In a former flower warehouse in Doral on a recent Saturday morning, 10 operating tables each contained a human hand and arm. Dozens of surgeons hovered over them, learning how to insert small titanium plates to fix fractures.
For this exercise, more than 60 doctors had come from Brazil, the Czech Republic, Mexico, Colombia and California to get advanced training using cadaver parts at the Miami Anatomical Research Center.
``This is wonderful for us,'' said Rames Mattar, the head of hand and microsurgery at the University of Sao Paolo. ``We do not have this kind of facility. Catholic countries don't allow using cadavers like this.'' That's why 40 of the surgeons had come from Brazil for the weekend training session.
MARC -- a for-profit business -- opened three years ago. Serge Kozacki, MARC's lab director, said it cost about $6 million to redo the former warehouse, including 38 stations in operating suites and an auditorium with a large screen for video conferencing.
On this Saturday, while hand surgeons worked in one area, orthopedic surgeons were next door, operating on human shoulders -- being used to practice new techniques in arthroscopic surgery.
Kozacki said all its specimens come from from two sources -- Science Care and the LifeLegacy Foundation, both based in Arizona. ``They're very, very expensive'' -- $5,000 to $10,000 for a full specimen.
Sometimes MARC buys full bodies and cuts them up for various uses. At other times, it purchases specific body parts for certain procedures. As required by state law, all its shipments are reported to the Florida Anatomical Board, based in Gainesville.
Moira Jackson, the board's executive director, said nine or 10 companies provide cadavers for research and education nationwide. Of MARC, she said: ``We have very good relations with them.''
By law, no one is allowed to sell cadavers. Companies can charge, however, for preparation and shipment of the specimens.
Kristin Dorn, spokeswoman for Science Care, said all its specimens come from the United States, donated by persons who want to help science -- either through advance directives or by family members after death. In return, the company pays all post-death costs and returns cremated remains to the family.
Dorn said the for-profit company specializes in providing parts of corpses, shipping ``human tissue across the entire world'' for medical education and training. ``We customize whatever the researcher wants, to maximize the donation.''
LifeLegacy Foundation co-founder Marc Griesenbrock said the price variations for specimens can be caused by researchers' requirements. Some groups want specimens plastinated, meaning veins, arteries and muscles are preserved for long-term use, a process that requires both man-hours and chemicals. That process would add considerably to the fee.
Like Science Care, all LifeLegacy specimens are from U.S. donors. ``I'm not aware of any coming in outside the country. . . . Time and temperature might make for problems,'' not to mention getting health certificates that the corpses are free of communicable disease, Griesenbrock said.
What's more, many countries don't allow the scientific use of cadavers. ``The Japanese don't recover anything,'' Griesenbrock said, but the country has a strong need for such things as corneal transplants and is always seeking to import corneas and other tissue parts from the United States.
In the United States, MARC has competitors scattered around the country, including Chicago and Denver.
Many organizing groups like MARC's location. ``It's very easy for Latin Americans to get to,'' said José Manuel Vázquez, executive director of the Swiss-based International Bone Research Association, which sponsored the hand surgery conference. He praised MARC: ``They have good specimens here. Excellent power tools.''
Doral hand surgeon Alejandro Badia, an investor in MARC and an instructor, said the opportunity to practice on human flesh and bone attracts many doctors. ``There's no way you can get the same feel'' with a plastic-rubber dummy that cadaver parts provide.
MARC's basic business model is to rent its facility to groups like IBRA, which then markets to doctors and charges them fees -- about $600 in the case of the hand surgery for a two-day seminar. The co-sponsor was Medartis, which provided the plates and screws used in the surgeries, in order to promote its products.
Kozacki, the lab director, said MARC creates a boost for Miami-Dade's travel industry. ``At least 6,000 physicians are coming through a year.''
Amy Ladd, chief of hand surgery at Stanford University, said she had flown across the country with one of her fellows because ``there is nothing better to learn from than the human body.''
She paused at her table, looking down at the specimen, then said, ``We greatly appreciate the gift'' of the donor.
The chances to study human body parts is so rare, Ladd added, that at the end of the practice surgeries, she planned to work with her fellow in examining the interior of the hand, its nerves and muscles. That time element in the program was labeled: ``Free swim.''
Florida center trains doctors from around the world
Doral, Florida center uses cadavers to train surgeons from throughout the world.
PhotoDisc, Sun Sentinel