*Oregon: *On July 20, a Hong Kong-flagged cargo ship departed Charleston, South Carolina carrying thousands of containers. One of them held a lucrative commodity: body parts from dozens of dead Americans.
According to the manifest, the shipment bound for Europe included about 6,000 pounds of human remains valued at $67,204. To keep the merchandise from spoiling, the container's temperature was set to 5 degrees Fahrenheit.
The body parts came from a Portland business called MedCure Inc. A so-called body broker, MedCure profits by dissecting the bodies of altruistic donors and sending the parts to medical training and research companies.
MedCure sells or leases about 10,000 body parts from US donors annually, shipping about 20 percent of them overseas, internal corporate and manifest records show. In addition to bulk cargo shipments to the Netherlands, where MedCure operates a distribution hub, the Oregon company has exported body parts to at least 22 other countries by plane or truck, the records show.
Among the parts: a pelvis and legs to a university in Malaysia; feet to medical device companies in Brazil and Turkey; and heads to hospitals in Slovenia and the United Arab Emirates.
Demand for body parts from America - torsos, knees and heads - is high in countries where religious traditions or laws prohibit the dissection of the dead. Unlike many developed nations, the United States largely does not regulate the sale of donated body parts, allowing entrepreneurs such as MedCure to expand exports rapidly during the last decade.
No other nation has an industry that can provide as convenient and reliable a supply of body parts.
Since 2008, Reuters found, US body brokers have exported parts to at least 45 countries, including Italy, Israel, Mexico, China, Venezuela and Saudi Arabia. Whole bodies are studied at Caribbean-based medical schools. Plastic surgeons in Germany use heads from dead Americans to practice new techniques. Thousands of parts are shipped overseas annually; a precise number cannot be calculated because no agency tracks industry exports.
Most donor consent forms, including those from MedCure, authorize brokers to dissect bodies and ship parts internationally. Even so, some relatives of the dead said they did not realize that the remains of a loved one might be dismembered and sent to the far reaches of the globe.
"There are people who wouldn't necessarily mind where the specimens were sent if they were fully informed," said Brandi Schmitt, who directs the University of California system's anatomical donation program. "But clearly there are plenty of donors that do mind and that don't feel like they're getting enough information."
MedCure shipments are now the subject of a federal investigation. In November, the Federal Bureau of Investigation raided the company's Portland headquarters. Though the search warrant remains sealed, people familiar with the matter say it relates in part to overseas shipping.
MedCure is cooperating with the investigation, said its lawyer, Jeffrey Edelson. He declined to comment on the FBI raid, but said: "MedCure is committed to meeting and exceeding the highest standards in the industry. It takes very seriously its obligation to not only deliver safe specimens securely, but to do it in a way that respects the donors."
Edelson also said MedCure "partners with government and industry agencies to follow and exceed requirements for shipping human tissue," and that "shipping handlers, drivers and carriers are specially trained for the safe handling and transportation of human specimens."
*INFECTED PARTS AT THE BORDER*
As a Reuters series last year revealed, the body donation industry is so lightly regulated in the United States that almost anyone can legally buy, sell or lease body parts.
Although no federal law expressly regulates the body trade, there is one situation in which the U.S. government does exercise oversight: when body parts leave or enter the country. Border agents have the authority to ensure that the parts are not infected with contagious diseases and are properly shipped.
This authority played a leading role in the government securing a conviction last month of Detroit broker Arthur Rathburn, who stored body parts in grisly, unsanitary conditions, according to trial testimony. The FBI began to focus intently on Rathburn's business, International Biological Inc, after repeated border stops in which he was found ferrying human heads, court records show.
The jury found that Rathburn defrauded customers by supplying body parts infected with HIV and hepatitis.
"The fraud scheme orchestrated by IBI shocked even the most experienced of our investigative team," said FBI special-agent-in-charge David Gelios. Even in death, Gelios said in a statement after the verdict, donors were "victimized as IBI intentionally and recklessly marketed and transported contaminated human remains... Personal greed overcame decency."
Rathburn was also convicted of transporting hazardous materials - the head of someone who had died of bacterial sepsis and aspiration pneumonia. The transportation conviction underscored the U.S. government's growing concern about shipments of body parts that might endanger public health, officials said.
Martin Cetron, director of Global Migration and Quarantine for the Centers of Disease Control and Prevention, said that when brokers dissect a body that is infected, there is added risk of transferring that disease to anyone who handles the parts.
"In the case of saws (used) to cut bones or limbs, there may be additional procedures that could potentially turn a fluid into an aerosol that could be inhaled and be communicable," Cetron said.
A Reuters review of government records shows that border agents intercepted body parts suspected to be infected at least 75 times between 2008 and 2017. Border agents pay more attention to goods entering the country than those departing, and virtually all of the intercepted shipments were remains of American donors whose body parts were being returned to United States. Typically, body parts are returned to America for three reasons: to comply with foreign laws on final disposition; when cremation is not available in the foreign country; or when a U.S. broker intends to reuse the parts.
In 2016 and 2017, for example, federal agents stopped shipments being returned to MedCure at the border, law enforcement records show. The body parts they stopped included torsos carrying infectious biological agents that cause sepsis, a body's extreme response to infection. At least one carried the life-threatening MRSA bacteria, the records show.
For more than a year, records show, US officials and some body brokers have disagreed over whether the presence of sepsis in a corpse - without further information about a person's cause of death -poses enough of a risk to warrant special packaging and warning labels.
"Sepsis itself is not a disease diagnosis but it raises a red flag," said Cetron, the CDC official. The pathogen that caused sepsis, he said, "could be a bacteria, could be Ebola, could be salmonella, could be E coli." That's why further documentation, including a death certificate, must accompany any body part imported into the United States, he said.
The CDC has an exemption intended to allow for shipping blood and other lab testing samples. Reuters found dozens of examples of brokers labeling customs manifests and packages with a version of the term "exempt human specimen" to ship body parts.
"I think that's a deceptive practice," Cetron said. "If they are human remains, part or in whole - heads, arms, limbs, etc. - they are not exempted."
Several brokers said the government should clarify the rules - whether the CDC's or those of other regulatory entities. They cited, for example, a U.S. Department of Transportation regulation that, they believe, exempts body parts. Transportation officials declined to comment on their regulations.
Alyssa Harrison, executive director of Oklahoma-based broker United Tissue Network, said most in her industry want to follow the law. But, she added, "there are many guidelines that are unclear and or contradictory to other department's regulations."
The disconnect between what the industry and government believe is dangerous, and what precautions are required by law, should be resolved, said Matthew Zahn, chairman of the public health committee for the Infectious Diseases Society of America, a group that represents doctors, researchers and other health professionals.
"It's a situation where we don't have a huge amount of regulation or clarity as to what the risks are," Zahn said. "It feels like one of those cracks in the system where a practice has developed and the risk factors and oversight have not fully matured."