Melting down hips and knees: The afterlife of implants

 
Surgical implants

As people live longer and medical technology improves, more and more of us will have a surgical implant before we die. We are also getting cremated in larger numbers - and so there is often some expensive metal left among the ashes. Where does it go?

"You tell people what you do, and they think... well, that's a bit strange," says Ruud Verberne above the din of giant sorting machines twirling and clanking.

Verberne is co-founder of OrthoMetals, which recycles metal implants from cremated human bodies. That's everything from steel pins to titanium hips and cobalt-chrome knees.

These are the knees that we have to recover," he says. "Some metals can be sorted by magnets. And the remaining have to be sorted by hand."

Strange it may be, and a bit macabre perhaps, but this kind of recycling is a growth industry.

"I know the existence of five or six competitors that we have, most of them in the United States," says Verberne, whose company is based in the Dutch city of Zwolle. "But we were first."

The rise of cremation

Country 1995 2010

Japan

98%

99%

UK

68%

73%

Australia

53%

69%

Canada

40%

58%

Netherlands

46%

57%

China

33%

49%

USA

21%

40%

France

11%

30%

Italy

2%

13%

Ireland

3%

11%

Ghana

1%

4%

Source: Pharos International, Cremation Society of Great Britain

Verberne had a long career in aluminium recycling. Then, in 1987, he met Jan Gabriels, an orthopaedic surgeon, who asked him what happened to the metal implants he spent his working life attaching to patients.

Verberne had no idea, so he did some research and he found out that they were thrown away. "They were basically buried," he says.

The value of implants collected from a crematorium is only a fraction of their value before surgery, but they are made from good quality metal that is worth recycling.

"The operation to provide a new hip may cost you around £5,000 ($8,000. 6,000 euros)," he explains.

"But the return value as scrap is maybe, per kilo, around £10 ($16, 12 euros). And there are five hips per kilo!"

In 1997, Gabriels and Verberne founded OrthoMetals. Fifteen years later the company recycles more than 250 tons of metal from cremations annually, which gets used to make things like cars, planes, and even wind turbines.

The company works by collecting the metal implants for nothing, sorting them and then selling them - taking care to see that they are melted down, rather than reused.

After deducting costs, 70-75% of the proceeds are returned to the crematoria, for spending on charitable projects.

"In the UK for example," he says. "We ask for letters from charities that have received money from the organisation we work with in the UK and we see that the amount we transferred to them has been given to charity. This is a kind of controlling system that we have."

surgical implants being sorted

Henry Keizer oversees a charitable memorial fund named after the first Dutch person ever cremated - a Dr Vaillant - back in 1913.

He says the fund has helped Dutch crematoria distribute money received from OrthoMetals to support everything from cancer research to school libraries.

The ethical argument

Does recovering metal from cremated corpses contravene that most important of ethical principles - respect for human life?

It depends partly on the purpose of the intervention on the corpse. Medical students dissecting a corpse in order to learn anatomy, done respectfully, is ethical. Using a corpse in a display as a form of entertainment is not.

To be acceptable, I believe the prior consent of the dead person or of the surviving spouse or next-of-kin is required.

The fact that what is recovered is a prosthesis and not "human remains" is also relevant. It makes the process more likely to be seen as ethical, as does giving some of the profits to charity.

Margaret Somerville, Centre for Medicine, Ethics and Law, McGill University, Montreal

"I think the recycling of implants, and artificial joints, is an excellent idea," he says. "Now we get to use them for good purposes, for funds for people that do social things that are extremely important."

Michael Donohue, director of the Donohue Funeral Home in the US state of Pennsylvania, found OrthoMetals through a Google search, when the home recently built its own cremation facility.

"Before we actually started to get up and operating, our biggest thing was - what are we going to do with the metal remains that are left at the end of the process?" says Donohue.

Now, recovered surgical implants go back to Holland for recycling.

Donohue says his staff are candid with loved ones about this. "We are honest with them, and tell them that whatever money is given to us goes to local organisations, and they love knowing that something from their loved one is being used in a great capacity."

Relatively few people are cremated in the US by international standards - the figure currently stands at 40%, though the trend is upwards and there are some big geographical variations.

Start Quote

In earlier days the family would visit a grave to see dad or mum - nowadays they want no obligations”

End Quote Ruud Verberne

Recent figures show Hawaii and Nevada up near 70%, but Mississippi at less than 10%. That could be a mark of socio-economic status, says Verberne. Statistics tend to show poorer people prefer in-ground burials.

In Verberne's native Holland, some 57% of all bodies are cremated. Britain is the biggest cremator in Europe with 73%. And since the Catholic church eased its opposition to cremation, the company has seen growth in places such as Italy and Spain. In all, it operates in 15 countries.

He has some thoughts on why cremation rates are increasing in many parts of the world.

"Two reasons are space and cost," he says. A traditional burial can cost four times as much as cremation. And regarding space, one survey showed 750 burials taking up an acre of ground.

Verberne also identifies some cultural changes. "In earlier days the family would visit a grave to see dad or mum," he says. "Nowadays they scatter the ashes and they are free. They want no obligations."

Mr Verberne has no metal implants himself, but he points out his business partner's wife, who is helping sort out bits of metal at the recycling plant.

"She has two titanium hips", he says. "And she was once asked: "Isn't it strange that you know that one day your hips will run along this conveyor belt?'"

