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de Jongh D, Thom RL, Cronin AJ, Bunnik EM, Massey EK. Clinical Translation of Bio-Artificial Pancreas Therapies: Ethical, Legal and Psychosocial Interdisciplinary Considerations and Key Recommendations. Transpl Int 2023; 36:11705. [PMID: 37789914 PMCID: PMC10543913 DOI: 10.3389/ti.2023.11705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023]
Abstract
The field of regenerative medicine offers potential therapies for Type 1 Diabetes, whereby metabolically active cellular components are combined with synthetic medical devices. These therapies are sometimes referred to as "bioartificial pancreases." For these emerging and rapidly developing therapies to be clinically translated to patients, researchers must overcome not just scientific hurdles, but also navigate complex legal, ethical and psychosocial issues. In this article, we first provide an introductory overview of the key legal, ethical and psychosocial considerations identified in the existing literature and identify areas where research is currently lacking. We then highlight two principal areas of concern in which these discrete disciplines significantly overlap: 1) individual autonomy and 2) access and equality. Using the example of beta-cell provenance, we demonstrate how, by harnessing an interdisciplinary approach we can address these key areas of concern. Moreover, we provide practical recommendations to researchers, clinicians, and policymakers which will help to facilitate the clinical translation of this cutting-edge technology for Type 1 Diabetes patients. Finally, we emphasize the importance of exploring patient perspectives to ensure their responsible and acceptable translation from bench to body.
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Affiliation(s)
- Dide de Jongh
- Department of Nephrology and Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Rebecca L. Thom
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College, London, United Kingdom
| | - Antonia J. Cronin
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s College, London, United Kingdom
| | - Eline M. Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Emma K. Massey
- Department of Nephrology and Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
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2
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de Jongh D, Massey EK, Cronin AJ, Schermer MHN, Bunnik EM. Early-Phase Clinical Trials of Bio-Artificial Organ Technology: A Systematic Review of Ethical Issues. Transpl Int 2022; 35:10751. [PMID: 36388425 PMCID: PMC9659568 DOI: 10.3389/ti.2022.10751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/07/2022] [Indexed: 01/25/2023]
Abstract
Regenerative medicine has emerged as a novel alternative solution to organ failure which circumvents the issue of organ shortage. In preclinical research settings bio-artificial organs are being developed. It is anticipated that eventually it will be possible to launch first-in-human transplantation trials to test safety and efficacy in human recipients. In early-phase transplantation trials, however, research participants could be exposed to serious risks, such as toxicity, infections and tumorigenesis. So far, there is no ethical guidance for the safe and responsible design and conduct of early-phase clinical trials of bio-artificial organs. Therefore, research ethics review committees will need to look to related adjacent fields of research, including for example cell-based therapy, for guidance. In this systematic review, we examined the literature on early-phase clinical trials in these adjacent fields and undertook a thematic analysis of relevant ethical points to consider for early-phase clinical trials of transplantable bio-artificial organs. Six themes were identified: cell source, risk-benefit assessment, patient selection, trial design, informed consent, and oversight and accountability. Further empirical research is needed to provide insight in patient perspectives, as this may serve as valuable input in determining the conditions for ethically responsible and acceptable early clinical development of bio-artificial organs.
