Although he takes 60 pills a day—and has shrunk almost 3 inches as a result of bone calcium loss caused by the drugs—in many ways he feels like a new man. His sex life, he says, has actually improved. “It's a 17‐year‐old‐heart with 30 years of experience.”
THE ‘BOTTLENECK IN BODIES’ HAS CREATED THE AGONIZING ETHICAL DILEMMA: WHO SHALL LIVE AND WHO SHALL DIE?
By David Dempsey, Oct. 13, 1974
Ever since April of this year, William O’Neill, a 44‐year‐old assistant general sales manager for the Titanium Metals Corporation of America, has been living without his kidneys, the result of an operation to save his life. Three times a week this tall, once‐energetic man travels from his apartment on East End Avenue to Columbia Presbyterian’s hemodialysis center on the West Side; here, for six hours, he stretches out in a reclining chair while blood is drawn from his veins and circulated through the filtering mechanism that does the work of the human kidney. O’Neill submits to this uncomfortable treatment between midnight and 6 A.M. (the only time a machine is available to him), one of 12 patients being dialyzed simultaneously at the center.
As O’Neill dozes during the long silent hours of this twilight world, he often indulges in fantasy. The most recurrent image—triggered sometimes by the wail of an ambulance siren—is that an accident or homicide victim will be brought to the hospital’s emergency room and die soon afterward; in his wallet will be found a donor card—the little “pocket will” declaring that the bearer agrees to give his organs for transplantation. O’Neill’s follow‐up fantasy is that cross‐matching between the donor’s tissue and his own will indicate that the new kidney is not likely to be rejected. In the final act, O’Neill is rushed to the operating room where a transplant team, with the surgical derring‐do that has become relatively common in the past few years, implants a kidney that will give him a normal life. The cost of $10,000 or more is no problem: since 1973, Medicare pays 80 per cent of the operation for people of any age and his insurance company will pick up the balance.
The major difficulty with this fantasy is that it is shared by at least two‐thirds of the transplant candidates in this country (an estimated 8,000 each year) who must wait for someone else to die if they are to have a second chance. (The luckier one‐third look to a member of the family who is willing to donate one of his two kidneys.) Yet only about 30 per cent of these people will receive a graft; there are simply not enough accidents or homicides occurring in the right place at the right time and the organs of those who die more lingering deaths are not being salvaged by hospitals.
“Thousands of people,” says Dr. Donald Kayhoe, who oversees tissue‐typing research for the National Institutes of Health, “look forward to claiming the heart, liver or kidneys from the latest 17‐year‐old boy who is killed on a motorcycle.” Such a person, Dr. Kayhoe notes, makes the best organ donor, although he is least likely to carry a donor card. Out of the ashes of such accidents, he points out, arises a new 20th‐century phoenix, the transplantable organ that gives life to others.
In the San Francisco Bay area, the state high way patrol notifies the University of California Medical Center whenever it investigates a serious accident; if injuries prove fatal, victims are transferred from the emergency room of the local hospital to the center where a transplant team is standing by. However, the next of kin must give permission for this procedure. In a Swift‐inspired article in Medical Opinion and Review, Dr. Warren J. Warwick of the University of Minnesota Medical School foresees the time when “mobile bodyrescue teams … accident watching clubs … as well as television monitors” along busy highways will be common. Dr. Warwick’s “modest proposal” also includes the prohibition of seat belts and cancellation of speed limits to increase the number of accidental deaths. A humorous lapel button already reads: “Drive carefully, Dr. Barnard is waiting.”
This bottleneck in bodies has come about largely because of medicine’s spectacular advances in transplant technique. What was once a rare and exotic procedure, accompanied by awesome levels of publicity fallout, is now performed with clinical, if not routine, confidence. Skin, bone and cornea grafts have long been common. Thymus gland tissue has been implanted in babies born without a thymus. Experimental work has been done with parts of the small intestine, lymph glands, ovaries and testicles. The liver has successfully been grafted into the dying and, although the survival rate is low, one such person lived five years.
Today, it is easier to graft a kidney than to procure one—the three‐year survival rate from live donors approaches 80 per cent and for cadaver kidneys alone it runs better than 50 per cent. Men like Bill O’Neill, for example, know that Columbia Presbyterian’s first kidney recipient, Dreanna Winfield, is going strong six years later, although there have been some reparable complications. An attractive black woman in her mid‐30’s, Miss Winfield used her recuperative time to get a master’s degree in social work and is now employed by a child‐care agency.
