Barbara Sumner Burstyn: Prickly donor-organ issues can get under your skin

COMMENT

It's confession time again: the photo at the top of this column is not a true likeness. Some of my lines are missing, erased courtesy of Photoshop technology.

Thinking I'd like this look in real life, I started investigating new dermal filler products. The one the doctor recommended is made with cadaver dermis. It comes in either dissolvable sheets or micronised for easy injection into those tiny wrinkles and skin folds that seem to spring up overnight.

In soothing tones, the doctor assures me there's nothing wrong with using cadaver dermis. Yes, he says, this product is made from the skin of dead people. And, yes, they were organ donors.

But when I ask if the donor's gift of life-saving organs included consent to use their skin in expensive, profit-heavy cosmetic procedures, he's not so confident.

Finally, he agrees that perhaps donors are a little naive about just what it means to have your body harvested for medicine; or just not up with modern medical theory.

Like the definition of death. As anyone who watches ER knows, a heartbeat can be restarted, so the old definition - cessation of cardiac function - is not sufficient.

Instead, brain death is the legal organ donor standard in most countries.

The term and diagnosis of brain death was created by the Harvard Medical School in 1968 to enable doctors to harvest organs for transplantation.

The definition of death becomes an issue only because of organ transplantation. But the standard of brain death is fraught.

Take, for instance, the case a couple of years ago of a Taiwanese newscaster, declared brain-dead by London doctors after she was injured in a train crash. She was prepped for organ donation when her family arrived and insisted on moving her to a Beijing hospital, where herbal remedies and electrical stimulation of her brain caused her to regain consciousness three months later.

Despite this and similar cases, there's a growing call for mandatory organ donation. Vocal supporters like Canadian forensic pathologist H.E. Emson contend that since our bodies are "on loan to the individual from the biomass" and constitute "a unique and invaluable resource", control over cadavers should be vested in governments.

Bioethicist Julian Savulescu says that when "meaningful mental life ceases, organs should be available". British bioethicist John Harris backs "automatic or mandatory availability of donor organs" and is calling for an end to seeking consent.

While this all makes sense in a pragmatic way, perhaps the ethicists are being a little disingenuous. After all, with over 650 harvestable body parts, the cadaver products industry represents big money.

In the United States, a single donor body can provide the raw ingredients for US$220,000 ($335,000) - at wholesale - worth of products. Add in the surgical costs and your dead body is worth US$1 million ($1.5 million) retail. Throw in your major organs and it jumps to US$2 million ($3 million).

Organ donation critics, such as researcher Norm Barber in his book The Nasty Side of Organ Transplanting, outline a hungry market, with demand outstripping supply. Barber and others say most donated skin is sold to the regenerative (cosmetic) industry, while burn victims must either wait in line or use skin stripped from their generous (living) relatives.

There is also evidence that in the US a number of non-profit procuring organisations are fronts for private companies.

We're not talking about the illegal sale of organs. The most successful regenerative medicine companies not only have patents on what they do to your body parts, they run share price indicators on their websites.

Even more worrying, say donor critics, US hospitals, especially those serving the poor, are under pressure to minimise the amount or quality of care given to some patients to secure much-needed organs.

So what drives this new relativity of death? Is public opinion being manipulated so that we believe the gift of life is a compassionate and simple altruistic transfer of organs? Is organ donation a commonsense reassignment of your body once you've finished with it? Or is it a form of creepy neo-cannibalism and just another instance of the rich feeding off the poor.

The response from the medical industry is to say, "Trust us, we're doctors, we're here to do good". But our society is way past the "trust us" paradigm. We are naive if we think that the free market has not extended to the organ-donation business and that the business model of efficiency and expediency does not prevail.

I'm not against the idea of donating a specific organ to a specific cause. But until I can specify, until the industry can guarantee my gift of life is not a market commodity, and that I'm really dead before I'm dissected and harvested for every usable scrap, until it can be guaranteed my tissue, sorry my biomaterial, is not being used in profit-laden cosmetic procedures, and until there's a better way to define death, I won't be signing my donor card.

And I won't be having someone's dead skin injected into my face either, no matter how wrinkly I get.