The body as resource

How the NHS became a 'harvesting machine' for modern medicine.

Collecting and processing material taken from living people and dead bodies is central to modern medicine. So much so, claims historian Professor Naomi Pfeffer of the London Metropolitan University, that hardly any area of medicine is untouched. "Our bodies during life and after death have come to represent an indispensable resource, without which modern medicine simply could not function. The body is literally mined - turned to good use in the pathology lab, the operating theatre and the research lab." There are plenty of examples: "Valves used in heart surgery, dentists rebuilding jaws, and surgeons repairing hips all rely on using other people's bodies. These collections have had far more impact on medical research and practice than the larger body organs - the heart and lungs - that attract so much publicity."

Professor Pfeffer is researching and writing about the "remarkably little known history" of tissue banking. Her current research focuses on three 'unglamorous' tissues - the cornea, skin and pituitary gland. These are apparently uncontroversial tissues collected from dead bodies, but they are in extensive use and were associated with major legal changes. "It was demand for corneas, for example, that led in 1952 to the Corneal Transplantation Act, the first English law allowing tissues and organs to be donated after death." (Legally, the body is not property and so cannot be bequeathed without special legislation.)

The cornea, pituitary and skin all attracted medical interest around the same time, and represent three different uses of human material. Skin is a medical stopgap - a dressing for severe burns, which is why it was stockpiled in vast quantities during the Cold War by the US military. Corneas are surgical 'spare parts'; and pituitary glands are 'raw materials', the sources of growth hormones and gonadotrophins (which are no longer used because of their potential to transmit Creutzfeldt-Jakob disease). "All of these materials began to be used in the 1920s and 1930s, but it was not until WWII that demands for reliable and regular supplies led to tissue banks becoming established."

This, she shows, all developed without public debate in the UK: "While the professionals clearly evolved an internal market, nobody outside knew about it." Why? Professor Pfeffer links the rise of tissue banking with the founding of the NHS. "The social organisation of health changed; the hospital became a major source of bodies. But the NHS did not want their brave new world of healthcare associated so early on with issues of death and dying. So they fought to keep the issue out of the public domain." In contrast, in the US, a cottage industry developed. And like all commercial undertakings, it had a much higher public profile.

In 1961, the Human Tissue Act gave hospitals the right to remove and use tissues for therapeutic use, medical research and education. But it failed to provide a proper regulatory framework, especially in seeking consent from patients. By the time of the Alder Hey and Bristol scandals, NHS Trusts were holding 54 000 tissue samples.

Governments all over the world are now recognising the urgent need to review and revise what Professor Pfeffer describes as "an unbelievably complicated system that has arisen around the collection of material from dead people." In the UK, the Retained Organs Commission was set up in 2001 to monitor the return of organs, oversee new legislature and address issues of accountability and consent. The Department of Health published a consultation document 'Human bodies, human choices' in 2002.

Professor Pfeffer confesses herself as ambivalent as anyone in grappling with the difficult issues surrounding the donation of body parts after death. "We are inchoate, all of us, when faced with this issue - without a strong religious belief in the need to preserve the body whole, we struggle to articulate and think through our feelings about our bodies in death. I hope that my study will provide some tools with which to do so."

Missing bones

Dr Jonathan Reeve, who is studying fractures and the ageing process at the Wellcome Trust Clinical Research Facility in Cambridge, has found a novel way of ensuring he keeps an adequate supply of bone samples for his studies.

Once or twice a year a member of Dr Reeve’s team boards a plane for Australia collects a batch of 25 or so femurs from the University of Melbourne and returns a few days later with them packed in a suitcase (all done with the full knowledge of the airline).

Until a couple of years ago Dr Reeve had been receiving a couple of samples a month from Addenbrooke’s Hospital, where the Clinical Research Facility is based. But as the full ramifications of Liverpool’s Alder Hey Hospital scandal unravelled, supplies dried up.

This, combined with the fact that fewer routine post-mortems are being carried out, leads to difficulties for researchers trying to obtain human samples.

"Fortunately we already had a collaboration with Professor John Clement in Melbourne," explained Dr Reeve. "He has authorisation from the Victorian Institute of Forensic Medicine ethics committee and so has access to femurs from people, aged 20 upwards, who have died suddenly in a variety of circumstances.

"If we had to look around in this country for a similar supply I’m certain it would be extremely difficult to find one because of the sensitivities now following Alder Hey."

Dr Reeve and his team are investigating bone density, looking for clues that will explain why bones become more fragile with age. As he explains, some of the femurs take on the appearance of Swiss cheese following a fracture as the cortex becomes ‘moth-eaten’. In these cases they become perforated as capillaries deliver osteoclast cells which burrow into the bone.

The Australian samples are needed so they can be compared to bone from femurs that have suffered fractures and old age. Hip fracture is a very common problem in old age, costing the NHS and other services more than £1 billion annually in the UK.

The body as resource

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