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Richard Saunders and his wife Angie Saunders attending through a box absolute admired items acceptance to their son Cody Dale Saunders in Townsend, Tennessee July 23, 2017. REUTERS/Wade Payne

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TOWNSEND, Tennessee (Reuters) - Cody Saunders was built-in in 1992 with declining kidneys and a aperture in his heart.

When he died on his 24th birthday, he had endured 66 surgeries and added than 1,700 circuit of dialysis, his parents said. Some days, he hid the affliction in upbeat selfies on Facebook. Added days, he aggregate an acute reality, assuming in a hospital bed with bandages beggared beyond his aching chest.

On his Facebook profile, Cody wrote that he was attractive for a adherent who will acquire "me for me."

"Y am I ugly," he acquaint on Christmas Day 2015.

Cody lived with his parents in an age-old motorhome at an East Tennessee campground. Aback he was able-bodied enough, he formed on a acreage with his father, agriculture cattle, putting up hay, carriage molasses in a dump barter from one barn to another.

On August 2, 2016, Cody died afterwards a affection advance on his way home from dialysis. Too poor to coffin or bake him, Cody’s parents donated their son’s assay to an alignment alleged Restore Activity USA. The ability sells donated bodies – in accomplished or by allotment – to researchers, universities, medical training accessories and others.

"I couldn’t acquiesce nothin’ else," ancestor Richard explained.

The ages afterwards Cody died, Restore Activity awash allotment of the adolescent man’s body: his cervical spine. The transaction adapted aloof a few email exchanges and $300, additional shipping.

Whether Restore Activity vetted the applicant is unclear. But if workers there had absolute their customer’s identity, they would acquire abstruse he was a anchorman from Reuters. The annual bureau was gluttonous to actuate how accessible it ability be to buy animal assay genitalia and whether those genitalia would be advantageous for medical research. In accession to the spine, Reuters afterwards purchased two animal active from Restore Life, anniversary priced at $300.

The diplomacy authenticate the amazing affluence with which animal assay genitalia may be bought and awash in the United States. Neither the sales nor the shipments abandoned any laws, say lawyers, advisers and government admiral who chase the affair closely. Although it’s actionable to advertise organs acclimated for transplants, it’s altogether acknowledged in best states to advertise assay genitalia that were donated for assay or education. Buying wine over the Internet is arguably added deeply controlled, about acute at minimum affidavit of age.

To accede with legal, ethical and assurance considerations afore the purchases, Reuters consulted with Angela McArthur, who directs the assay donation diplomacy at the University of Minnesota Medical School. She took actual aegis of the aback and active for Reuters, analytical and autumn them at the medical school.

Angela McArthur, administrator of the assay donation diplomacy at the University of Minnesota, poses in the Assay Bequest Laboratory in Minneapolis, Minnesota, U.S. August 15, 2017. Picture taken August 15, 2017 REUTERS/Craig Lassig

McArthur said she was afflicted by how calmly the assay genitalia were acquired and by the abortion of Restore Activity to accomplish able due diligence.

"It’s like the Wild West," McArthur said. "Anybody could acquire ordered these specimens and had them delivered to their home for whatever purpose they want."

McArthur advised the charcoal and the affidavit included with them to actuate how advantageous the genitalia would be for medical research. Her assay was based on civic assurance and belief standards she helped abstract for the American Association of Tissue Banks, the American Association of Clinical Anatomists and the University of Minnesota.

She assured that the medical history Restore Activity provided was insufficient, and that the accompanying paperwork was awkward and inadequate. For those reasons, the specimens did not accommodated standards for use at her university, she said.

"I haven’t apparent annihilation this arrant before," McArthur said. "I anguish about the approaching of assay donation and accessible assurance in assay donation aback we acquire situations like this."

Contacted several months afterwards the sales, Restore Activity President James Byrd briefly explained his access to business.

"Organizations like ours are what I accede answerable because, abnormally us, we acquire absolute acquaintance with the donor family," he said. "And there’s a assertive akin of annual and abode that is complex there because we acquire that claimed accord with them."

Byrd afterwards beneath to be interviewed or acknowledgment accounting questions. But he emailed a annual in which he criticized Reuters for authoritative the purchases.

"It’s accessible your aggregation at Thomson Reuters has no affair for those that seek admonition from our organization," he wrote. "You alone ambition to aching those that charge admonition the most."

Byrd added that Restore Activity does acceptable assignment by bartering assay genitalia to advisers alive to cure cancer, dementia and added diseases.

"We admonition endless bodies through a advanced ambit of assay alive with world-renowned researchers," he wrote.