Heart transplants, after a dismal beginning in the late nineteen‐sixties, have also shown a dramatic increase in survival as more has been learned about the body’s immunology—its genetic tendency to reject foreign bodies. Although only 36 out of 241 heart recipients during the last six years are still alive, eight have survived at least five years and one has lived six. But this does not tell the whole story. The quick rejections that characterized the early days of transplant surgery are declining and the rate of survival is now higher than ever before.
At Stanford University, a team led by Dr. Norman Shumway has done 73 grafts, most of these in the last few years. One‐third of all his patients are still alive, 20 per cent have survived at least four years and an astonishing 50 per cent have lived at least a year. Because of the recentness of the operations, there is really no way of predicting how much longer these recipients will remain healthy. But Dr. Shumway believes that with better heart monitoring and immuno‐suppressive techniques, people with transplanted organs will eventually be able to live relatively average life spans.
One of Shumway’s patients is Richard Cope, a methods engineer at the Grumman Aerospace Corporation on Long Island. Cope got his new heart four years ago. Now 50, he is physically active, climbs and prunes trees, swims daily and, with the help of his son, has just added an extension to his house. (His donor was the proverbial “17‐year‐old boy killed in a motorcycle accident.”) Although he takes 60 pills a day—and has shrunk almost 3 inches as a result of bone calcium loss caused by the drugs—in many ways he feels like a new man. His sex life, he says, has actually improved. “It’s a 17‐year‐old‐heart with 30 years of experience.”
Shumway now transplants more hearts than any man in the world. Deliberately avoiding publicity, he stays off talk shows, limits most of his public statements to medical conventions and professional journals, and otherwise tries to keep a low profile. At Stanford, Shumway “wears an old pair of sneakers and an old green smock, and far be it from him to look like a famous heart surgeon,” Cope told a reporter for Medical World News.
Shumway’s improved success with hearts, and the extraordinary survival rate now being shown by kidney grafts, has intensified the demand for transplants of all kinds. With new discoveries into the nature of the body’s immune system, and research on drugs to combat it, successful transplantation of organs that have heretofore shown a poor outcome seems much more feasible. In their euphoric moments, some surgeons envision a “composite man” consisting almost entirely of spare parts. And with artificial organs on the drawing board—the heart in particular—in theory at least there is no reason why a person should ever wear out.
Promising as it may be, this ecological recycling of the human body has presented both medicine and society at large with a new range of problems, some of which seem to outweigh the cures that are being effected. Professionals see five such areas for which neither scientists nor social agencies have found a satisfactory solution:
■ In social terms, transplant medicine is hobbled by its own success. Logistics has not kept pace with technology. Even corneas, which can be “banked,” supply only half the present need; other or gans about one‐quarter to one‐third. With improved grafting techniques, this disparity will grow. And the money required, critics say, might better be spent on preventing disease among the many rather than giving new organs to the few. The N.I.H.’s Dr. Benjamin Burton estimates that by 1980 the annual cost to the Government for kidney dialysis and transplantation alone will run at least $1‐billion.
■ On the medical side of the ledger, transplants often substitute one disease for another. Kidney patients run a higher than normal risk of getting cancer, probably because of the drugs they need. People with heart grafts often develop premature sclerosis of the coronary arteries, and many die of stroke. Why, it is asked, give a person a new heart so that he can linger half‐paralyzed from some other ailment?
■ The shortfall in organs has created some major ethical dilemmas, chiefly the agonizing task of deciding who shall live and who shall die. Medical factors alone determine the initial suitability, but criteria of “social worth,” that is, income, educational background and professional standing are then frequently used to select the lucky candidate. Medicine, too, has had to revise its definition of death, speeding up the process in order to procure organs that are “fresh.” The brain, not the heart, has bethe vital of life as cessation of neurological function becomes the primary determination of when a person is dead. As a result, some physicians claim, the diagnosis of death is shifted, however subtly, from whether the injured has a chance to survive to whether the transplant has a chance to succeed.
