SAN RAFAEL, Calif. - Corneas, tendons and bones from the dead, packed in bed pillow-size packages, arrive regularly by overnight delivery at Tissue Banks International.
This nonprofit tissue processor, located in a nondescript office park near San Francisco, makes about 300 products surgeons use to fix torn knee ligaments, bad backs, burned skin and a host of other ailments.
"This is the best technology going for a lot of surgeons," said James Forsell, who runs TBI's processing center in San Rafael, a suburb about 15 miles north of the Golden Gate Bridge.
An increasing number of doctors are using tissue bank products, and TBI now processes some 600 cadavers a year, translating into about $20 million in annual revenue. But the entire industry has fallen under a cloud after a New Jersey company was accused of taking body parts without families' consent.
"This is the worst thing that could have happened," a teary-eyed Forsell said. He has been working in the donated body parts industry for 20 years and is president of the American Association of Tissue Banks.
He points out that the scandalized company, Biomedical Tissue Services, was not accredited by the organization, as most tissue banks are. The association has stringent consent requirements that include dozens of questions asked of family members who make donation decisions, Forsell said.
On a recent day, TBI workers wearing hospital gowns, goggles and masks in sterile rooms began ridding the tissue of its living matter.
Marrow is blown from the bone with high-pressure water spray and fat cut from muscle with scalpels, scissors and other instruments typically used in operating rooms. The goal is to turn the tissue into inorganic material that can be stored on hospital shelves until needed.
Once that first step is completed, some tissue such as spinal bone is carved and shaped by an industrial-sized table saw programmed by a computer to cut the material to specific shapes commonly used in back operations.
The tissue and bone is then freeze-dried, bottled and shipped to another company to be irradiated, which kills any lingering viruses. The radiation turns the clear bottles brown.
While all of this is happening, TBI administrators are reviewing the donor's medical history. Even before the team begins operating on a cadaver, family members are asked about the donor's medical and social history. A donor is disqualified, for instance, if he or she was recently released from prison or led a high-risk lifestyle.
And before any body parts arrive at TBI, the company's operating team gives the cadaver a physical examination - usually in a morgue or hospital. These technicians are looking for piercings, previous injuries and any other signs that the body isn't right for processing.
The donor's blood is also immediately shipped out to be tested for HIV, hepatitis and other infectious diseases. The medical charts are checked to ensure a clean history and often the attending physician is consulted.
"The real safety is in the monotonous details of going through the charts and the paperwork," Forsell said.
A look inside a tissue processing plant