The legality of the practice across the Atlantic raises a crucial question: is the consent of the donors really clear?
It’s not fiction. In the United States, injectable products made from human fat extracted from cadavers are used to plump up cheeks, correct hollows, or increase the volume of breasts and buttocks. And this is not new.
For about a decade now, in American aesthetic clinics, products like AlloClae (from Tiger Aesthetics) and Renuva (from MTF Biologics) are prescribed. These substances are made from fat harvested from organ donors. After a strict purification process that eliminates all genetic material, this fat is injected into patients. These patients do not face any health risks. “The body recognizes Renuva once injected,” explains Evi Chnari, Vice President of Research and Development at MTF Biologics. “The patient’s cells then transform it into their own fat.”
This is a legal practice overseas, approved by the FDA (the US Food and Drug Administration). Patients are increasingly turning to it, turning away from lipofilling, which involves extracting fat from one area of the patient’s body by liposuction to reinject it into other areas. This shift is due to products like Ozempic and others that have made people too thin for fat to be harvested from themselves.
As for hyaluronic acid injections, people are turning away from them due to the health risks they pose. Instead, “necro-cosmetics” – as they are nicknamed in the US – are becoming indispensable. “I thought it would put everyone off,” admits Dr. Haideh Hirmand, a plastic surgeon in New York interviewed by The Guardian. “But in the end, it doesn’t bother many people.”
And why not after all? Since the majority of public opinion is widely favorable to donating vital organs to save lives, why should we feel uncomfortable with fat donation for aesthetic purposes? Let’s put aside the fact that in a society where the pressure to have perfect buttocks, breasts, and cheekbones is undesirable: is there an ethical issue with retrieving fat from the corpse of a person who gave their consent?
Well, maybe, yes. Because, precisely, fat donors have not always given their consent in a clear manner.
Consent: a gray area
In the United States, the Uniform Anatomical Gift Act (UAGA) allows for the collection of tissues from organ donors. However, as reported by The Guardian, an investigation aired in 2012 by American radio NPR revealed an alarming figure: tissue bank recruiters mentioned the aesthetic use in only 29% of cases.
This means that the vast majority of families or registered donors are unaware that their fat could be used for purely cosmetic interventions. They often think their donations will be used exclusively for vital organ transplants (heart, kidney, liver) or unquestionable plastic surgeries (for severe burns, for example).
While some companies now claim to obtain clear consent, tracking remains complex. Forms vary by state, and there is no perfect traceability to ensure that the restrictions expressed by a donor (for example, “only for vital transplants”) are respected throughout the production chain.
A risk for vital organ donation?
The main concern of bioethicists is not so much the aesthetic use itself, but its indirect consequences. “If the number of donors decreases because people fear that their bodies will be used for this type of cosmetic surgery, the disadvantages of this practice will outweigh the benefits,” warns Ryan Pferdehirt, Vice President of Ethics Services at the Center for Practical Bioethics.
A single donor can save eight lives and improve 75 others. If the revelation that a loved one’s abdominal fat could end up in a buttock lift leads families to withdraw their consent for organ donation, the human cost could be substantial.
