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NEARLY EVERY MORNING for the past eight years, Dorothy Hyde has followed the same routine. Wake at 7. Put the coffee on. Grab the paper from in front of her home in suburban Houston. And then, while standing alone in the predawn stillness of her dark kitchen, turn the pages of the paper over, searching for a connection to her daughter Julie in, of all places, the sports section.
It wasn't always this way. The 85-year-old widow -- a quintessential Texas grammy, demure, stylish, fiercely independent and not to be trifled with -- used to start with the obits to check on friends and acquaintances. "It's just what you do at my age," she whispers. Then, for a little relief, she would jump straight to the comics. She never had much use for sports, and even now her level of understanding remains such that she sometimes says "pitch" when she means "pass."
But that was before the early-morning hours of March 17, 2004, before the drunken driver going 117 mph practically incinerated the Volvo driven by her daughter Julie De Rossi, 44, launching it into a nearby concrete barrier. Afterward the police had hoped to find clues in the skid marks left at the scene of the accident. But there weren't any. The guy never even touched his brakes. By the time her family arrived at the ICU, De Rossi was already on life support. There was no brain activity. And there never would be. "Never got to say goodbye," Hyde says.
Knowing her as they did, there was no question that Julie would want to become an organ and tissue donor; her gift would be to save or improve the lives of others. One of the people she eventually helped turned out to be a famous athlete. Quarterback Carson Palmer, after completely shredding his knee in the 2005 playoffs, was able to make a full recovery thanks to a new ACL reconstructed from De Rossi's Achilles tendon. "It's amazing that we can even do this," Palmer says now, "to use part of the body of someone who has passed on to help someone else walk or run or even keep their dream alive of playing sports again."
Hyde confesses that when Palmer reached out to her to express his gratitude (donors are usually anonymous, but he'd requested special permission to contact the family), she had to Google his name. "Julie always rooted for the underdog," Hyde says, "so she would have just loved knowing she was able to help someone like Carson."
During the first seven weeks of the 2014 season, Hyde's morning newspaper seemed to overflow with positive news out of Arizona -- about how the 34-year-old Palmer had led the Cardinals to their best start since 1948, when Dorothy was all of 19. Then on Monday, Nov. 10, she woke, unwrinkled her sports section and saw the story that put a sudden end to her routine. Early in the fourth quarter of a game against the Rams the night before, Palmer jumped up in the pocket to avoid the pass rush and hurriedly planted his left foot to stabilize himself. The momentum of his full body weight rotated awkwardly onto his left leg and -- pop -- his knee gave way. He collapsed into a seated position with his hands up, as if trying to surrender. Then he slumped onto his side. He knew instantly.
When Hyde first saw the headline about Palmer's injury, it didn't quite register. Instinctively, she drew the page closer to her face for a better look. With every word, disbelief turned to deep sadness. Julie's gift was gone.
"Carson cried, it said, and I cried a little too," Hyde says. "Part of Julie had always been a part of him, and that was a special connection for us. She did her part, and Carson made the most of the gift Julie gave him. That's more than enough for us. We certainly know there's an end to everything in this life."
BY RELYING ON donated tissue to save his knee, Palmer became one of the most high-profile beneficiaries of a fast-growing field in sports medicine: allografts. In the past decade, the use of musculoskeletal allografts -- transplanting pristine replacement parts recovered from deceased human donors to repair the ravaged knees, shoulders, elbows and spines of athletes and millions of others -- has quietly boomed into a billion-dollar industry, with more than 1.5 million tissue transplants each year. English soccer star Michael Owen, Olympic snowboarder Lindsey Jacobellis, White Sox star-turned-manager Robin Ventura and UConn basketball great Caroline Doty are just a few of the hundreds of elite athletes who have come back from injury thanks to the selfless final act of a stranger. "Unfortunately, someone had to pass for my recovery to happen," Palmer says. "If people didn't donate, my surgery, my recovery and everything else after isn't successful, or even possible. It's a lot to think about, just how lucky I am."
Of the 3 million people who die each year in the United States, fewer than one-tenth of 1 percent (14,257) become organ donors and roughly 30,000 share their tissue. Although few understand and appreciate it the way Palmer does, a donor's ligament is a rare and valuable gift. Human cartilage, for example, does not regenerate. Without a replacement part, an athlete who tears a meniscus would have to spend the rest of his or her life with bone grinding against bone and the debilitating white-hot pain that goes along with it.