■ Psychologically, life with a stranger’s organ can be difficult. Haunted by the feeling that they are “somebody else,” many people who have received new hearts or kidneys have undergone a personality transplant as well. Recipients of live‐donor kidneys often become excessively grateful, or guilty. Almost all transplant recipients live a life of nervous uncertainty. And those waiting for an organ, especially the dialysis patient, commonly get depressed and some become psychotic. One study of 127 dialysis centers showed that the suicide rate among patients was 100 times that for a comparable normal population. The “gift” of life, critics say, can be expensive.
■ Finally, the success of transplants has encouraged a new idolatry of the human body and with it, illusory intimations of immortality. Life is reduced to a set of replaceable functions when what is needed is a sense of closure. If the prospect of staying alive by all means becomes paramount, we will lose the transcendent relationship with the world that guides our spiritual nature.
In performing miracles on the dying, the radical Catholic priest Ivan Illich has said, modern medicine is depriving man of a natural vision of death. And it is this vision, he thinks, that adds genuine meaning to life.
Although not discounting the importance of these dilemmas—many, indeed, have been raised by physicians themselves — the transplant surgeon is confident that the benefits already outweigh the hazards and that virtually all problems plaguing the field can eventually be solved. Medically, the fact that one of the first kidney patients has lived more than 17 years, and that eight people survived five years with a new heart, shows that rejection is not inevitable, and that a “new disease” need not supplant the old.
Research into the compatibility of body tissues is also making it possible to predict with greater accuracy whether the new organ will “take.” Dr. Shumway, for instance, pulverizes a small amount of the donor’s tissue and injects it into the heart candidate to create advance tolerance. And the N.I.H. is funding a $4‐million annual program in tissue‐typing that is gradually zeroing in on the major components in the blood sera that act as heroes and villains in transplants between unrelated persons.
This, in fact, may be the key that unlocks the body’s inherited reluctance to accept a new organ. The white who sought to prove that he, not their clients, killed the victims by removing their hearts before they stopped beating.
The hearts were indeed beating, Dr. Shumway admitted—otherwise they would have no value—but only because the patient was on a resuscitator. Neurologically, the patients were dead. “To use stoppage of the heart is a Boy Scout definition of death,” he has stated. “When the brain is dead, that’s it.” (In both cases, involving Dr. Shumway, the indicted murderers were found guilty.) Two states, Kansas and Virginia, now recognize neurological function, rather than heartbeat and respiration, as the true measure of whether a person is airve. Cautiously interpreted, the idea of “brain death” can actually protect the patient; but abused, it permits a person to die at the doctor’s convenience.
Irving Ladimer, an attorney and director of the National Transplant Information Center in New York, states: “One thing you’ve got to realize is that the new definition of death speeds up the process; it doesn’t slow it down. It makes it easier to declare people dead.” Suggestions have been made that this process could be advanced even faster if death were defined as cessation, not of the whole brain, but merely of the cortex, which controls the higher functions of thought, memory and sensation. Still speaking in a satirical vein, Dr. Warwick adds that the time may come when it will be sufficient for a patient to be declared “95 per cent” dead; the percentage might vary as the demand for organs went up or down.
In spite of rigorous restrictions that aim to prevent abuses—it is recommended that the encephalogram reading (EEG), for instance, should be “flat” for 24 hours—cutting corners is not unknown. In a landmark case in 1968, a Virginia jury gave the green light to death by transplantation. Late on May 24 of that year, Bruce Tucker, a laborer, sustained a massive brain injury in a fall. Operated on at the Medical College of Virginia, he was placed on a respirator at 11:30 A.M. the next day. Although the EEG was flat, Tucker’s other vital signs — body temperature, blood pressure and rate of respiration — remained normal. This was in the early days of transplants and a heart recipient, one Joseph Klepp, was waiting. Thanks Medical, he did not have to wait long. Four hours after the respirator was turned on, and with no attempt to locate Tucker’s next of kin, it was turned off.
Tucker’s heart was removed an hour later and, while they were at it, surgeons also took out his kidneys (for possible future use). The unseemly haste with which all this was done caused Tucker’s brother to sue for $100,000 damages. The transplant team, he charged, was engaged in a “systematic and nefarious scheme to use Bruce Tucker’s heart and hasten his, death by shutting off the mechanical means of support.” Dr. Robert M. Veatch of the Institute of Society, Ethics and the Life Sciences, pointed out that “the patient was pronounced dead less than two hours and 35 minutes after the electroardiogram reading”—far too short a time, he says, if not to determine death, at least to look for relatives who might give permission for the transplant.