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Affiliation(s)
- Dide de Jongh
- Department of Nephrology and Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands,Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands,*Correspondence: Dide de Jongh,
| | - Emma K. Massey
- Department of Nephrology and Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Antonia J. Cronin
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom,King’s College, London, United Kingdom
| | - Maartje H. N. Schermer
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Eline M. Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
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3
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de Kanter AFJ, Jongsma KR, Verhaar MC, Bredenoord AL. The Ethical Implications of Tissue Engineering for Regenerative Purposes: A Systematic Review. TISSUE ENGINEERING PART B: REVIEWS 2022; 29:167-187. [PMID: 36112697 PMCID: PMC10122262 DOI: 10.1089/ten.teb.2022.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Tissue Engineering (TE) is a branch of Regenerative Medicine (RM) that combines stem cells and biomaterial scaffolds to create living tissue constructs to restore patients' organs after injury or disease. Over the last decade, emerging technologies such as 3D bioprinting, biofabrication, supramolecular materials, induced pluripotent stem cells, and organoids have entered the field. While this rapidly evolving field is expected to have great therapeutic potential, its development from bench to bedside presents several ethical and societal challenges. To make sure TE will reach its ultimate goal of improving patient welfare, these challenges should be mapped out and evaluated. Therefore, we performed a systematic review of the ethical implications of the development and application of TE for regenerative purposes, as mentioned in the academic literature. A search query in PubMed, Embase, Scopus, and PhilPapers yielded 2451 unique articles. After systematic screening, 237 relevant ethical and biomedical articles published between 2008 and 2021 were included in our review. We identified a broad range of ethical implications that could be categorized under 10 themes. Seven themes trace the development from bench to bedside: (1) animal experimentation, (2) handling human tissue, (3) informed consent, (4) therapeutic potential, (5) risk and safety, (6) clinical translation, and (7) societal impact. Three themes represent ethical safeguards relevant to all developmental phases: (8) scientific integrity, (9) regulation, and (10) patient and public involvement. This review reveals that since 2008 a significant body of literature has emerged on how to design clinical trials for TE in a responsible manner. However, several topics remain in need of more attention. These include the acceptability of alternative translational pathways outside clinical trials, soft impacts on society and questions of ownership over engineered tissues. Overall, this overview of the ethical and societal implications of the field will help promote responsible development of new interventions in TE and RM. It can also serve as a valuable resource and educational tool for scientists, engineers, and clinicians in the field by providing an overview of the ethical considerations relevant to their work. Impact statement To our knowledge, this is the first time that the ethical implications of Tissue Engineering (TE) have been reviewed systematically. By gathering existing scholarly work and identifying knowledge gaps, this review facilitates further research into the ethical and societal implications of TE and Regenerative Medicine (RM) and other emerging biomedical technologies. Moreover, it will serve as a valuable resource and educational tool for scientists, engineers, and clinicians in the field by providing an overview of the ethical considerations relevant to their work. As such, our review may promote successful and responsible development of new strategies in TE and RM.
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Affiliation(s)
- Anne-Floor Johanna de Kanter
- University Medical Centre Utrecht, Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, Stratenum 6.131, PO Box 85500, Utrecht, Utrecht, Netherlands, 3508 GA,
| | - Karin Rolanda Jongsma
- University Medical Centre Utrecht, Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands,
| | - Marianne C Verhaar
- University Medical Centre Utrecht, Department of Nephrology and Hypertension, Utrecht, Netherlands,
| | - Annelien L Bredenoord
- University Medical Centre Utrecht, Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
- Erasmus University Rotterdam, Erasmus School of Philosophy, Rotterdam, Netherlands,
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Niemansburg SL, Teraa M, Hesam H, van Delden JJM, Verhaar MC, Bredenoord AL. Stem cell trials for cardiovascular medicine: ethical rationale. Tissue Eng Part A 2014; 20:2567-74. [PMID: 24164351 PMCID: PMC4195508 DOI: 10.1089/ten.tea.2013.0332] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 10/24/2013] [Indexed: 12/29/2022] Open
Abstract
Stem cell-based interventions provide new treatment prospects for many disease conditions, including cardiovascular disorders. Clinical trials are necessary to collect adequate evidence on (long-term) safety and efficacy of novel interventions such as stem cells, but the design and launch of clinical trials, from first-in-human studies to larger randomized controlled trials (RCTs), is scientifically and ethically challenging. Stem cells are different from traditional pharmaceuticals, surgical procedures, and medical devices in the following ways: the novelty and complexity of stem cells, the invasiveness of the procedures, and the novel aim of regeneration. These specifics, combined with the characteristics of the study population, will have an impact on the design and ethics of RCTs. The recently closed JUVENTAS trial will serve as an example to identify the (interwoven) scientific and ethical challenges in the design and launch of stem cell RCTs. The JUVENTAS trial has investigated the efficacy of autologous bone marrow cells in end-stage vascular patients, in a double-blind sham-controlled design. We first describe the choices, considerations, and experiences of the JUVENTAS team. Subsequently, we identify the main ethical and scientific challenges and discuss what is important to consider in the design of future stem cell RCTs: assessment of risks and benefits, the choice for outcome measures, the choice for the comparator, the appropriate selection of participants, and adequate informed consent. Additionally, the stem cell field is highly in the spotlight due to the (commercial) interests and expectations. This warrants a cautious pace of translation and scrupulous set up of clinical trials, as failures could put the field in a negative light. At the same time, knowledge from clinical trials is necessary for the field to progress. We conclude that in the scientifically and ethically challenging field of stem cell RCTs, researchers and clinicians have to maneuver between the Skylla of hyper accelerated translation without rigorously conducted RCTs and the Charybdis of the missed opportunity of valuable knowledge.
