TOWNSEND, TENNESSEE (REUTERS) - Mr Cody Saunders was born in 1992 with failing kidneys and a hole in his heart.
When he died on his 24th birthday, he had endured 66 surgeries and more than 1,700 rounds of dialysis, his parents said.
Mr Saunders lived with his parents in an aged motorhome at an East Tennessee campground. When he was well enough, he worked on a farm with his father, feeding cattle, putting up hay, hauling molasses in a dump truck from one barn to another.
On Aug 2, 2016, Mr Saunders died after a heart attack on his way home from dialysis. Too poor to bury or cremate him, his parents donated his body to an organisation called Restore Life USA. The facility sells donated bodies - in whole or by part - to researchers, universities, medical training facilities and others.
The month after Mr Saunders died, Restore Life sold part of the young man's body - his cervical spine - to Reuters. The transaction required just a few e-mail exchanges and US$300 (S$408), plus shipping.
Whether Restore Life vetted the buyer is unclear. But if workers there had verified their customer's identity, they would have learnt that he was a reporter from Reuters. The news agency was seeking to determine how easy it might be to buy human body parts and whether those parts would be useful for medical research.
In addition to the spine, Reuters later purchased two human heads from Restore Life, each priced at US$300.
The transactions demonstrate the startling ease with which human body parts may be bought and sold in the United States.
Neither the sales nor the shipments violated any laws, say lawyers, professors and government officials who follow the issue closely.
Although it is illegal to sell organs used for transplants, it is perfectly legal in most states to sell body parts that were donated for research or education. Buying wine over the internet is arguably more tightly controlled, generally requiring at minimum proof of age.
To comply with legal, ethical and safety considerations before the purchases, Reuters consulted with Ms Angela McArthur, who directs the body donation programme at the University of Minnesota Medical School. She took immediate custody of the spine and heads for Reuters, inspecting and storing them at the medical school.
Ms McArthur said she was troubled by how easily the body parts were acquired and by the failure of Restore Life to perform proper due diligence.
"It's like the Wild West," Ms McArthur said. "Anybody could have ordered these specimens and had them delivered to their home for whatever purpose they want."
Ms McArthur examined the remains and the documentation included with them to determine how useful the parts would be for medical research. Her review was based on national safety and ethics standards she helped draft for the American Association of Tissue Banks, the American Association of Clinical Anatomists and the University of Minnesota.
She concluded that the medical history Restore Life provided was insufficient, and that the accompanying paperwork was sloppy and inadequate. For those reasons, the specimens did not meet standards for use at her university, she said.
"I haven't seen anything this egregious before," Ms McArthur said. "I worry about the future of body donation and public trust in body donation when we have situations like this."
RESPECT AND DIGNITY
Contacted several months after the sales, Restore Life president James Byrd briefly explained his approach to business.
"Organisations like ours are what I consider accountable because, especially us, we have direct contact with the donor family," he said. "And there's a certain level of respect and dignity that is involved there because we have that personal relationship with them."
Mr Byrd subsequently declined to be interviewed or answer written questions. But he e-mailed a statement in which he criticised Reuters for making the purchases.
"It's obvious your team at Thomson Reuters has no concern for those that seek help from our organisation," he wrote. "You only wish to hurt those that need help the most."
Mr Byrd added that Restore Life does good work by supplying body parts to researchers working to cure cancer, dementia and other diseases.
"We help countless people through a wide range of research working with world-renowned researchers," he wrote.
Whatever good Restore Life hoped to achieve by supplying these body parts, Ms McArthur said, its poor handling of the remains "miserably failed" to serve researchers and the three donors: Cody Saunders and the unidentified man and woman whose heads Mr Byrd sold to Reuters.
Ms McArthur said the relatives of donors, whose intentions are noble during a difficult time, deserve better from the industry.
"People think they are doing the right thing, and they want to fulfil their loved ones' wishes," said Ms McArthur, who formerly chaired Minnesota's body donation commission and serves on the leadership council of the American Association of Clinical Anatomists. "I know they would feel exploited to know that something like this happened."
Anatomy professor Thomas Champney at the University of Miami Miller School of Medicine also expressed alarm at the ease of the sales.
"Human body parts should not be bought and sold in the same manner as used refrigerators," he said.
Mr Byrd, 50, has been in the body parts business for two decades. An East Tennessee native, the body broker recently was runner-up in a stand-up comedy contest called "The Funniest Person in the Tri-Cities", the region surrounding Kingsport, Johnson City and Bristol.
Before opening Restore Life, Mr Byrd directed a non-profit tissue bank called American Donor Services, then located near Memphis.
For several years, one of American Donor's chief orthopaedic customers was a Texas firm affiliated with a company that distributed bone grafts made in part from human tissue. In 2005, according to sworn testimony in a civil lawsuit, American Donor shifted to a new chief orthopaedic customer. The new buyer paid as much as US$10,000 per donor, provided a US$200,000 line of credit and began managing American Donor's financial affairs.
Mr Byrd left American Donor Services a short while later, worked briefly for a vascular tissue bank, and then founded Restore Life in 2008. Based in Elizabethton, Tennessee, Restore Life obtains bodies mostly from people in Tennessee, Virginia and North Carolina. In return for body donations, Restore Life offers to pick up the deceased, cremate the unused remains for free and return them to the family.
In 2011, Mr Byrd spoke publicly about Restore Life in a presentation to the commissioners in nearby Sullivan County. Officials there had grown frustrated by the increasing cost to taxpayers of cremating the indigent. According to a recording of that meeting, Mr Byrd explained that he could help the county. He also noted that many families who donated to Restore Life did so for financial reasons: All expenses were covered, including cremation.