At one point, medical experts at one of the world's leading allograft acquisition companies predicted the market for donated tissue would dry up within five years because researchers were getting close to developing functional synthetic human tissue. That was 20 years ago.
"There is a long, crowded history of people trying to use things to repair the body other than human tissue," says Lonnie Paulos, Palmer's orthopedic surgeon. "But it's nearly impossible to fool Mother Nature."
The biological truth at the center of the allograft industry is simple and profound: Humans aren't just similar, we're practically interchangeable. Unlike organs, which must be matched by blood type and antigens and transplanted immediately, tissue is universal. It can be recovered up to 24 hours after death, stored for years and reused regardless of age or sex. That explains why a Pro Bowl quarterback could have a new ACL created from the Achilles tendon of someone who seemed to be his exact opposite: a woman 11 inches shorter and 19 years older who'd never thrown a football more than 10 yards.
IN MARCH 2004, De Rossi, a band manager living in Houston, was busy with preparations for the South by Southwest Music Festival in Austin. She was ecstatic about the venues she had secured for her bands and word from Seattle that a record label was interested in signing one of her acts.
De Rossi's piercing eyes and wavy shock of black hair seemed to perfectly fit her untamed spirit and life's path that at times resembled the stylish mess of a Jackson Pollock painting. After four marriages and careers in music, art and drag racing, the fearless and headstrong De Rossi believed she had finally found her calling working with bands. "She led the most interesting, colorful life," says Karen Abercrombie, her younger sister. "She loved pushing the envelope as hard as she could and in as many directions as she could."
On that March 17, De Rossi stopped by the home of Aaron Hehr, her 24-year-old son (from her second marriage), to deliver orange juice because he wasn't feeling well. Then she was trying to get home for a few hours of sleep before dashing back to Austin for the festival. She was cruising along Houston's Southwest Freeway when her car was struck from behind by a BMW SUV. Police say Eric Hinton, then 31, had a nearly lethal blood-alcohol level of 0.234, three times the legal limit. When the prosecutor later read aloud the list of what Hinton had drunk that night before getting behind the wheel, people in the courtroom gasped. Hinton, who was unharmed, was convicted of manslaughter and sentenced to five years in prison.
By the time Hyde, Abercrombie and Hehr arrived at the ICU of Memorial Hermann hospital that night, De Rossi was on life support with no signs of brain activity. The discussion about what to do next was brief. In the hospital Hehr recalled the time, a few years earlier, when he picked up his mom at the airport after a massive rainstorm had flooded large parts of Houston. De Rossi had overheard a stranger on the plane worrying aloud about flood waters trapping her family and preventing her from making it home. After they landed, almost without the woman's permission, De Rossi grabbed her bags, put her in Hehr's car and announced, "She's staying with us." De Rossi had always been something of a patron saint to wayward souls, lost causes and especially stray cats -- she adopted two.
"My mom was such a nut," says Hehr. "But the singular thing at the core of her being was if someone or something needed help, she would help. So when the counselor came into the waiting room of the hospital, it was like, 'Yeah, of course, whatever we need to do.'"
That counselor was an organ and tissue donation representative from a Houston company called LifeGift, one of 58 federally regulated organ procurement organizations (OPOs) in the United States. When a patient is approaching imminent death or brain death, hospitals are required to contact the nearest OPO, and families are approached to make the emotional decision to donate. If they agree, they're then faced with a heartbreaking paradox. Up to that point, they have often spent countless hours -- sometimes days -- keeping a bedside vigil pleading for a miracle, for their loved one to fight to stay alive. But to maximize the chance of success for organ and tissue donation, a patient needs to die within 90 minutes of being taken off life support. As procurement teams scramble into place inside the ICU unit, family members must drastically reverse course. And so instead of encouraging De Rossi to keep fighting, her family begged her to surrender. For probably the first time in her life, she complied.
De Rossi's final gesture of organ and tissue donation would eventually save or improve the lives of more than 50 people. One of them just happened to be a Pro Bowl quarterback in need of a new knee. "A cadaver didn't save Carson's career, that was Julie, a person called Julie," says Dorothy Hyde. "There was absolutely no one else on this planet like her."
BEFORE DE ROSSI'S tissue could become Palmer's, however, it had to be sent to a tissue bank in New Jersey, where it was processed, cleaned, tested and stored. That facility is much like AlloSource outside of Denver, one of the country's leading allograft hubs. Located in a quiet, grassy business park just down the road from the Broncos' practice facility, AlloSource deals in skin grafts, full bone replacements, spinal grafts, osteobiologics and even stem cells. In conjunction with the Joint Restoration Foundation, it also distributes 225 tendons a week and nearly 240,000 allografts a year.
