Organoids as hybrids: ethical implications for the exchange of human tissues

Recent developments in biotechnology allow for the generation of increasingly complex products out of human tissues, for example, human stem cell lines, synthetic embryo-like structures and organoids. These developments are coupled with growing commercial interests. Although commercialisation can spark the scientific and clinical promises, profit-making out of human tissues is ethically contentious and known to raise public concern. The traditional bioethical frames of gift versus market are inapt to capture the resulting practical and ethical complexities. Therefore, we propose an alternative approach to identify, evaluate and deal with the ethical challenges that are raised by the increasing commercialisation of the exchange of sophisticated human tissue products. We use organoid technology, a cutting-edge stem cell technology that enables the cultivation of 'mini-organs' in a dish, as an example. First, we examine the moral value of organoids and recognise them as hybrids that relate to persons and their bodies as well as to technologies and markets in ambiguous ways. Second, we show that commercialisation of organoids is legitimised by a detachment of the instrumental and commercial value of organoids from their associations with persons and their bodies. This detachment is enacted in steps of disentanglement, among which consent and commodification. Third, we contend that far-reaching disentanglement is ethically challenging: (1) Societal interests could be put under pressure, because the rationale for commercialising organoid technology, that is, to stimulate biomedical innovation for the good of society, may not be fulfilled; (2) The interests of donors are made subordinate to those of third parties and the relational moral value of organoids may be insufficiently recognised. Fourth, we propose a 'consent for governance' model that contributes to responsible innovation and clinical translation in this exciting field.

3D Bioprinting Technology: Scientific Aspects and Ethical Issues

The scientific development of 3D bioprinting is rapidly advancing. This innovative technology involves many ethical and regulatory issues, including theoretical, source, transplantation and enhancement, animal welfare, economic, safety and information arguments. 3D bioprinting technology requires an adequate bioethical debate in order to develop regulations in the interest both of public health and the development of research. This paper aims to initiate and promote ethical debate. The authors examine scientific aspects of 3D bioprinting technology and explore related ethical issues, with special regard to the protection of individual rights and transparency of research. In common with all new biotechnologies, 3D bioprinting technology involves both opportunities and risks. Consequently, several scientific and ethical issues need to be addressed. A bioethical debate should be carefully increased through a multidisciplinary approach among experts and also among the public.

Darurah (Necessity) and Its Application in Islamic Ethical Assessment of Medical Applications: A Review on Malaysian Fatwa

The discovery and invention of new medical applications may be considered blessings to humankind. However, some applications which might be the only remedy for certain diseases may contain ingredients or involve methods that are not in harmony with certain cultural and religious perspectives. These situations have raised important questions in medical ethics; are these applications completely prohibited according to these perspectives, and is there any room for mitigation? This paper explores the concept of darurah (necessity) and its deliberation in the formulation of fatwas on medicine issued by the National Fatwa Council of Malaysia. Darurah has explicitly been taken into consideration in the formulation of 14 out of 45 fatwas on medicine thus far, including one of the latest fatwas regarding uterine donation and transplantation. These fatwas are not only limited to the issues regarding the use of unlawful things as remedies. They include issues pertaining to organ transplantation, management of the corpse and treatment of brain dead patients. While deliberation of darurah in medicine may vary from issue to issue, darurah applies in a dire situation in which there are no lawful means to prevent harm that may be inflicted upon human life. Nevertheless, other aspects must also be taken into the deliberation. For example, consent must be obtained from the donor or his next of kin (after his death) to conduct a cadaveric organ transplantation.

Principle of serviceability and gratuitousness in transplantation?

INTRODUCTION

the issue of commercialization of transplantation analyses in the article. Attention is paid to the importance of transplantation as a method of treatment and saving human lives.

AIM

the clarify the feasibility of the introduction of donation commercialization as an avenue to solve the shortage of donor organs and means of combating with black organ market and finding alternative avenues solving these problems, which are more morally acceptable for society is the aim of this article.

MATERIALS AND METHODS

the experience of foreign countries has been analyses in the research. Additionally, we used data from international organizations, conclusions scientists and report of Global Financial Integrity in the research.

RESULTS

it is impossible to solve most problems by means of paid donation.

CONCLUSIONS

therapeutic organ and tissue cloning based on genetic technology is the best way out and solving ethical transplantation problems.