Whatever acceptable Restore Activity hoped to accomplish by bartering these assay parts, McArthur said, its poor administration of the charcoal "miserably failed" to serve advisers and the three donors: Cody Saunders and the anonymous man and woman whose active Byrd awash to Reuters.

McArthur said the ancestors of donors, whose intentions are blue-blooded during a difficult time, deserve bigger from the industry.

"People anticipate they are accomplishing the adapted thing, and they appetite to accomplish their admired ones’ wishes," said McArthur, who aforetime chaired Minnesota’s assay donation bureau and serves on the administration board of the American Association of Clinical Anatomists. "I apperceive they would feel exploited to apperceive that article like this happened."

Thomas Champney, an assay assistant at the University of Miami Miller Academy of Medicine, additionally bidding all-overs at the affluence of the sales.

"Human assay genitalia should not be bought and awash in the aforementioned abode as acclimated refrigerators," he said.

Byrd, 50, has been in the assay genitalia business for two decades. An East Tennessee native, the assay agent afresh was runner-up in a amateur ball challenge alleged The Funniest Being in the Tri-Cities, the arena surrounding Kingsport, Johnson City and Bristol.

Before aperture Restore Life, Byrd directed a nonprofit tissue coffer alleged American Donor Services, afresh amid abreast Memphis.

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For several years, one of American Donor’s arch orthopedic barter was a Texas close affiliated with a aggregation that broadcast cartilage grafts fabricated in allotment from animal tissue. In 2005, according to affidavit affidavit in a civilian lawsuit, American Donor confused to a new arch orthopedic customer. The new applicant paid as abundant as $10,000 per donor, provided a $200,000 band of acclaim and began managing American Donor’s banking affairs.

Byrd larboard American Donor Casework a abbreviate while later, formed briefly for a vascular tissue bank, and afresh founded Restore Activity in 2008. Based in Elizabethton, Tennessee, Restore Activity obtains bodies mostly from bodies in Tennessee, Virginia and North Carolina. In acknowledgment for assay donations, Restore Activity offers to aces up the deceased, bake the bare charcoal for chargeless and acknowledgment them to the family.

In 2011, Byrd batten about about Restore Activity in a presentation to the commissioners in adjacent Sullivan County. Admiral there had developed balked by the accretion amount to taxpayers of cremating the indigent. According to a recording of that meeting, Byrd explained that he could admonition the county. He additionally acclaimed that abounding families who donated to Restore Activity did so for banking reasons: All costs were covered, including cremation.

"We acquire become added a annual for those busted and pauper cases that can’t acquiesce a funeral," Byrd told the commissioners. "It’s a absolute fit for situations breadth families don’t acquire the allotment or sometimes breadth it’s larboard to the canton for funding."

Restore Life’s breezy adjustment with Sullivan Canton to booty busted bodies continues today, canton admiral said. A few times a month, they said, the medical examiner or added admiral accredit pauper cases to Byrd for accessible donation. At the 2011 meeting, Canton Attorney Dan Street said a academic adjustment with Byrd was accidental because admiral were alone apropos the busted to him, afterwards any endorsement implied.

"This aggregation is artlessly activity to appear and booty these bodies," Street told commissioners. "We’re artlessly accepting out of the way and absolution them do what clandestine action does best."

Since it opened, Restore Activity has developed about every year, according to the latest accessible tax annal filed with the Internal Acquirement Service.

Records appearance that Restore Life’s anniversary acquirement rose from $49,251 in 2009 to $1.1 amateur in 2016. Assets additionally increased, the annal show. In 2009, costs exceeded acquirement by $1,277. Aftermost year, revenues were $187,884 college than expenses. The tax annal appearance the charity’s net assets were $354,556 on Aug. 31, 2016, the aftermost date for which annal are available.

Byrd lives and works in a Tennessee boondocks breadth the average domiciliary assets is $30,000. The nonprofit he operates paid him a bacon of $113,000 aftermost year, the tax annal show.

Angie Saunders holds a photo of her son Cody Dale Saunders in Townsend, Tennessee, U.S. July 21, 2017. Picture taken July 21, 2017. REUTERS/Wade Payne

Angie Saunders recalls that during her pregnancy, there were no signs of agitation in her prenatal check-ups or ultrasound tests. But aback Cody was built-in on August 2, 1992, he accustomed in grave distress.

He was confused from the canton hospital to the University of Tennessee Medical Center in Knoxville, breadth he backward for three months. He was diagnosed with VATER Syndrome, a action involving assorted bearing defects.

Besides the aperture in his affection and declining kidneys, Cody was built-in afterwards a rectum. For the aboriginal two years of his life, Cody’s parents said, they fed him through a gastrostomy tube.

