooke's America--the face of genteel, urbane Albion to millions of Americans--was being carved up for parts.

Cooke had died on March 30, 2004, the victim of a cancer that spread from lung to bone. He left behind a 95-year-old disease-ridden corpse. Susan Kittredge, Cooke's daughter, was mindful only of the potentially exorbitant funerary expenses and flipped through the yellow pages in search of a good price. She eventually settled on a funeral home with a $595 cremation fee.

The home, East Harlem's New York Mortuary Service, promised Kittredge a box of ashes but said nothing of its bigger plans for her father, who would not make it to the cremator whole. For a fee, the funeral director gave a New Jersey tissue procurement agency access to Cooke's remains. His bones, worth some $7,000, were prepped for resale, and his records were falsified to alter his age and cause of death. Three days later, as promised, Susan received a cardboard box of ashes by mail.

Alistair Cooke's remains were only the most famous of more than a thousand bodies plundered by Michael Mastromarino, owner of Biomedical Tissue Services (BTS). He had a simple business model: Pay funeral directors for access to bodies and resell bones, heart valves, spines, and other tissues to biotech firms in need of spare parts.

A former dental surgeon, Mastromarino was familiar with the biotech industry and its rising demand for transplantable tissue. While he was a legitimate practitioner, he had co-authored a book about the benefits of replacing old with new, buoyantly tided Smile: How Dental Implants Can Transform Your Life. He stopped transforming lives through maxillofacial surgery six years ago, when his predilection for self-medication led to trouble. He botched a surgery, and the patient charged that he was stoned on Demerol as he did so. He lost the trust of his patients, and then he lost his license. BTS was an attempt at fiscal redemption, and it proved very lucrative.

As the scandal unraveled in 2005, prosecutors revealed that Mastromarino had netted $4.6 million in three years of back-room dissections. He paid undertakers $1,000 a pop for providing access to the dead, paid cutters $300 to $500 for extracting the most marketable parts, and, according to his lawyer, managed to take home up to $7,000 per body. (One of Mastromarino's former employees contends the boss was pulling in double that.) The New York Police Department later interviewed the families of 1,077 people whose bodies were raided for spines, bones, tendons, and other tissues. BTS had cut deals with funeral homes in New York City, Rochester, Philadelphia, and New Jersey.

The company's work was amateurish at best, dangerous at worst. For families who planned an open-casket funeral, BTS cutters would patch up gutted corpses as best they could. Investigators later found legs stuffed with plastic piping of the kind found at hardware stores. An employee said that he had used roils of socks to the same purpose, and police found surgical gloves sewn up inside hastily repaired remains.

Cooke's bones were sold to Regeneration Technologies, one of the country's largest tissue banks. The company says Cooke's bones were deemed unsuitable for implantation, but it can't say the same for other pieces of tissue it bought from Mastromarino. The tissues BTS distributed ended up everywhere from a woman's neck in Kentucky to a man's jaw in Tampa Bay. Hundreds of people wake up every morning knowing that they are partly composed of stolen body parts.

In February 2005, Mastromarino and three others were indicted on 122 charges, including body stealing and opening graves. The grisly story received perhaps more media attention than any such scandal since a wave of body snatching in the 18th century. A February 2006 Paula Zahn Now segment spun the story into the perfect media narrative, complete with a villain, a celebrity, and a whistleblower. But that telling, and many others, failed to point out that much of Mastromarino's basic business model was perfectly legal, common, and necessary to the biotech industry. If Mastromarino had been smarter, he could have made a fortune off body parts while staying well within the limits of the law.

Consider the massive market in which Mastromarino played but a tiny role. Demand for human tissue has never been higher, and human remains have never been more valuable. According to the American Association of Tissue Banks, doctors perform more than I million tissue transplants each year, using everything from secondhand ligaments to hand-me-down heart valves. That fuels a thriving industry composed of tissue banks, biotech firms, and middlemen. Each year the industry takes in an estimated $1 billion in revenue, not a cent of which will go to the families or heirs of the donors who provide the raw material.

As the Cooke scandal deepened in early 2006, the Association of American Tissue Banks sent its members a set of talking points, almost all of which emphasized the outlier status of Mastromarino's operation. There are important differences between BTS and legal banks, the association emphasized. Most crucially, Mastromarino never sought the consent of donor families before harvesting the tissue of their relatives. He conspired with funeral directors, lied about the quality of the tissue, and put transplant recipients in danger. "What these folks are alleged to have done violates everything we stand for and everything we are trying to do," says Robert Rigney, CEO of the association.

Yet a small but growing number of academics, doctors, and legislators believe the Cooke scandal wasn't an aberration but an inevitability. They believe the tissue industry as a whole, even as it strives to distance itself from Mastromarino, is abusing families on a scale well beyond the reach of any one body broker. "The industry will argue that these are aberrant, isolated events that are irrelevant" says Todd Olson, a professor of anatomy and structural biology at the Albert Einstein School of Medicine. "My view is it's exactly the opposite. What we're really dealing with here is the tip of the iceberg."

Olson believes that the generosity of donors is being abused on an "epic scale" by tissue procurement organizations, middlemen, and biotech companies that depend on tissue for their survival. With scientific advances there has emerged an enormously beneficial market in remains. But the players most fundamental to that market, donors, are locked out, prohibited by law from sharing in the benefits that others derive from their bodies. At the heart of this inequity is a confusion over to what extent we control our own persons--over whether we own our increasingly valuable component parts.

Resting in Pieces

Mastromarino found several buyers for his cadaveric contraband, among them a highly profitable biotech firm known as LifeCell. The New Jersey-based corporation ranked 16 on Fortune's list of fastest growing businesses in 2006, and with good reason: Its stock shot up 28 percent that year. The company owes much of the success to its flagship skin graft, AlloDerm.

"AlloDerm is a miraculous substance,' says Maryland plastic surgeon Mark Richards, "given its universal acceptance into the human body." Doctors have found that human bodies are far less likely to reject AlloDerm than previous skin substitutes. The graft melts into human flesh because it is derived from human flesh, the stripped-down product of bodies pulled apart after death.

Surgeons use AlloDerm for all manner of life-enhancing procedures, from reconstructive breast surgery to hernia repair, as well as some perhaps less urgent operations. AlloDerm injections are a leading method of lip enhancement, an increasingly popular procedure among women. And the miracle substance is not without cosmetic benefit for men. "Some surgeons promote its...