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Affiliation(s)
- Sophie L Niemansburg
- 1 Department of Medical Humanities, Julius Center, University Medical Center Utercht , The Netherlands
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5
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Niemansburg SL, van Delden JJ, Dhert WJ, Bredenoord AL. Regenerative medicine interventions for orthopedic disorders: ethical issues in the translation into patients. Regen Med 2013; 8:65-73. [PMID: 23259806 DOI: 10.2217/rme.12.112] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Regenerative medicine (RM) technologies, such as cell therapy, gene transfer and tissue engineering, are expected to move the field of orthopedics into a new era. Now that more and more attempts are underway to translate preclinical research into clinical studies, it is time to proactively discuss the ethical issues associated with first-in-human applications of RM interventions for musculoskeletal disorders. The design and launch of early clinical trials will be ethically challenging due to the specific features of RM in general, and the application for musculoskeletal disorders specifically. In this paper, we identify three sets of ethical issues that need to be addressed when considering initiating early clinical trials: assessment of risks and benefits; designing a study in terms of outcome measures and comparators; and participant selection. These issues are particularly emphasized in RM research that aims to apply these approaches in an early stage of degenerative musculoskeletal disorders.
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Affiliation(s)
- Sophie L Niemansburg
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands.
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6
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Oerlemans AJM, van Hoek MEC, van Leeuwen E, van der Burg S, Dekkers WJM. Towards a richer debate on tissue engineering: a consideration on the basis of NEST-ethics. SCIENCE AND ENGINEERING ETHICS 2013; 19:963-81. [PMID: 23229374 DOI: 10.1007/s11948-012-9419-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 11/06/2012] [Indexed: 05/04/2023]
Abstract
In their 2007 paper, Swierstra and Rip identify characteristic tropes and patterns of moral argumentation in the debate about the ethics of new and emerging science and technologies (or "NEST-ethics"). Taking their NEST-ethics structure as a starting point, we considered the debate about tissue engineering (TE), and argue what aspects we think ought to be a part of a rich and high-quality debate of TE. The debate surrounding TE seems to be predominantly a debate among experts. When considering the NEST-ethics arguments that deal directly with technology, we can generally conclude that consequentialist arguments are by far the most prominently featured in discussions of TE. In addition, many papers discuss principles, rights and duties relevant to aspects of TE, both in a positive and in a critical sense. Justice arguments are only sporadically made, some "good life" arguments are used, others less so (such as the explicit articulation of perceived limits, or the technology as a technological fix for a social problem). Missing topics in the discussion, at least from the perspective of NEST-ethics, are second "level" arguments-those referring to techno-moral change connected to tissue engineering. Currently, the discussion about tissue engineering mostly focuses on its so-called "hard impacts"-quantifiable risks and benefits of the technology. Its "soft impacts"-effects that cannot easily be quantified, such as changes to experience, habits and perceptions, should receive more attention.
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Affiliation(s)
- A J M Oerlemans
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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7
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de Vries RBM, Leenaars M, Tra J, Huijbregtse R, Bongers E, Jansen JA, Gordijn B, Ritskes-Hoitinga M. The potential of tissue engineering for developing alternatives to animal experiments: a systematic review. J Tissue Eng Regen Med 2013; 9:771-8. [PMID: 23554402 DOI: 10.1002/term.1703] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 11/28/2012] [Accepted: 12/20/2012] [Indexed: 01/18/2023]
Abstract
An underexposed ethical issue raised by tissue engineering is the use of laboratory animals in tissue engineering research. Even though this research results in suffering and loss of life in animals, tissue engineering also has great potential for the development of alternatives to animal experiments. With the objective of promoting a joint effort of tissue engineers and alternative experts to fully realise this potential, this study provides the first comprehensive overview of the possibilities of using tissue-engineered constructs as a replacement of laboratory animals. Through searches in two large biomedical databases (PubMed, Embase) and several specialised 3R databases, 244 relevant primary scientific articles, published between 1991 and 2011, were identified. By far most articles reviewed related to the use of tissue-engineered skin/epidermis for toxicological applications such as testing for skin irritation. This review article demonstrates, however, that the potential for the development of alternatives also extends to other tissues such as other epithelia and the liver, as well as to other fields of application such as drug screening and basic physiology. This review discusses which impediments need to be overcome to maximise the contributions that the field of tissue engineering can make, through the development of alternative methods, to the reduction of the use and suffering of laboratory animals.