Cody had so abounding comestible restrictions – no milk, no chocolate, no tomatoes, no alkali – that he acclimatized on dry Fruit Loops as his go-to meal. For dessert, he took a brace of bites from a stick of butter.

Cody bare dialysis three times a week, four hours per session. Given her son’s needs, his mother couldn’t assignment much. His ancestor told every employer upfront that his adolescent came first.

"Half of his life, if it wasn’t the hospital, it was dialysis," Richard said. "I went through a lot of jobs."

When Cody was about 9 years old, his parents said, he accustomed a branch displace that adapted him. It freed him from connected dialysis. He abstruse to bathe and had added time for school.

"I wouldn’t say he was normal," Richard said, "but at atomic we wasn’t accepting to be angry bottomward as much."

The new branch lasted a little added than bristles years, and aback it failed, Cody was rushed by helicopter to the hospital for a monthlong stay, his parents said. Dialysis began anew.

At 14, Cody won a children’s art contest. The charity, American Branch Fund, flew him to Washington, D.C. On a challenge questionnaire, he listed his admired things, including gym class, coloring, and benumbed his bike. His admired amateur was Scooby Doo. His role models: his dad and his mom. Aback he grew up, Cody wrote, he hoped to assignment with his father.

Cody larboard academy in the 11th grade. His parents say he was annual at a second-grade level. He formed on farms as about as he could with his dad, and in the winter they awash firewood. He chewed Skoal tobacco and played basin at a bounded club. To assure his kidneys and heart, he didn’t booze alcohol. But he didn’t consistently chase doctors’ advice. He could booze a six-pack of Mello Yello soda in a day, his parents said.

In his final years, Cody grew sad and lonely. His parents noticed, and so did his accompany on Facebook. He was weary of the pills, the dialysis, the hospitals and the connected reminders of what he could and could not do, his parents said.

"I anticipate not aloof his assay was tired, but his accomplished apperception was done," his ancestor said.

"He wasn’t scared," his mother said. "He was ready."

Cody’s affection chock-full on his birthday, August 2, 2016. Not continued afterward, Restore Activity calm his body.

On August 29, 2016, Reuters anchorman Brian Grow beatific an assay via email to Restore Life’s Byrd. At the time, the annual bureau knew annihilation about Cody Saunders.

To acquaintance Byrd, the anchorman acclimated his absolute name and his Thomson Reuters email account.

"We are gluttonous pricing, including aircraft costs, to annex one cervical aback case for purposes of a assay activity involving non-transplant tissue," the concern said. The appellation "non-transplant tissue" refers to assay parts, such as active and spines, which cannot be crude into active humans.

The appeal from the anchorman provided a commitment abode in Minneapolis, a few afar from the University of Minnesota’s assay lab. The concern concluded, "We attending advanced to audition from you."

Byrd responded about an hour later. "Thank you for your email, I do not acquire we acquire formed with you in the past. How did you apprehend about our organization?"

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"Your close was referred to us by an industry contact," Grow replied.

Byrd asked if Grow capital a abounding cervical aback – the base and tissue in the neck, aloof beneath the skull. Aback told yes, Byrd replied that the amount would be $300, additional $150 shipping. He absorbed X-rays, which were declared as acceptance to a 24-year-old male.

Three canicule later, Grow accustomed the offer.

Byrd replied, "Thank you afresh for acceptance us the befalling to assignment with you and your organization." He added three questions. One anxious billing, and one asked to affirm that the aback should be beatific frozen, not thawed. Byrd’s third catechism was whether the case would be acclimated for "medical assay or medical education."

In accession to chargeless how accessible it ability be to buy assay parts, Reuters approved to appraise the affection of the specimens and the affidavit that came with them. Aback the anchorman responded simply, "It’s actuality acclimated for medical research," Byrd bankrupt the deal.

"Thank you afresh (sic) the befalling to assignment with you and your organization," he wrote.

McArthur said the Reuters acquirement was acknowledged and ethical. No law prohibits such sales, she said, and the annual bureau was administering accepted research. Byrd, she added, bankrupt no laws by affairs the assay parts. Still, she said, the three questions he asked in his email approved the broker’s focus on commutual the sale, rather than on gluttonous added capacity about the buyer’s intentions.

That action can accommodate a appeal by the agent for capacity about how the applicant intends to use the assay genitalia for assay or education.

McArthur said brokers like Byrd who acquire donations acquire an ethical albatross – admitting not a acknowledged one – to ensure that assay genitalia will be acclimated in a medical ambience for an adapted purpose. Reuters angry over the charcoal to McArthur for assay and safekeeping. But accession applicant could acquire done annihilation with the animal aback and heads, she said.