Since the late 1990s, when surgical pioneers like Paulos and Brian Cole of Chicago's Rush University Medical Center made allografts so popular in ACL surgery that tissue banks began running out of tendons, AlloSource -- managed by six regional OPOs -- hasn't been able to grow fast enough. In fact, the demand in orthopedic surgery is so high that an entire section of the company's 30-page color catalog is dedicated to sports medicine.
At AlloSource, donor tissue from hospitals and OPOs usually arrives directly from the Denver airport by FedEx or medical courier. But during The Mag's visit to AlloSource this past spring, a guy wearing a Snappy Delivery polo shirt steps out of a burgundy Passat and hand delivers a large brown cardboard box covered in air cargo tape and large white labels that reads: DONATED HUMAN TISSUE, PLEASE RUSH.
Within seconds of the delivery, a young technician in a white lab coat and blue-tinted goggles places the box on a dolly and rolls it into a large, open receiving room. Inside the box, under several layers of protection, are a variety of full human limbs. Less delicate material, like bone, can be stored in one of the dozens of floor freezers that line AlloSource's receiving room. But with cartilage, which must be transplanted within 28 days, the clock is ticking. Provided the tissue passes a multitude of federally regulated pathology guidelines to ensure it doesn't contain infections, disease or defects, it is immediately prepped and moved across the hall to a highly sterile sealed area known as the Core. Entering this part of the building, sealed off by two separate air locks, requires full scrubs and two layers of foot and head protection, as well as surgical gloves, mask and goggles. On the interior walls of the AlloSource changing rooms, the last thing technicians read before entering the air lock is this statement: Remember, this core becomes sacred when a family entrusts us with their most precious gift.
Deep inside, at the end of the Core's central hallway, AlloSource technicians have been working for several hours on a limb from a 17-year-old donor, reducing it to a transplantable piece of smooth, milky, knuckle-shaped hemi-condyle cartilage located at the bottom of the femur. In another room, a tech completes work on an Achilles tendon just like the one transplanted into Palmer's knee. Using a scalpel, the tech slices away small yellowish pieces of excess tissue and discards them in a red biowaste bag during the final stages of preparing the long, shoelace-sized tendon of a 63-year-old donor from the Midwest.
Achilles tendons are a popular choice of knee surgeons because they are nearly twice as strong as native ACLs. Allografts strengthen over time as they assimilate with the recipient's tissue. (Transplanted cartilage is different because it actually remains the donor's tissue and maintains its DNA forever, inside the host.) Even so, a recent study revealed that ACL allograft repairs in young, active patients had a failure rate as high as 20 percent -- a group that now includes Palmer. Autografts, harvested from a patient's own tissue, fail less than 10 percent of the time.
When operating on an elite athlete, an orthopedic surgeon will have allograft options prepped and waiting. But they will avoid using them if at all possible. Paulos estimates that among professional athletes who have ACLs repaired, only 1 in 25 receives donated tissue.
Far more problematic to Paulos is the escalating cost (and profit margins) associated with allografts. While federal law prohibits the sale of human tissue or payment of any kind to the donor's family, OPOs are allowed to charge hospitals an acquisition fee -- ranging from a few hundred dollars for a common ligament or bone chip, to $30,000 for vital organs -- based on the cost of recovering each donation. Tissue from a single donor can generate up to $100,000 for a company. (Palmer, meanwhile, has earned nearly $100 million since receiving De Rossi's tendon.) It's an exchange that strikes some as eerily close to flesh peddling. The trade in human tissue is so lucrative that in 2008, New Jersey resident Michael Mastromarino was sentenced to up to 54 years in prison after he made more than $4 million illegally recovering and selling body parts.
"I have literally had people recoil from me when I tell them what I do," says AlloSource CEO Tom Cycyota. "Somebody died and now we're in business. I get it. But because of that we are able to do truly miraculous, life-changing things."