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Affiliation(s)
- Rob B M de Vries
- 3R Research Centre / SYRCLE, Central Animal Laboratory, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Marlies Leenaars
- 3R Research Centre / SYRCLE, Central Animal Laboratory, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Joppe Tra
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Erik Bongers
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - John A Jansen
- Department of Periodontology and Biomaterials, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Bert Gordijn
- Institute of Ethics, Dublin City University, Dublin, Ireland
| | - Merel Ritskes-Hoitinga
- 3R Research Centre / SYRCLE, Central Animal Laboratory, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Oerlemans AJ, Feitz WF, van Leeuwen E, Dekkers WJ. Regenerative Urology Clinical Trials: An Ethical Assessment of Road Blocks and Solutions. TISSUE ENGINEERING PART B-REVIEWS 2013; 19:41-7. [DOI: 10.1089/ten.teb.2012.0136] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Anke J.M. Oerlemans
- Scientific Institute for Quality of Healthcare, Section Ethics, Philosophy and History of Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Wouter F.J. Feitz
- Department of Urology, Radboud University Nijmegen Medical Centre, Radboud Children's Hospital, Nijmegen, The Netherlands
| | - Evert van Leeuwen
- Scientific Institute for Quality of Healthcare, Section Ethics, Philosophy and History of Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Wim J.M. Dekkers
- Scientific Institute for Quality of Healthcare, Section Ethics, Philosophy and History of Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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9
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de Vries RBM, Buma P, Leenaars M, Ritskes-Hoitinga M, Gordijn B. Reducing the number of laboratory animals used in tissue engineering research by restricting the variety of animal models. Articular cartilage tissue engineering as a case study. TISSUE ENGINEERING PART B-REVIEWS 2012; 18:427-35. [PMID: 22571623 DOI: 10.1089/ten.teb.2012.0059] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The use of laboratory animals in tissue engineering research is an important underexposed ethical issue. Several ethical questions may be raised about this use of animals. This article focuses on the possibilities of reducing the number of animals used. Given that there is considerable debate about the adequacy of the current animal models in tissue engineering research, we investigate whether it is possible to reduce the number of laboratory animals by selecting and using only those models that have greatest predictive value for future clinical application of the tissue engineered product. The field of articular cartilage tissue engineering is used as a case study. Based on a study of the scientific literature and interviews with leading experts in the field, an overview is provided of the animal models used and the advantages and disadvantages of each model, particularly in terms of extrapolation to the human situation. Starting from this overview, it is shown that, by skipping the small models and using only one large preclinical model, it is indeed possible to restrict the number of animal models, thereby reducing the number of laboratory animals used. Moreover, it is argued that the selection of animal models should become more evidence based and that researchers should seize more opportunities to choose or create characteristics in the animal models that increase their predictive value.
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Affiliation(s)
- Rob B M de Vries
- SYRCLE/3R Research Centre, Central Animal Laboratory (Post 231), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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10
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Tenorio DMH, Scaletta C, Jaccoud S, Hirt-Burri N, Pioletti DP, Jaques B, Applegate LA. Human fetal bone cells in delivery systems for bone engineering. J Tissue Eng Regen Med 2011; 5:806-14. [PMID: 22002924 DOI: 10.1002/term.381] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 09/22/2010] [Indexed: 01/03/2023]
Abstract
The aim of this study was to culture human fetal bone cells (dedicated cell banks of fetal bone derived from 14 week gestation femurs) within both hyaluronic acid gel and collagen foam, to compare the biocompatibility of both matrices as potential delivery systems for bone engineering and particularly for oral application. Fetal bone cell banks were prepared from one organ donation and cells were cultured for up to 4 weeks within hyaluronic acid (Mesolis®) and collagen foams (TissueFleece®). Cell survival and differentiation were assessed by cell proliferation assays and histology of frozen sections stained with Giemsa, von Kossa and ALP at 1, 2 and 4 weeks of culture. Within both materials, fetal bone cells could proliferate in three-dimensional structure at ∼70% capacity compared to monolayer culture. In addition, these cells were positive for ALP and von Kossa staining, indicating cellular differentiation and matrix production. Collagen foam provides a better structure for fetal bone cell delivery if cavity filling is necessary and hydrogels would permit an injectable technique for difficult to treat areas. In all, there was high biocompatibility, cellular differentiation and matrix deposition seen in both matrices by fetal bone cells, allowing for easy cell delivery for bone stimulation in vivo.
