American bone increasingly fills Dutch jaw

For dentists it is becoming increasingly common: the use of human bone material, for example when placing jaw implants. And more and more often that bone comes from the United States, according to figures requested by New Year’s Eve. Recent research raises the question of whether all that bone is obtained in an ethically responsible manner.

The sale of donated human bone is big business in the US and Europe appears to be an attractive additional market. In five years time the use in the Netherlands has increased from about 500 to about 2200 American jars of finely ground donor bone per year.

Dentists and implantologists have started to report more about the use of human bone, says the TRIP foundation, which monitors the safety and quality of the transplantation chain. But that can only partly explain the growth

According to dentist-implantologist Jan Willem Vaartjes, chairman of the Association of Dutch Dentists, working with human bone granules has the great advantage that it stimulates the growth of the patient’s own bone. “Animal and natural products often don’t have that. Moreover, you can work faster and more predictably with human bone material”

This does not yet explain why dentists and implantologists mainly use American bone. After all, there is no shortage of donor bone in the Netherlands. And the Dutch bone is just as expensive as the material from America, says Piet Jan Kruit, director of the Dutch tissue bank ETB-BISLIFE.

“However, the pharmaceutical companies that supply the American bone often offer a total package. So in addition to bone products, they also offer instruments and implants,” says Kruit. In addition, the trade in human materials in America is further commercialized than in Europe.

Cause of death still unknown

The question is whether bone from America is always removed responsibly. The Los Angeles Times revealed last year that bone banks, under pressure of competition, want to extract as much material as possible from dead people. This sometimes happens before a coroner has been able to determine the cause of death.

Withdrawal organizations say they played by the rules. An investigation into their modus operandi is ongoing. There are no indications that this bone material also ended up in the Netherlands, although the Health Care and Youth Inspectorate, which supervises it, cannot rule it out either.

Institutions that deal with blood, tissues and cells in the European Union must comply with European directives. But supervision is not carried out in the same way in every Member State, according to the European Commission in a report from October 2019.

Dentist Vaartjes pleads for good information and a good control system. “It’s partly about material from dead people, you have to deal with that ethically. You have to be sure that no strange things have happened to them.”

A European tracking system – the Single European Code – should ensure that the origin of human material can always be traced. However, it appears to be possible to buy bone material without that mandatory code. On websites such as eBay and Alibaba bone material can be bought against their own selling rules. A Dutch buyer who took the test tells us that the bone will be on the doorstep at home within two weeks.

We show the jar of bone material obtained via the internet to a professor of health law. He immediately sees that there is something wrong with it:

Nieuwsuur found no evidence that Dutch dentists get bone material in this way. Anyone caught in the Netherlands with such a purchase can be fined. According to dentist Vaartjes such material should be stopped at the border by the American and Dutch customs.

Martin Buijsen, Professor of Health Law at the Erasmus University in Rotterdam, is concerned that donor bone is increasingly becoming an international commodity. After all, commercialisation can have a negative effect on how willing people are to donate their own bone material.

“If, for example, body material is sold at a profit on Ebay, this reduces the willingness to donate body material in the Netherlands. You have to be very apprehensive about that.”

After being asked to respond to online sales of human bone material, eBay removed the ads.