A HEISMAN TROPHY winner at USC, Palmer was selected No. 1 overall in the 2003 draft by the Bengals and just three years later had the once-hapless franchise back in the playoffs. Then everything changed. In a wild-card game in January 2006, after a beautiful 66-yard completion on his first pass attempt of the game, Palmer was hit in the shin by Pittsburgh's Kimo von Oelhoffen. His knee buckled inward, grotesquely, tearing the ACL and MCL, dislocating the kneecap and damaging a large swath of the meniscus. On a scale of 1 to 3, the Bengals team doctor described the severity of the injury as a 4. With Palmer's career in jeopardy and with very little of his own connective tissue left to work with, Paulos turned to his only remaining option for reconstruction: a donated Achilles tendon.
Leading up to the surgery, Palmer and Paulos joked that the less-than-nimble quarterback should ask the tissue bank to send him a tendon from someone who ran a sub-4.5 in the 40-yard dash. But instead, Paulos and the surgical team ordered the youngest tendon possible, then cut it to the correct size. (Today, tissue banks use measurements taken from an MRI to find an allograft match for the length, strength and diameter of the patient's knee.) The data were entered into the company's records, and a few potential matches, marked with bar codes, were pulled from the freezers and shipped to Paulos' hospital in Houston. (Whenever possible, donated tissue is transplanted into patients from the same region.)
Twenty-two months after she was killed, De Rossi's Achilles tendon became part of Palmer's knee. Within five months, Palmer was already jogging. He was back under center for the Bengals 2006 season opener without missing a single game. "It's a little eerie, but it's also pretty amazing," Palmer said in an interview just two days before he re-tore his ACL. "Dorothy's daughter lives on; a part of her is still moving and running and cutting. All the things my knee is doing, she's doing too."
After the procedure, Palmer began to wonder about the anonymous donor responsible for his quick comeback. "When you have an injury and a surgery like that, it's usually like 'Whatever man, let's just get this thing done,' so I can do my rehab and get back to normal," he says. "Then, I remember the doc saying, 'We used a cadaver tendon,' and I was like 'Wait, wow, where'd it come from?' The more I learned, the more and more it meant to me."
Although medical privacy laws protect the identity of both tissue donor and recipient, Paulos and the Bengals were able to track down De Rossi's family and obtain their permission to reveal her identity so the quarterback could express his gratitude. "When a tragedy like that happens, I bet it's hard to find anything positive in it in order to celebrate that person's life," says Palmer. "I was lucky enough to be able to use her tissue and benefit from her. I hope the family could find some peace in that, maybe."
In September 2006, when he heard De Rossi's family was in Cincinnati for an organ and tissue donor event, Palmer sent them tickets to the Bengals game. In 2013, after he signed with Arizona, he sent Abercrombie's son a personalized Cardinals jersey. But while the family has gotten to know some of De Rossi's other recipients, including the Vietnam vet who received her liver, her family never pushed for a face-to-face meeting with Palmer. "We left that up to him," says Abercrombie. "He doesn't owe us anything. He's expressed his gratitude, he's been so gracious. The last thing we wanted was to appear to be star digging."
At family get-togethers, though, like a recent lunch at a Houston restaurant, the topic of this odd couple still comes up: the bizarre and beautiful story of Palmer, the straight-laced All-American QB, teaming up with a one-of-a-kind wild child like De Rossi. "In the end," says Abercrombie, tears pooling in the corner of her eyes, "Carson Palmer became another one of the stray cats Julie managed to save."
UNTIL THE RAMS game, the De Rossi-Palmer duo had been enjoying its most successful season ever. In September, Hyde read about how Palmer overcame nerve damage in his throwing shoulder. Then came stories about his dominant performances and his 95.6 passer rating, his highest in nine seasons. "I wish I could tell Carson that grandma is so proud of him," Hyde said in late October. Less than 48 hours before re-tearing his ACL against the Rams, Palmer had signed a $50 million contract extension.
His latest injury has severed his physical link to De Rossi. In fact, his procedure on Nov. 18 began with his surgeon cleaning out and discarding De Rossi's remaining tissue in order to make room for the new graft. And because there was far less damage this time, the decision was that he'd go it alone: His new ACL was created from his own patellar tendon.
Yet the deeper connection between Palmer and De Rossi remains intact. Shortly after learning about Julie while recuperating from his 2006 surgery in California, Palmer asked his wife, Shaelyn, to drive him to the DMV. Eight years later, when he reported to a hospital for his latest surgery, he would have been asked to provide identification and any pertinent medical information. Palmer would have reflexively reached into his wallet, pulled out his driver's license and handed it to a hospital administrator.
On the lower-left-hand corner of the ID, just next to Palmer's smiling, tan face, is a tiny dark-pink circle with a single word written in small, thick black letters.
Donor.