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Affiliation(s)
- Diene M H Tenorio
- Department of Musculoskeletal Medicine, University Hospital of Lausanne, Lausanne, Switzerland
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11
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Oerlemans AJ, Rodrigues CH, Verkerk MA, van den Berg PP, Dekkers WJ. Ethical Aspects of Soft Tissue Engineering for Congenital Birth Defects in Children—What Do Experts in the Field Say? TISSUE ENGINEERING PART B-REVIEWS 2010; 16:397-403. [DOI: 10.1089/ten.teb.2009.0666] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Anke J.M. Oerlemans
- Scientific Institute for Quality of Healthcare, Section Ethics, Philosophy, and History of Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Catarina H.C.M.L. Rodrigues
- Health Sciences/Medical Ethics, University of Groningen/University Medical Centre Groningen, Groningen, The Netherlands
| | - Marian A. Verkerk
- Health Sciences/Medical Ethics, University of Groningen/University Medical Centre Groningen, Groningen, The Netherlands
| | - Paul P. van den Berg
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Wim J.M. Dekkers
- Scientific Institute for Quality of Healthcare, Section Ethics, Philosophy, and History of Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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12
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Trommelmans L, Selling J, Dierickx K. Is tissue engineering a new paradigm in medicine? Consequences for the ethical evaluation of tissue engineering research. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2009; 12:459-467. [PMID: 19629749 DOI: 10.1007/s11019-009-9192-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Accepted: 01/31/2009] [Indexed: 05/28/2023]
Abstract
Ex-vivo tissue engineering is a quickly developing medical technology aiming to regenerate tissue through the introduction of an ex-vivo created tissue construct instead of restoring the damaged tissue to some level of functionality. Tissue engineering is considered by some as a new medical paradigm. We analyse this claim and identify tissue engineering's fundamental characteristics, focusing on the aim of the intervention and on the complexity and continuity of the process. We inquire how these features have an impact not only on the scientific research itself but also on the ethical evaluation of this research. We suggest that viewing tissue engineering as a new medical paradigm allows us to develop a wider perspective for successful investigation instead of focusing on isolated steps of the tissue engineering process in an anecdotal way, which may lead to an inadequate ethical evaluation. We argue that the concept of tissue engineering as a paradigm may benefit the way we address the ethical challenges presented by tissue engineering.
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Affiliation(s)
- Leen Trommelmans
- Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35/3, Box 7001, 3000, Leuven, Belgium.
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13
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Trommelmans L, Selling J, Dierickx K. An Exploratory Survey on the Views of European Tissue Engineers Concerning the Ethical Issues of Tissue Engineering Research. TISSUE ENGINEERING PART B-REVIEWS 2009; 15:241-7. [DOI: 10.1089/ten.teb.2008.0647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Leen Trommelmans
- Faculty of Medicine, Centre for Biomedical Ethics and Law, Catholic University of Leuven, Leuven, Belgium
| | - Joseph Selling
- Faculty of Theology, Research Unit Theological Ethics, Catholic University of Leuven, Leuven, Belgium
| | - Kris Dierickx
- Faculty of Medicine, Centre for Biomedical Ethics and Law, Catholic University of Leuven, Leuven, Belgium
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14
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Horch RE, Pepescu LM, Vacanti C, Maio G. Ethical issues in cellular and molecular medicine and tissue engineering. J Cell Mol Med 2009; 12:1785-93. [PMID: 19145705 PMCID: PMC4506149 DOI: 10.1111/j.1582-4934.2008.00460.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Raymund E Horch
- Department of Plastic and Hand Surgery, University Hospital Erlangen, University of Erlangen-Nuernberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany.
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