Bruce Tucker’s brother did not collect any money. Possibly one reason is that Tucker was black and Klepp (who died a week later) was white. Earlier fears that transplantable organs would come from poor blacks, because they provide a disproportionate number of unclaimed bodies, have not been borne out.
A more, revealing question is: who gets the second chance? The answer, not surprisingly, is that, as a scarce resource, it goes mainly to the more important and powerful members of society.
A few years ago at Seattle’s Swedish Hospital, an anonymous “life or death” committee was appointed to select the most suitable candidates for kidney grafts. Although representing a good cross section of the community, it soon found itself wrestling with such criteria as the patient’s marital status, his income and net worth, educational background, social and professional status, and his future potential. In some cases, while the committee deliberated, the patient died. “Committee decisions reflected the middle‐class prejudices of its members and ruled out ‘creative nonconformists’ who rub the bourgeoisie the wrong way,” observed two law proressors at the University of California at Los Angeles. “The Pacific Northwest is no place for a Henry David Thoreau with bad kidneys.” The committee has since disbanded.
Those seeking dialysis as a prelude to transplantation may also be screened for a variety of nonmedical attributes. In a 1969 survey of 87 dialysis centers in this country, two investigators, A. Katz and D. Proctor, found that great emphasis was placed by the doctors on the patient’s intelligence, since this factor presupposed ability to cooperate in the treatment. The individual’s “social worth” was often taken into account, and in some cases it came down to how “congenial” and “likable” he seemed; such people might well be entitled to go on living.
Katz and Proctor also found that 91 per cent of all dialysis patients are white (this was before Medicare). Among this group, 45 per cent had attended college for at least a year (compared with 18 per cent of the general adult population) and “60 per cent had incomes … at, or above, the U.S. median family income.” Within the next five years, Dr. Burton thinks, as more people are referred for treatment under Medicare, some 60,000 patients will enter the dialysistransplant “holding pattern.”
Today, the average time on dialysis is 11 years. “It’s a life net, but life nets are not comfortable to live in,” Dr. Burton says. “Half of these people do not lead productive lives.” Recently, a Detroit man, tired of waiting, placed an ad in a local newspaper offering $3,000 for a kidney and received 100 calls from people willing to seal one. The hospital, however, would not accept a purchased organ. Some physicians nevertheless see a future black market in organs, and Dr. Henry K. Beecher of the Harvard Medical School once warned that the “body snatcher” of the 19th century may be replaced by the “organ snatcher” of today.
Irving Ladimer believes that the shortage will continue as long as there is no money in “harvesting” organs by salvaging those in good condition, banking them briefly and searching out a recipient. “Medicine is a free‐market enterprise,” he says, “and for hospitals to do this just adds to their deficits.” (A proposal by Ladimer by which hospitals in the New York area would be paid for sharing organs through a cooperative, regional arrangement, failed to catch on.) Blair Sadler, a lawyer who, with his brother Alfred helped write the Uniform Anatomical Gift Act, making it possible legally to will one’s body to science—as property is willed to heirs —thinks that some physicians resent the transplant surgeon as an interloper and “hold back” organs that might save a life.
The Uniform Anatomical Gift Act, once seen as a solution to the organ shortage, has in fact done little to alleviate it. Under provisions of the act, the donor must be at least 18 years old and he may revoke the gift at a later date. His decision, however, supersedes any rights of the survivors to withhold the gift unless a mandatory autopsy is declared. Yet figures compiled by Irving Ladimer showed that, up to 1971, only three card‐carrying donors had provided organs, despite the fact that about 10 million cards have been distributed, mainly through the National Kidney Foundation. Dr. Ira Griefer, the foundation’s medical director, estimates that to yield 8,000 kidneys each year, a pool of 70 million cardbearers would be needed.
Maryland and Illinois now issue driver’s licenses which include space for the motorist to sign over his organs in case of death. The proposal has also been made that people carry cards—or tattoo marks on their body—only if they don’t wish to be donors. Although Sadler prefers the voluntary approach, he states that “if we get to the point where we can show that lives are being lost, I would seriously consider giving medicine the right of eminent domain.” Authorities would be permitted to condemn medically suitable bodies without permission of the donor or his family if a life might be saved.