"We have become more a service for those indigent and pauper cases that can't afford a funeral," Mr Byrd told the commissioners. "It's a perfect fit for situations where families don't have the funding or sometimes where it's left to the county for funding."
Restore Life's informal arrangement with Sullivan County to take indigent bodies continues today, county officials said. A few times a month, they said, the medical examiner or other officials refer pauper cases to Mr Byrd for possible donation.
At the 2011 meeting, County Attorney Dan Street said a formal arrangement with Mr Byrd was unnecessary because officials were merely referring the indigent to him, without any endorsement implied.
"This company is simply going to come and take these bodies," Mr Street told commissioners. "We're simply getting out of the way and letting them do what private enterprise does best."
Since it opened, Restore Life has grown almost every year, according to the latest available tax records filed with the Internal Revenue Service.
Records show that Restore Life's annual revenue rose from US$49,251 in 2009 to US$1.1 million in 2016. Income also increased, the records show. In 2009, expenses exceeded revenue by US$1,277. Last year, revenues were US$187,884 higher than expenses. The tax records show the charity's net assets were US$354,556 on Aug 31, 2016, the last date for which records are available.
Mr Byrd lives and works in a Tennessee town where the median household income is US$30,000. The non-profit he operates paid him a salary of US$113,000 last year, the tax records show.
ORDERING A SPINE
On Aug 29, 2016, Reuters reporter Brian Grow sent an inquiry via e-mail to Restore Life's Mr Byrd. At the time, the news agency knew nothing about Mr Cody Saunders.
To contact Mr Byrd, the reporter used his real name and his Thomson Reuters e-mail account.
"We are seeking pricing, including shipping costs, to procure one cervical spine specimen for purposes of a research project involving non-transplant tissue," the query said. The term "non-transplant tissue" refers to body parts, such as heads and spines, which cannot be transplanted into living humans.
The request from the reporter provided a delivery address in Minneapolis, a few miles from the University of Minnesota's anatomy lab.
Mr Byrd responded about an hour later: "Thank you for your email, I do not believe we have worked with you in the past. How did you hear about our organisation?"
The reporter replied: "Your firm was referred to us by an industry contact."
Mr Byrd then asked if the reporter wanted a full cervical spine - the vertebrae and tissue in the neck, just below the skull. When told yes, Mr Byrd replied that the price would be US$300, plus US$150 shipping. He attached X-rays, which were described as belonging to a 24-year-old male.
Three days later, the reporter accepted the offer.
Mr Byrd replied: "Thank you again for allowing us the opportunity to work with you and your organisation."
He added three questions. One concerned billing, and one asked to confirm that the spine should be sent frozen, not thawed. Mr Byrd's third question was whether the specimen would be used for "medical research or medical education".
In addition to determining how easy it might be to buy body parts, Reuters sought to assess the quality of the specimens and the documentation that came with them. When the reporter responded simply that "it's being used for medical research", Mr Byrd closed the deal.
Ms McArthur said the Reuters purchase was legal and ethical. No law prohibits such sales, she said, and the news agency was conducting legitimate research. Mr Byrd, she added, broke no laws by selling the body parts. Still, she said, the three questions he asked in his e-mail demonstrated the broker's focus on completing the sale, rather than on seeking more details about the buyer's intentions.
That process can include a request by the seller for details about how the buyer intends to use the body parts for research or education.
Ms McArthur said brokers like Mr Byrd who accept donations have an ethical responsibility - though not a legal one - to ensure that body parts will be used in a medical setting for an appropriate purpose. Reuters turned over the remains to Ms McArthur for analysis and safekeeping. But another buyer could have done anything with the human spine and heads, she said.
THE SPINE ARRIVES
On Sept 27, 2016, a FedEx driver delivered a brown cardboard box to the Minneapolis location where Reuters had leased a mailing address. There, the reporter received the package and gave it to a courier who specialises in transporting human remains. The courier drove it directly to Ms McArthur at the medical school.
Ms McArthur immediately noticed problems. She said she found it odd that the outside of the box was not labelled with a customary warning that human remains were inside.
Ms McArthur found a pair of one-page documents in the box. One contained the results of a serology test by a reputable company, certifying that the donor was free of infectious disease. The other page offered a handwritten summary, in layman's terms, of the donor's medical history.
"In my experience, I would have expected to see a more robust form," Ms McArthur said, explaining that most brokers provide precise and detailed medical histories. "It's very superficial."
The medical summary contained neither letterhead nor contact phone number, she noted. Ms McArthur also cited inconsistencies in the specimen identification numbers listed at the top and bottom of one of the pages. And she noticed a small discrepancy between the identification numbers listed on the paperwork and a tag attached to a plastic bag covering the spine.
Precise, legible medical history and consistent donor identification systems are critical information for proper medical research, said University of California anatomical services director Brandi Schmitt. The medical history helps the researcher account for variables such as disease or trauma. Clear paperwork and accurate tagging, she said, allow researchers to track specimens in a scientific manner.
To prevent mishaps that could lead to lost or misidentified body parts, most hospitals and medical schools use modern tracking techniques, including computer-generated metal discs or barcode tags, Ms Schmitt said. A label of some sort should have been directly attached to the spine itself, she said, not merely to the packaging.
"Misidentification is a real problem, for sure," said Ms Schmitt, who coordinates body donation for the University of California's medical schools statewide. "I don't think that a handwritten document is your most professional approach. It can lead to human error."