"She said, 'No, it's just a part of life. You're going to die, and I know that reusing metals is a very good thing, so it is no problem at all.'"

She added "'My mother's hip was on here too!'"

Listen to more on this story at PRI's The World, a co-production of the BBC World Service, Public Radio International, and WGBH in Boston.

 

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  • rate this
    -1

    Comment number 73.

    Sproutaholic

    In Victorian times, legs, whole bodies were on the open market. In Dickens, Mr Venus bought Mr Weg's leg as a part of a job lot. When Mr Weg hopped in looking for his leg, Mr Venus sold it back to him

    Paupers were cut up & sold to medical schools. The entire workhouse 200 children would all die from scarlet fever. The whole lot then sold

    Such is our lamentable social history

  • rate this
    +7

    Comment number 72.

    I have to laugh at the people likening the common sense recycling of various implanted limbs to some sort of morals envisioned by practiced by the Nazis (???). I mean, keh? What planet are you from?

    I find the recycling of limbs perfectly reasonable. Hell, I'd let all of me be recycled if I could, it serves no purpose to me when I'm dead, burned, and gone. :)

  • rate this
    -1

    Comment number 71.

    70. coram-populo-2010

    I have over time had all my amalgams replaced with white polymers.

    Not only do they look better when I open my mouth, I have far fewer migraines.

    I paid to have this done, although not at the extortionate dental rates charged in this country.

  • rate this
    -1

    Comment number 70.

    @54 'coram-populo-2010.

    That post seems to have upset a few dentists? Who, by the way, do not recommend, nor use amalgam fillings for their own family and friends - but it's OK for their patients. Best advice if you are having a filling, NHS or private, you need to actually request NOT to have an amalgam filling?

  • rate this
    +8

    Comment number 69.

    Ashes to ashes
    Rust to rust.

  • Comment number 68.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this
    0

    Comment number 67.

    62 & 59
    Grateful for the answers, always wondered how hospitals treated human material taken from operations.

  • rate this
    0

    Comment number 66.

    "dissecting a corpse in order to learn anatomy is ethical. Using a corpse in a display as a form of entertainment is not".
    Agreed. But there's always a line, such as where the corpse of an 'obese' man who left it to med science was instead dissected on a TV show (hosted by Jamie Oliver) as a sensationalised 'example' of the dangers of being fat. Apparently the donor would have objected to this.

  • rate this
    +4

    Comment number 65.

    Every culture and belief system is different - if your life has been improved by science-based medical intervention, or via metal joint replacements why fuss?

    Perhaps do something basic while alive and be a blood donor? Or google how to register as a bone marrow donor with a simple blood test to help children recovering from treatment of cancers? No, nothing to do with organ transplants.

  • Comment number 64.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this
    +5

    Comment number 63.

    My father died just before Christmas, and he'd had a hip replacement a while ago. I was too busy to think about it at the time, but I hope his hip joint was recycled so that others can benefit in some way, even if it is just by slightly reduced spending on our under-funded NHS budget. BTW, he didn't carry a donor card because he was 90, he'd lived life to the full and used up all the bits!

  • rate this
    +4

    Comment number 62.

    @23

    Amputated limbs are disposed of via the Hospital's biohazardous/clinical waste - it will be sent off for incineration with a specilist company. In the UK in some hospitals, patients who have a total hip replacement are able to donate the bone that is normally removed to NHS Blood and Transplant who do all the necessary testing for it to be used for bone grafting.

  • rate this
    +3

    Comment number 61.

    #48 - there is, of course, no difference in the consensual recycling of prosthetic parts from people who have passed on under their own volition and those who were murdered by tyrants for reasons of an unfathomable dark ideology...

    You should read a little bit more around the history of those desperate days and ponder upon why your postings here are rather misguided to say the least.

  • rate this
    -14

    Comment number 60.

    Didn't the Nazi's do this during the holocast with gold teeth etc?

  • rate this
    +2

    Comment number 59.

    #53 - 'left over bits' are classed as 'Healthcare Risk Wastes' from memory and would be sent for incineration in appropriately permitted medical waste incineration facilities, along with certain other materials such as various swabs, dressings etc. The controls on these plants are more stringent than those on crematoria, and they are likely to be larger more centralised facilities.

  • rate this
    0

    Comment number 58.

    I'd imagine it is one of those topics that completely divides the nation - with those who have no interest in the issue what-so-ever on one side, and those that are shoulder-shruggingly indifferent on the other.

  • rate this
    +1

    Comment number 57.

    Whilst some here have passed this subject off as trivial it is a fact that with technological advancement more people are going to have artificial bits in the future. Already there is advanced work being done to control motorised limbs directly by the brain and it is foreseeable that there will come a time when humans may well be more machine than biological life form if we venture into deep space

  • rate this
    +12

    Comment number 56.

    In a way, internal man-made body parts are no different from external aids such as walking sticks and glasses. No need to get too squeamish or sentimental about them.

  • rate this
    +10

    Comment number 55.

    @ 52. redrobb
    'This type of recyling is not new, like a great many other immoral things we learned from the NAZI'S this practice is so wrong'
    ............
    I think this far removed from that!

  • rate this
    -2

    Comment number 54.

    @18
    ~~~
    Regarding vaporisation of mercury in fillings during cremation. My advice is not to have any amalgam fillings at all - especially when you are alive - as the harmful compounds will leach into your immune system.

 

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