Organ preservation promises to alleviate at least part of this problem. Kidneys are now kept for as long as five days in a perfusion chamber —indeed, one was flown by Dr. Thomas Starzl from Denver to Holland and successfully transplanted, even after a delay in getting it through customs. Dr. Shumway packed one of his hearts in brine and flew it by helicopter from Oakland to Stanford.
Logistics, too, is improving. At the University of California at Los Angeles, Dr. Paul Terasaki and his associates have established a national transplant communications network. Using data banks, teletype terminals search recipient and donor pools throughout the country to coordinate the optimum tissue‐matching; the patient is then flown to the source of the organ. Within the Common Market, “Eurotransplant” exchanges livers, hearts, kidneys and other organs among 10 countries. In spite of these advances, Dr. Terasaki estimates that in the United States, out of 100,000 potentially suitable cadaver kidney donors that become available each year, not more than 10 cent are harvested.
Probably the most ingenious solution to the spare parts problem has been described by Columbia University sociologist Amitai Etzioni. Inste?? of cremating or burying people, Dr. Etzioni told a meeting of the American Association for the Advancement of Science in 1973, medicine could keep them indefinitely “alive” by artificial resuscitation; the body need never “die” until it had been suitably cannibalized.
“These cadavers,” writes Dr. Willard Gaylin in Harper”s, “would have the legal status of the dead with none of the qualities one now associates with death. They would be warm, respiring, pulsating, evacuating, and excreting bodies requiring nursing, dietary, and general grooming attention — and could probably be maintained so for a period of years.” Such “neomorts,” as Dr. Gaylin calls them, would be especially useful for bloodand tissue‐typing, since this could be done well in advance of transplantation.
Cadaver farms are not an immediate prospect; for one reason, Dr. Gaylin points out, people have a natural revulsion to exploiting the newly dead. “Sustaining life is an urgent argument for any measure,” he writes, “but not if that measure destroys those very qualities that make life worth sustaining.”
A far less objectionable procedure would be the transplantation of animal organs into human beings. More than 10 years ago, Dr. Keith Reemtsma at the Tulane University Medical Center grafted the kidneys of a 25‐pound rhesus monkey into a 32‐year‐old housewife. The organs did not “take,” were removed 10 days later and the woman died. Dr. Reemtsma next transplanted a chimpanzee”s kidney into a man who, after surviving two months, died of pneumonia. Now at Columbia Presbyterian in New York, Dr. Reemtsma continues his laboratory experiments in cross‐species grafting — from dogs to rabbits, for example —in the belief that matching and rejection problems should be licked before renewing animal transplants into humans. “In many primates, such as chimpanzees, we do know that the immunological barrier is not insurmountable,” he says.
Chimpanzees, however, are expensive to catch and keep, and although baboons are cheaper, “they fight like hell to keep their kidneys,” N.I.H.’s Dr. Kayhoe declares. Dr. Denton Cooley at the Texas Heart Institute in Houston once tried transplanting a ram’s heart into a dying patient. It failed immediately. The team had a pig standing by but by the time it was chased around the room, caught, bound and anesthetized, it was too late. However, Dr. Reemtsma says that in the long run he is “still hopeful for such heterografts.” Should this day arrive, the animal ranch may eliminate the need for cadaver farms. Genetically homogeneous animals would be bred purposely for their human‐organ compatibility, much as race horses are now bred for stamina and speed. And the supply of organs could easily be geared to human requirements.
In the case of the heart, even this may prove unnecessary. According to the American College of Cardiology, as many as 50,000 people with heart disease might be saved yearly by transplantation. Since not this many donors are available, the quantum leap at present is toward the Totally Implantable Artificial Heart. Funded by the N.I.H.’s Heart and Lung Institute, models of this “workbench organ” have already been tried in animals with fair success, and the researchers hope that a human version can be made practical within the next 10 years. They caution, however, that this is not a sure thing.
The Totally Implantable Artificial Heart —or T.I.A.H., as its inventors like to call it—is a miniaturized pump with Saran Wraplike lining and rigid plastic parts. In one battery‐powered prototype—the “businessman’s special” —energy is stored in the patient’s vest pocket or carried in an attaché case. In another version, batteries are implanted just beneath the skin and can be recharged at night. The most promising, long‐range model, however, is the nuclear‐fueled heart; a small canister of Plutonium238, carried inside the body, would be good for at least 10 years. At death, with the heart still beating, the fuel would be recovered and allocated to someone else.
