Ownership and uses of human tissue: does the Nuffield bioethics report accord with opinion of surgical inpatients?

Gay and Bisexual Men's Perceptions of the Donation and Use of Human Biological Samples for Research: A Qualitative Study

Human biological samples (biosamples) are increasingly important in diagnosing, treating and measuring the prevalence of illnesses. For the gay and bisexual population, biosample research is particularly important for measuring the prevalence of human immunodeficiency virus (HIV). By determining people's understandings of, and attitudes towards, the donation and use of biosamples, researchers can design studies to maximise acceptability and participation. In this study we examine gay and bisexual men's attitudes towards donating biosamples for HIV research. Semi-structured telephone interviews were conducted with 46 gay and bisexual men aged between 18 and 63 recruited in commercial gay scene venues in two Scottish cities. Interview transcripts were analysed thematically using the framework approach. Most men interviewed seemed to have given little prior consideration to the issues. Participants were largely supportive of donating tissue for medical research purposes, and often favourable towards samples being stored, reused and shared. Support was often conditional, with common concerns related to: informed consent; the protection of anonymity and confidentiality; the right to withdraw from research; and ownership of samples. Many participants were in favour of the storage and reuse of samples, but expressed concerns related to data security and potential misuse of samples, particularly by commercial organisations. The sensitivity of tissue collection varied between tissue types and collection contexts. Blood, urine, semen and bowel tissue were commonly identified as sensitive, and donating saliva and as unlikely to cause discomfort. To our knowledge, this is the first in-depth study of gay and bisexual men's attitudes towards donating biosamples for HIV research. While most men in this study were supportive of donating tissue for research, some clear areas of concern were identified. We suggest that these minority concerns should be accounted for to develop inclusive, evidence-informed research protocols that balance collective benefits with individual concerns.

Public views on the donation and use of human biological samples in biomedical research: a mixed methods study

OBJECTIVE

A mixed methods study exploring the UK general public's willingness to donate human biosamples (HBSs) for biomedical research.

SETTING

Cross-sectional focus groups followed by an online survey.

PARTICIPANTS

Twelve focus groups (81 participants) selectively sampled to reflect a range of demographic groups; 1110 survey responders recruited through a stratified sampling method with quotas set on sex, age, geographical location, socioeconomic group and ethnicity.

MAIN OUTCOME MEASURES

(1) Identify participants' willingness to donate HBSs for biomedical research, (2) explore acceptability towards donating different types of HBSs in various settings and (3) explore preferences regarding use and access to HBSs.

RESULTS

87% of survey participants thought donation of HBSs was important and 75% wanted to be asked to donate in general. Responders who self-reported having some or good knowledge of the medical research process were significantly more likely to want to donate (p<0.001). Reasons why focus group participants saw donation as important included: it was a good way of reciprocating for the medical treatment received; it was an important way of developing drugs and treatments; residual tissue would otherwise go to waste and they or their family members might benefit. The most controversial types of HBSs to donate included: brain post mortem (29% would donate), eyes post mortem (35%), embryos (44%), spare eggs (48%) and sperm (58%). Regarding the use of samples, there were concerns over animal research (34%), research conducted outside the UK (35%), and research conducted by pharmaceutical companies (56%), although education and discussion were found to alleviate such concerns.

CONCLUSIONS

There is a high level of public support and willingness to donate HBSs for biomedical research. Underlying concerns exist regarding the use of certain types of HBSs and conditions under which they are used. Improved education and more controlled forms of consent for sensitive samples may mitigate such concerns.

Consent for the use of human biological samples for biomedical research: a mixed methods study exploring the UK public's preferences

OBJECTIVE

A mixed-methods study exploring the UK general public's views towards consent for the use of biosamples for biomedical research.

SETTING

Cross-sectional population-based focus groups followed by an online survey.

PARTICIPANTS

12 focus groups (81 participants) selectively sampled to reflect a range of demographic groups; 1110 survey responders recruited through a stratified sampling method with quotas set on sex, age, geographical location, socioeconomic group and ethnicity.

