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The case is one of dozens of death investigations across the country, including more than two dozen in Los Angeles and San Diego counties, that The Times found were complicated or upended when transplantable body parts were taken before a coroner’s autopsy was performed.

In multiple cases, coroners have had to guess at the cause of death. Wrongful-death and medical malpractice lawsuits have been thwarted by early tissue harvesting. A death after a fight with police remains unsettled. The procurement process caused changes to bodies that medical examiners mistook as injuries or abuse. In at least one case, a murder charge was dropped.
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To raise those numbers, California and other states over the last decade passed laws requiring coroners and medical examiners to “cooperate” with the companies to “maximize” the number of organs and tissues taken for transplant. Procurement companies’ lobbyists helped to write the legislation and push it into law.

In a handful of states the laws go even further, giving the companies the power to force coroners to delay autopsies until they have harvested the body parts.

Although the companies have emphasized organ transplants, in far more cases nationwide they harvested skin, bone, fat, ligaments and other tissues that are generally not used for life-threatening conditions. Those body parts fuel a booming industrial biotech market in which a half-teaspoon of ground-up human skin is priced at $434. That product is one of those used in cosmetic surgery to plump lips and posteriors, fill cellulite dimples and enhance penises. A single body can supply raw materials for products that sell for hundreds of thousands of dollars.
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The county’s contract with OneLegacy does contain restrictions. Procurements from victims of suspected child abuse and officer-involved homicides must be approved by a senior morgue official.

Another notable contract exception: Donation is “generally unsuitable” in cases of media interest, including celebrity deaths.
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In 2007, the year the laws passed in California and many other states, the procurement companies obtained just 2% of donors of bone, skin or other tissues through referrals by coroners and medical examiners, according to a survey by the American Assn. of Tissue Banks. Now, some companies report that a majority of their donors come from those being wheeled into the county morgue.

Mone, the CEO of OneLegacy, which operates in seven Southern California counties, said about 63% of organ donors and 51% of tissue donors came from the company’s partnerships with morgues in 2017.

“The law,” he said, “has been very beneficial.”
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To increase the supply of harvested body parts, the companies have embedded procurement teams inside government morgues across the country.

Morgue officials at times give the corporate employees key cards so they can enter at any hour. The companies rent rooms inside the morgues, including suites where surgical teams harvest donors’ tissues.

In a growing number of counties nationwide, the companies can log into government computer files on the newly deceased, allowing them to swiftly find potential candidates for procurement.

In Michigan, a company called Gift of Life said donations of bone and other tissues soared after its foundation gave some coroner offices iPads loaded with special software to record details of a death at the scene, which are transmitted instantly to the company.

For several decades, federal rules have required hospitals to alert procurement companies when anyone dies inside their walls. With the new connections to government morgue computers, the companies also know immediately about deaths outside hospitals — and have contacted families when the body of a loved one is still at the scene, according to written complaints made to supervisors by morgue staff in Los Angeles and Tacoma, Wash.

“I was inside the residence performing my investigation and the family was standing by outside,” Kim Pavek, an L.A. County coroner investigator, wrote in an internal complaint about OneLegacy after a suicide in 2008. “The decedent’s mother asked me why someone from my office would call her cellphone during such a distraught time.... She explained to me that someone from OneLegacy said they were a representative from the coroner’s office inquiring about ‘donating parts.’ ”
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Despite the limited review, The Times found more than two dozen cases in which the procurements made it harder to determine the cause of death. In many of those cases, coroners were unable to conclude either why or how the person died.

The cases included possible homicides, highway accidents, deaths after surgeries, a drug overdose, a suspected suicide and a death that followed a fight with a police officer. The deceased ranged from homeless people to members of wealthy families, although more were poor than rich. Most were middle-age or younger. One was a child.

In at least five cases, the documents show that companies harvested body parts without reporting what appeared to be a death from a crime, an accident or suicide to coroner officials. California law requires any person in charge of a body who has knowledge that the death may have been from unnatural causes to immediately alert the coroner.