Like real‐organ grafts, however, the T.I.A.H. threatens to introduce its own physical side effects. Too many nu clear‐powered hearts could be dangerously radioactive. One atomic scientist whose views were solicited by an N.I.H. panel wrote: “My main worry about a Plutonium‐238‐powered heart pump is that one day on a trans‐Pacific flight, economy class, I will be sitting between two of them.” Most scientists, however, discount the radiation hazard to others, pointing out that it is unlikely that very many artificial hearts would be concentrated in one place.
The risk to the bearer, however, would be considerable. The 1–2/3 ounces of plutonium required, although well‐shielded in the body, would expose a person to relatively large doses of radiation. The onset of cancer or leukemia is a possibility, and sterilization would probably result after 10 to 20 years. (With younger women, this would happen much more rapidly.) A married recipient would not be able to sleep with his or her spouse without inducing sterility. It is for this reason that some skeptics, viewing the device as unduly hazardous, call it the Totally Impractical Artificial Heart.
The institute’s Artificial Heart Assessment Panel does anticipate certain practical and philosophical difficulties. “The prospect of a recall of artificial hearts for repairs is, to say the least, disturbing,” the panel points out. Expense is a factor and the nuclear fuel might have to be financed through a bank or a loan company. The fatal heart attack, considered a boon to many who have reached old age, would no longer take place, providing “a much greater probability of a lingering and painful death.” And should Medicare do for the heart what it does for kidneys, the cost, at about $25,000 per heart, would be enormous. Politically, the public may look to Government “as the giver of life itself.
More problematical is the effect of the T.I.A.H. on one’s sense of self‐identity. With technology implanted at the very center of man’s bosom, would the fundamental role which the human heart symbolizes be altered? The panel suggests it might, and cites the Tin Woodsman Syndrome in “The Wizard of Oz.” This character fell into a depression searching for a “real heart.”
Many of these objections have also been raised against real‐organ grafts. And when Bill O’Neill, reclining at the hemodialysis center at Colum bia Presbyterian, thinks about them, he groans. Philosophical niceties are slight consolation when measured against the more urgent problem of organ supply. O’Neill, for instance, is planning to switch to another dialysis center, and then to a third. “I want to get on as many waiting lists as I can,” he says. Time is growing short, and for some the fantasy turns into a nightmare. (The?) cells of every person carry four chemical molecules containing “histocompatibility antigens” (HL‐A), two from the mother and two from the father. Because they are drawn from a pool of 32 known antigens, the possible combination in any one individual is quite large. The trick is to identify by tissuetyping the antigens of both donor and host to reduce the risk of the new organ being rejected. And since the chances of a perfect match are small, drugs are used to temper the body’s immune reaction.
The most promising drug for this purpose is antilymphocyte globulin, or ALG. ALG is directed at the lymphocyte cells in which antigens are a part, suppressing those that are antagonistic and thus giving the body a better chance of retaining the graft. In one study, a new “superpure” ALG, which permits much larger doses to be given, has shown an 80 per cent survival rate with cadaver kidneys, compared to the average rate of 50 per cent.
Other drugs are helping to reduce the side effects that produce malignancies or calcium loss in the bones. As we learn more about the effect of diet on transplant acceptance, strokes and coronary disease need not be a common hazard. One reason the survival rate will never be 100 per cent is that recipients will continue to die of accidents, or ailments unrelated to their primary disease. But don’t all?
A more formidable issue is time of death. How quickly can “heroic” measures justifiably be terminated so the organs will not deteriorate? The ideal donor will be in the prime of life, dying from irreversible brain damage but with his other organs diseasefree. Finally, these organs should be tissue‐compatible with a transplant candidate.
Although a policy statement by the Judicial Council of the American Medical Association recommends, among other things, that the physician who declares a patient dead not be a member of the transplant team, the knowledge that another dying person is waiting in the wings could easily affect his decision. Twenty‐nine of 85 potential candidates for heart transplantation admitted to the Stanford hospital died before a donor became available. Dr. Shumway has twice been “accused” of manslaughter by defense attorneys.
I made it to this article while looking up a couple of maniacs and their dreams of cadaver farms but there is so much WTF material in this article that we are taking the long way around to that.