MAIN OUTCOME MEASURES

(1) Views on the importance of consent when donating residual biosamples for medical research; (2) preferences for opt-in or opt-out consent approaches and (3) preferences for different consent models.

RESULTS

Participants believed obtaining consent for use of residual biosamples was important as it was 'morally correct' to ask, and enabled people to make an active choice and retain control over their biosamples. Survey responders preferred opt-in consent (55%); the strongest predictor was being from a low socioeconomic group (OR 2.22, 95% CI 1.41 to 3.57, p=0.001) and having a religious affiliation (OR 1.36, 95% CI 1.01 to 1.81, p=0.04). Focus group participants had a slight preference for opt-out consent because by using this approach more biosamples would be available and facilitate research. Concerning preferred models of consent for research use of biosamples, survey responders preferred specific consent with recontact for each study for which their biosamples are eligible. Focus group participants preferred generic consent as it provided 'flexibility for researchers' and reduced the likelihood that biosamples would be wasted. The strongest predictor for preferring specific consent was preferring opt-in consent (OR 4.58, 95% CI 3.30 to 6.35, p=0.015) followed by non-'White' ethnicity (OR 2.94, 95% CI 1.23 to 7.14, p<0.001).

CONCLUSIONS

There is a preference among the UK public for ongoing choice and control over donated biosamples; however, increased knowledge and opportunity for discussion is associated with acceptance of less restrictive consent models for some people.

Contributing to research via biobanks: what it means to cancer patients

CONTEXT AND OBJECTIVE

Biobanks have become strategic resources for biomedical and genetic research. The aim of the present empirical qualitative study was to investigate how patients with cancer perceive and experience the process of donation to biobanks, focussing on the subjective meanings associated with their decisions when they are asked in a routine context to agree to their own biological specimens being used for research projects.

DESIGN

A qualitative study, using semi-structured interviews to explore in depth the reasons why patients with cancer agree to participating in biobanking. Participants  Nineteen patients (aged 28-82 years) being treated for colorectal cancer or leukaemia at a French cancer centre participated in this study.

RESULTS

Contributing to biobanks was experienced here as a rewarding and empowering individual experience because of the psychological issues involved, such as feelings of hope associated with research, because it makes the relationship with researchers and clinicians less asymmetrical, revalorization of otherwise 'wasted' tissue, and also as an act of solidarity and reciprocity, which makes patients part of a community.

DISCUSSION AND CONCLUSION

Patients seem to regard contributing to biobanks as an act of benevolence, which they are motivated to perform because of societal welfare considerations as well as the hope of subjective benefits. Knowledge about the patients' perspective and of the psychological rewards associated with tumour donation should be taken into account by physicians and caregivers discussing this topic with their patients.

A trial of consent procedures for future research with clinically derived biological samples

Background:

The aims of this study were to determine which consent procedure patients prefer for use of stored tissue for research purposes and what the effects of consent procedures on actual consenting behaviour are.

Methods:

We offered 264 cancer patients three different consent procedures: ‘one-time general consent’ (asked written informed consent), ‘opt-out plus’ (had the opportunity to opt out by a form), or the standard hospital procedure (control group). The two intervention groups received a specific leaflet about research with residual tissue and verbal information. The control group only received a general hospital leaflet including opt-out information, which is the procedure currently in use. Subsequently, all patients received a questionnaire to examine their preferences for consent procedures.

Results:

In all, 99% of patients consented to research with their residual tissue. In the ‘one-time consent’ group 85% sent back their consent form. Patients preferred ‘opt-out plus’ (43%) above ‘one-time consent’ (34%) or ‘opt-out’ (16%), whereas 8% indicated that they did not need to receive information about research with residual tissues or be given the opportunity to make a choice.

Conclusions:

The ‘opt-out plus’ procedure, which places fewer demands on administrative resources than ‘one-time consent’, can also address the information needs of patients.

