The old system of quasi-legal corpse-theft had some subtle and unexpected horrifying consequences, in addition to the obvious and expected ones. In the 1920’s, doctors were trying to understand the cause of SIDS, Sudden Infant Death Syndrome, in which perfectly healthy babies died for no clear reason. Autopsies showed that the infants dying seemed to have thymus glands two to three times the standard size, and so a mechanism was suspected: Status thymicolymphaticus, an enlarged thymus cutting off the airway. Infants were routinely checked for this, and enlarged thymuses removed — first surgically, but soon using the radical new technique of radiotherapy. High-powered X-ray beams, it turned out, would quickly and non-invasively shrink the thymus. Thousands of children were soon being treated.

It was a few years before doctors became suspicious that so many children were showing these symptoms. Why did all these healthy-seeming children have enlarged thymus glands?

It turned out the reason was horribly simple. Until the beginning of the 20th century, dissection of human bodies was largely illegal, and so doctors acquired their anatomy specimens on the gray and black markets. And resurrectionists (to nobody’s surprise) found it easiest to ply their trade among the poor: buying the dead from poorhouses, “borrowing” from paupers’ graves, or simply “borrowing” the paupers themselves. But stressors of any sort cause the thymus to shrink, and the stresses of chronic poverty cause it to shrink a lot.

The “normal size” of the thymus in anatomy textbooks was simply wrong. These children’s glands had all been normal.

But the worst was yet to come: the thymus is right next to the thyroid, and irradiating that has some very dangerous consequences, indeed. By the 1940’s, many of the children who had been treated were dying of thyroid cancer.

Today, this is a standard story which students learn about the kinds of subtle error which can affect statistics and medicine, and a grim reminder: always think carefully about your baseline. But it also speaks to the importance of having a well-regulated system for doctors to get organs for dissection and study.

(For those who want to know more about the story, you can read a paper or hear a podcast. You can read about more modern views of the thymus here.)

Today, we have a carefully regulated system of organ and whole-body donation. Its first rule is that human body parts cannot be sold. This rule has led to a great deal of controversy over the years, because it means that people cannot be offered monetary compensation for any kind of donation — even giving blood. In a time when these parts are desperately needed to save lives, and often in critically short supply, many have advocated changing some of these rules.

But there are potentially subtle consequences to doing so. An obvious one is that people could be pressured to give up their organs for money; another obvious one is that you could end up with a system in which the rich buy organs from the poor, compared to the current system in which transplants are allocated based on need.

A less obvious one is the definition of the property right that we have in our bodies. Right now, with bodies being strictly non-marketable goods, that answer is (fairly) well-defined: bodies cannot be sold, and with the banning of slavery, at least in theory neither can the totality of their use. (There are, of course, many asterisks which that sentence would need) But if your body or its parts could be sold, then unpleasant questions start coming up. Could a person legally sell their own heart? Could a court demand a person’s kidney in order to satisfy a legal debt? Could your spleen be taken in bankruptcy?

These questions could be answered, of course, but they give a hint of just how complicated the rules around organ donation really are.

But while the rules around the sales of organs are incredibly strict, the rules around their rental are quite lax. This is presumably because organ rentals are generally not used for transplantation. (At least, I sincerely hope they aren’t. If you think home evictions can be bad, consider what happens to the person who falls behind on his liver payments.) Instead, they are used for research: for example, periodontists might want to rent a fairly-fresh head to study the different shapes which gums can take.

This business can be quite lucrative, and legally so: a single dead body can easily bring in $10,000 to $100,000.

Or it can be even more lucrative, when done illegally. And this brings us to International Biological Inc., the home business (I wish I were making this up) of Arthur and Elizabeth Rathburn.

It’s hard to do better justice to this story than the Detroit Free Press, referring to them as “shady cadaver dealers” where “he cut up the bodies; she dealt with the customers.” Arthur Rathburn started out innocently enough, coordinating the University of Michigan’s donation program, until he was fired in 1989 when he was caught selling bodies. At this point, he started his own small business.

According to the indictment and the news reports, the Rathburns found a number of means to reduce their overheads. Instead of medical facilities, they disassembled the bodies using standard shop tools. Careful sealing and isolation was replaced with large refrigerators and coolers, in which the body parts were basically stacked up. Bodies infected with various infectious diseases, from HIV to hepatitis to syphilis, were available cheaply because (unsurprisingly) customers didn’t want them; the Rathburns simply bought them, forged the paperwork, and sent them on their way. (Not to mention stacking them in the same refrigerators as uninfected body parts, with predictable consequences)

And their shipping methods were, shall we say, a little unorthodox. The federal investigation into the Rathburns was started when they noticed “what appeared to be bizarre shipments arriving for Rathburn at Metro Airport, including a bucket full of human heads that arrived from Israel one year.” (It’s really hard to beat Tresa Baldas’ prose on this story, and I won’t even try) The bucket of heads was apparently no anomaly; the indictment contains a number of similar head cases, many of which were shipped aboard passenger flights in coolers, falsely labeled as being embalmed.

When police finally raided their business in 2013, they found themselves having to deal with over 1,000 body parts, many infected, all improperly stored; I do not envy the police officers who got the job of transporting them to the Wayne County Morgue. The court proceedings have been made all the more amusing by being intertwined with the Rathburns’ somewhat acrimonious-seeming divorce, currently in progress.

In short, this is a story which has everything: romance, frustrated passions, avarice, and a great number of dead bodies.

Those who wish to know more about the shadier side of the modern business of human remains should take a look at Annie Cheney’s Body Brokers, an entire book about just how one does go about getting a body for the market.

Having given you a series of anatomical horror stories, I wanted to emphasize that, by and large, the work of transferring human organs is not only legitimate, it’s lifesaving. Probably the most exciting advance in this field in the past few years has been the idea of “paired organ exchange.”

This idea started with kidneys, which a living donor can give. Unfortunately, while there are many people in need of kidneys who have loved ones willing to give them one, it’s rare that this loved one has a kidney which they can use: one of the right size, blood and antigen types, and so on. So people with willing donors were waiting, and sometimes dying, for want of an organ.

The solution to this is a paired exchange. If we have several people, each of whom have a need of a kidney and a willing donor, we can start to draw a path through the people, with a person from the first pair donating a kidney to a recipient in the second pair, the donor from the second pair donating to a recipient in the third pair, and so on, until the donor from the last pair donates to the recipient in the first pair.

It was long worried that this would never work: what if a donor backed out? If they did, not only would the entire rest of the chain be interrupted, but the first couple — the ones who had donated a kidney to start all of this — would find themselves having donated a kidney and still in desperate need of one.

But it turns out that humans are better than anticipated. Last year, a record-setting 35 pairs participated in a single kidney transplantation cycle. And people without a donor handy benefit from this as well: each of those 35 people who received a kidney from this ring are no longer waiting for a kidney from the ordinary (deceased-donor) transplant lists, and so there are 35 more kidneys to go around.

So when all is said and done, the existence of a system of trading organs around has been a powerful system to save lives, both directly through transplants, and indirectly through research. It’s an honorable and critical profession. But when it goes wrong, it does so in a spectacular fashion.