On September 27, 2016, a FedEx disciplinarian delivered a amber agenda box to the Minneapolis breadth breadth Reuters had busy a commitment address. There, Grow accustomed the amalgamation and gave it to a bagman who specializes in alteration animal remains. The bagman collection it anon to McArthur at the medical school.

McArthur anon noticed problems. She said she begin it odd that the alfresco of the box was not labeled with a accepted admonishing that animal charcoal were inside. McArthur begin a brace of one-page abstracts in the box. One independent the after-effects of a serology analysis by a acclaimed company, certifying that the donor was chargeless of communicable disease.

The added folio offered a handwritten summary, in layman’s terms, of the donor’s medical history.

"In my experience, I would acquire accepted to see a added able-bodied form," McArthur said, answer that best brokers accommodate absolute and abundant medical histories. "It’s actual superficial."

The medical arbitrary independent neither card nor acquaintance buzz number, she noted. McArthur additionally cited inconsistencies in the case identification numbers listed at the top and basal of one of the pages. And she noticed a baby alterity amid the identification numbers listed on the paperwork and a tag absorbed to a artificial bag accoutrement the spine.

Precise, clear medical history and constant donor identification systems are analytical advice for able medical research, said University of California anatomical casework administrator Brandi Schmitt. The medical history helps the researcher annual for variables such as ache or trauma. Bright paperwork and authentic tagging, she said, acquiesce advisers to clue specimens in a accurate manner.

To anticipate mishaps that could advance to absent or misidentified assay parts, Schmitt said, best hospitals and medical schools use avant-garde tracking techniques, including computer-generated metal discs or barcode tags. A characterization of some array should acquire been anon absorbed to the aback itself, she said, not alone to the packaging.

"Misidentification is a absolute problem, for sure," said Schmitt, who coordinates assay donation for the University of California’s medical schools statewide. "I don’t anticipate that a handwritten certificate is your best able approach. It can advance to animal error."

A anniversary afterwards the aback arrived, Byrd responded to a aftereffect email from Grow. Byrd said animal active were accessible for $300 each. He additionally offered discounts on knee and bottom specimens to chargeless up "some freezer space." He wrote that his low prices for assay genitalia reflect the company’s "nonprofit accessible charity" status, adding: "We are attractive to aloof awning our overhead."

Richard Saunders and Angie Saunders are pictured in Townsend, Tennessee, U.S. July 21, 2017. Picture taken July 21, 2017. REUTERS/Wade Payne

Richard and Angie Saunders said they capital to coffin Cody beside ancestors in a adjacent cemetery. But Richard, who struggles to read, earns alone about $900 a month. Angie, who has continued suffered from debilitating anxiety, cannot assignment or drive. A burying was artlessly too expensive.

Friends offered to pay for cremation, which about costs at atomic $695 in the region. But the Saunders said they acquainted afraid about accepting alms from association they know. So they donated Cody’s assay to Restore Life. At the time, Richard said he was beholden for the chargeless burying the close promised.

The accident the ancestors faced is not aberrant amid donors, said Martha Thayer, armchair of the mortuary science diplomacy at Arapahoe Community College in Colorado.

Bereaved families are "vulnerable and are actuality put in the position of allotment this as an advantage aback they don’t acquire money," Thayer said. "The alone affair that’s added sad than a being who can’t acquiesce to alive is a being who can’t acquiesce to die."

In Cody’s case, a about apprehend a donor accord anatomy aloud to his parents afore they active it.

One branch says: "I accredit Restore Activity USA to access all all-important tissue and organs for assay and educational purposes. I accept this allowance will be acclimated for accurate research, teaching or added befitting purposes and for use in assorted assay or educational venues with for accumulation and/or non-profit organizations that Restore Activity USA, in their sole discretion, deems all-important to facilitate the gift."

The Saunders said they believed this meant that Restore Activity would alone abolish baby bark samples from Cody for medical research, bake him and afresh acknowledgment his ashes. The Restore Activity accord anatomy for Cody didn’t acknowledge that a donated assay may be dismembered, as accord forms of best added brokers do.

A few weeks afterwards the donation, a man from Restore Activity delivered an urn with Cody’s ashes. Angie can’t anamnesis the man’s name but said he was kind.

"Really nice and understanding," she said.

The assessment Cody’s afterlife has taken on Richard worries Angie. He won’t eat added than a few bites of whatever she cooks and usually refuses to allocution about their loss. Richard said Angie isn’t wrong, but he acclaimed he has bargain his smoking, from bristles packs a day to about three.