A walk in the park: a case study in research ethics

Can researchers, interested in novel ways to assess HIV seroprevalence among populations which are otherwise hidden, collect condoms that have been discarded on the ground in a public sex environment and test them for HIV? Researchers, who use other types of abandoned samples, such as discarded syringes, hair or saliva samples, or excess biological samples, confront similar issues. This review evaluates whether such abandoned tissues can be studied based on U.S. Code of Federal Regulations and literature on related issues including: research involving banked tissues, blinded seroprevalence studies, and property claims that individuals might make on the samples. It also addresses broader questions of potential for stigma and risk to individuals and communities. The article concludes that the research should be permitted legally because either it does not involve human subjects, or it satisfies the requirements for waiver of consent; and that the research should also be permitted because the ethical principal of avoiding harm to individuals is fully satisfied based on a careful reading of the lessons of the tissue bank, biological property rights, and blinded seroprevalence study debates, as well as a consideration of other potential harms that might be involved.

Experiences from the front-line routine consenting of surplus surgically removed tissue: without investment by the National Health Service fully informed consent for all is not available

The study investigated the routine introduction of a new surgical consent form containing a tissue consent section to investigate patient attitudes to the use of surplus tissue for research (after the Alder Hey inquiry) and also the differing approaches by consent takers. All surgical consent forms received in histopathology for the same 2-month period in 2 consecutive years were analysed, recording available information about the specimen, the tissue consent section and, for the second year, the consent taker. The findings showed that <5% of patients whose views were recorded disagreed with the use of their tissue for research. They also showed that the number of completed forms sent to histopathology had increased but the pattern of completion had changed very little. A wide variation between departments and also between clinicians was apparent in the levels of completion of the tissue consent section, suggesting wide variability in the quality of the consenting process. When asked, patients rarely object (<5%) but if the highest standards of consent for surgical tissue are to be achieved and the wishes of patients to donate tissue are to be effectively recorded then new resources or approaches will be needed for this process.

One-time general consent for research on biological samples

It is now recognised that people should give informed consent for use of their biological samples in research. The literature on individuals' views supports one-time general consent as the best approach for this purpose

Human Research Tissue Banks: The ATRA Project for Establishing a Human Research Tissue Bank in Switzerland

A large number of experiments in biomedical research are carried out on tissues, but, even though the results should be applicable to humans, these tissues are mainly of animal origin. The difficulty encountered in obtaining human organs and tissues is an acknowledged problem: not enough human tissues are available to meet research needs. We are introducing the ATRA Project, with the purpose of supporting progress in biomedical research in Switzerland through the establishment of one or more human tissue banks, which will be able to find, treat, preserve and supply human material. Where similar projects have already been launched, concerns have been expressed that donation for research purposes might compete with donation for transplantation, but most organs and tissues are in any case non-transplantable. Surplus surgical tissue is considered “sanitary waste”, and must be treated according to specific regulations for collection, packaging, transport, treatment and disposal. A human tissue bank would not only abate the costs of treating sanitary waste, but would actually turn what is now considered waste into a resource which could be used to save human and animal lives.

Obtaining explicit consent for the use of archival tissue samples: practical issues

BACKGROUND

Over the past few years, research ethics committees have increasingly demanded explicit consent before archival tissue samples can be used in research projects. Current UK guidance in this area requires an assessment of whether it is "practical" to obtain explicit consent. Ethics committees have little experience or evidence to help them to judge what is "practical" in this context.

METHODS

We attempted to obtain general consent for research use of surplus tissue from renal transplant biopsies from the entire patient population of the renal transplant unit in Leicester. The nature of this patient population would be expected to facilitate this task.

RESULTS

A total of 495 letters were sent. Attempts were made to contact non-responders when they attended the outpatient clinic. One year after the initiation of the project, the opinions of 26% of the patients had still not been ascertained.

CONCLUSIONS

The results confirm that the vast majority of patients are happy for "surplus" biopsy material to be used for research; the situation does not parallel the use of autopsy tissue. A requirement to obtain explicit consent for the study of archival tissue is likely, however, to block or at least seriously delay research, which is contrary to the public interest and specifically may harm the interests of the patients concerned. In the UK, the problem of tissue being used against the wishes of the donor has now been largely replaced by the problem of prohibition of tissue use against the wishes of the donor.