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On the decayed red-and-white auto he acclimated to ride in with his son, Richard placed a ample sticker on the rear window: "In Loving Memory of Cody Saunders."

"He was my buddy. He was my best friend," Richard said. "I accumulate cogent myself I’ll get over it, I’ll get over it."

In a shoebox central her motorhome, Angie Saunders keeps four photographs of Cody. In anniversary one, he looks anon into the camera, shades perched over his ballcap. She additionally keeps a argent urn absolute his ashes on the dashboard.

"I didn’t get to authority Cody aback he came into the apple and I didn’t get to authority him aback he went out," she said. "But he came aback to me, so he’s in actuality with me."

In January, Restore Activity alien a additional amalgamation to Reuters at the aforementioned Minneapolis address. This one independent two animal heads: one male, one female. As an accessible adventure will detail, Reuters purchased the active as allotment of its assay into a case in Pennsylvania. There, a animal arch was begin in a abounding breadth abreast Pittsburgh about three years ago.

Again, the specialist bagman brought the box to McArthur’s university lab, breadth she donned careful accessory and opened it.

The Styrofoam alembic central the agenda box accustomed absurd forth two of the alfresco edges, authoritative it accessible to leaks and presenting a abeyant bloom accident to anyone administration it, from shippers to researchers, McArthur said.

She additionally begin problems with the paperwork for the macho head.

"The breadth breadth tissue samples are usually listed – usually with client, sample description, sample ID, blazon of preservation, and the date and time of canning – is all blank," she said.

Likewise, the paperwork for the changeable arch was unprofessionally prepared, she said. McArthur said the abstracts were so adamantine to apprehend that she struggled to accept key advice any researcher would require, including the person’s medical history.

After the wrapping and paperwork were removed, McArthur begin that neither arch had an identification tag. A tag is advised critical, McArthur said, to clue identity, abnormally aback alive with assorted assay parts.

McArthur said that she was accustomed with belief of accidental sales of assay genitalia by brokers, but the sloppiness of this addition afraid her.

"I don’t acquire what I acquire aloof apparent actuality should be accustomed or should be legal," McArthur said. "I apperceive that it can be handled in a way that won’t asphyxiate medical apprenticeship and research. We can do this the adapted way."

A canonizing decal is apparent in the rear window of the barter endemic by Richard Saunders in Townsend, Tennessee, U.S. July 21, 2017. Picture taken July 21, 2017. REUTERS/Wade Payne

As is accepted in the assay agent industry, Restore Activity did not accommodate the names of the bodies who donated the assay genitalia it awash to anchorman Grow – aloof anniversary person’s age and date of death.

Reuters could not analyze the individuals whose active were shipped. But at aloof 24, Cody Saunders died so adolescent that the annual bureau was able to analyze him afterwards analytic through obituaries in southern states.

With his parents’ permission and participation, Reuters assassin a argumentative lab to accomplish a DNA test. It accepted that the cervical aback came from Cody.

In backward August, Grow alternate to appointment Richard and Angie Saunders to acquaint them what Reuters had learned: Restore Activity had dissected their son’s assay and awash allotment of his spine.

For a few moments, Cody’s parents sat silently.

Angie stared into the distance. Richard looked at the ground.

Then Angie spoke. "I anticipation they was aloof demography bark samples," she said and began to cry.

Richard approved to abundance her. "It’s over with, honey."

"I didn’t appetite no added surgeries," she said.

"At that time, we did not acquire no choice," Richard reminded her. "But you acquire to attending at it this way: Like you kept saying, if it’s activity to admonition somebody else…"

"I know, I know."

The brace said annihilation added for about bisected a minute. Finally, Richard angry to Angie. This allotment of their lives was "done and over," he told her.

Had they accepted Cody would be dissected, his parents said, they would not acquire donated his body. Cody, they felt, already had endured too abounding surgeries during his abbreviate life. They didn’t want, or expect, anyone to "cut on him" in death, Richard said.

And yet, he added, "I couldn’t acquiesce to do annihilation else, so I acquainted like that was the best advantage we had."

Richard asked whether Restore Activity acclimated any added genitalia of Cody’s body. The anchorman said he didn’t know. Brokers about don’t acknowledge that information. Richard said he doubted he would seek answers from Restore Life. "I don’t accusation them," he said. But he accepted acquirements what happened to Cody’s remains.

"Because we would acquire never known," he said.

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Angie agreed. "We wouldn’t acquire had a clue."

Early this month, in befitting with the family’s wishes and at Reuters’ expense, Cody’s aback was cremated in Minnesota. Grow delivered the ashes to the Saunders ancestors at their home in Tennessee.

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