A study of public opinion on the use of tissue samples from living subjects for clinical research

AIMS

To assess public opinion on the use of tissue samples from living adults and children for clinical research.

METHODS

A questionnaire study of 100 healthy volunteers (100% response rate) from a Newcastle NHS dental practice. The issues investigated were the types of tissues that individuals were prepared to donate for research, the type of research donors would be prepared to consent to, and attitudes to research on children's tissues.

RESULTS

Eighteen per cent of the participants said that they would not give consent for research to be carried out on their tissues, 50% would not give consent for the donation of a child's tissues. Only 26% of subjects said that they would give consent for research on genetic cloning compared with 82% for cancer research. Sex differences existed in the responses.

CONCLUSIONS

Greater research attention needs to be given to public opinion on the use of tissue from living subjects for medical research to facilitate drafting of new legislation.

A study of public opinion on the use of tissue samples from living subjects for clinical research

AIMS

To assess public opinion on the use of tissue samples from living adults and children for clinical research.

METHODS

A questionnaire study of 100 healthy volunteers (100% response rate) from a Newcastle NHS dental practice. The issues investigated were the types of tissues that individuals were prepared to donate for research, the type of research donors would be prepared to consent to, and attitudes to research on children's tissues.

RESULTS

Eighteen per cent of the participants said that they would not give consent for research to be carried out on their tissues, 50% would not give consent for the donation of a child's tissues. Only 26% of subjects said that they would give consent for research on genetic cloning compared with 82% for cancer research. Sex differences existed in the responses.

CONCLUSIONS

Greater research attention needs to be given to public opinion on the use of tissue from living subjects for medical research to facilitate drafting of new legislation.

Obtaining and using human tissues for research: ethical and practical dilemmas

The wide publicity given to the inappropriate retention of organs at post-mortem has resulted in new regulations governing the use of all human samples. thical review and explicit consent are required, even for research using urine samples. This editorial argues that the result, far from protecting patients, is now damaging patients' interests.

Research using human tissues--a crisis of supply?

It is a paradox that the pursuit of ethical practice can sometimes produce distinctly unethical results. Pathologists seek to study diseased human tissues for the benefit of mankind, but in the UK there has been a sudden restriction in the availability of this basic resource, supposedly on ethical grounds. This was triggered by adverse publicity about the inappropriate retention of whole organs at paediatric post-mortem, but the reaction has spread to influence the use of 'surgical waste' left over after routine analysis of therapeutic resections, diagnostic biopsies, and even blood samples. The use of such material for research is being restricted, and its use in teaching and laboratory quality control is being questioned. This has occurred despite the facts that public opinion favours using such 'waste' material for research; that the tissues would otherwise be incinerated; and that until very recently, such tissues were regarded as having been 'abandoned' by the patient. This review attempts to chart how this dramatic change has occurred. It then considers some of the ethical problems in using such 'surplus' tissues and proposes mechanisms by which this valuable resource can remain available for most biomedical research, while maintaining or enhancing the autonomy of individual patients. This crisis has shown a tendency for regulatory authorities to apply very restrictive, oversimplified rules, without due consideration of the character of each project. The motivation is to avoid the possibility of media criticism, even though such rules block ethically sound work which is of value to all, including the individuals whose protection is supposedly being sought. The moral need for logical ethical arguments instead of such 'one size fits all' regulations is emphasized.

Supplying commercial biomedical companies from a human tissue bank in an NHS hospital--a view from personal experience

NHS histopathology laboratories are well placed to develop banks of surgically removed surplus human tissues to meet the increasing demands of commercial biomedical companies. The ultimate aim could be national network of non-profit making NHS tissue banks conforming to national minimum ethical, legal, and quality standards which could be monitored by local research ethics committees. The Nuffield report on bioethics provides ethical and legal guidance but we believe that the patient should be fully informed and the consent given explicit. Setting up a tissue bank requires enthusiasm, hard work, and determination as well as coordination between professionals in the NHS trust and in the commercial sector. The rewards are exiting new collaborations with commercial biomedical companies which could help secure our future.