[Fetal experimentation, transplantations, cosmetics and their connection with induced abortion]

The increase in induced abortion produces large numbers of cells, tissues and organs, which are used in several fields of Medicine, either in research or in treatment. The main uses are in Cardiology, Hematology, Metabolism, Embryology, Neurology, Immunology, Ophthalmology, Dermatology and Transplantations. Flavor enhancers and cosmetics also benefit. Utilitarianism has led to an increase in abortion-originated cell and tissue banks. Abortion is justified through the manipulation of language. Vested interests give rise to complicity in researchers and society as a whole. Abortion and tissue 'donation' cannot be split; since fresh tissues are involved there is a symbiotic relationship between them. Valid consent is not possible. A contradiction emerges, the nasciturus is not desired or valued but fetal organs are. When someone is deprived of his rights it is because another wants to enslave them. Research must have a moral base. Knowledge should not be increased at any price. Something that is legal and well intentioned is not always morally acceptable. The duty of omission is applicable. Means to achieve a goal must be ethical means. Educational efforts to restore respect for the human embryo and fetus must be promoted. Technical advances are not always in accordance with human nature and dignity. Research and treatment that do not resort to cells, tissues and organs obtained from induced abortions should be promoted.

Composite tissue allotransplantation in Europe. Logistics and infrastructure of a centre

BACKGROUND

Composite Tissue Allotransplantation (CTA) is a new medical field of growing importance. This paper focuses on the infrastructure and organisation of European CTA centres and discusses the differences between national health systems.

MATERIAL/METHODS

Eight European centres (Valencia, Innsbruck, Munich, Lyon, Amiens, Creteil, Wroclaw, Monza) were sent with a specially-designed, standardized, 20-item questionnaire.

RESULTS

Five of the eight centres returned our questionnaire: Munich, Innsbruck, Lyon, Amiens, Wroclaw. Since 1998, CTA has been performed at these centres. In both French centres and the Polish centre public funding is available in addition to the coverage provided by health insurers. In Munich the costs for a double upper-arm transplantation were Euro 150,000 with an additional Euro 50,000-70,000 per year. In Lyon the costs for a singular hand transplantation were Euro 70,000 per year and in Wroclaw (Poland) the costs for a hand or upper arm transplantation were Euro 20,000-30,000. As many as 17 different medical professions are involved in the CTA at the different centres.

CONCLUSIONS

CTA is an innovative promising therapeutic tool that is based on the experiences of solid organ transplantation and profound microsurgical skills. Due to the complexity of the infrastructure, sourcing and the organisation CTA can only be successfully performed at specialized centres. A European network with an international European waiting list and a central coordination for CTA should be established. In order to advance CTA as an important tool in reconstructive surgery we must turn our attention to how the costs will be met, the legal environment for procurement of adequate donors and open ethical questions.

Informed consent to tissue donation: policies and practice

Nearly 10 years ago, the tissue industry's informed consent practices with donor families in the United States were criticized. In response, the industry, along with the Inspector General of the Department of Health and Human Services, suggested elements to be included in the informed consent process. This study examines which of these elements were present in the informed consent documents of 45 (78%) of the nation's 58 Organ Procurement Organizations (OPOs). Some elements, such as involvement of for-profit companies, were present in almost all. Others, such as labeling tissue as a gift from donor families, never were. The authors conclude that the time is ripe for reexamination of the informed consent process with an eye to meaningful consent that promotes the benefits of tissue transplantation and at the same time protects the rights and interests of donor families; can be realistically implemented; and, maintains the trust of the American public.

International perspectives on the ethics and regulation of human cell and tissue transplantation

The transplantation of human cells and tissues has become a global enterprise for both life-saving and life-enhancing purposes. Yet current practices raise numerous ethical and policy issues relating to informed consent for donation, profit-making, and quality and safety in the procurement, processing, distribution, and international circulation of human cells and tissues. This paper reports on recent developments in the international debate surrounding these issues, and in particular on the attention cell and tissue transplantation has received in WHO's ongoing process of updating its 1991 Guiding principles on human organ transplantation. Several of the organizers of an international working group of stakeholders from a wide range of backgrounds that convened in Zurich in July 2006 summarize the areas of normative agreement and disagreement, and identify open questions regarding facts and fundamental concepts of potential normative significance. These issues must be addressed through development of common medical, scientific, legal and ethical requirements for human cell and tissue transplantation on a global basis. While guidance must accommodate the distinct ethical issues raised by activities involving human cells and tissues, consistency with normative frameworks for organ transplantation remains a prime objective.

[Medical care, organ and tissue transplants, and targeted policies]

This article reflects on the moral legitimacy of implementing public policies for targeting advanced medical care, specifically in the case of organ and tissue transplants. The article refers to two theoretical approaches: the theory of capabilities by Nussbaum and Sen and the bioethics of protection by Schramm and Kottow, considered complementary in this context. The article begins by characterizing the issue of resource scarcity in transplantation, as well as strategies to overcome this problem. Next, the capabilities approach and bioethics of protection are briefly presented. Finally, from the perspective of the above-mentioned ethical approaches, in situations of scarce health resources such as the Brazilian case, the author contends that it would be morally justified to adopt targeted policies in advanced medical care, including organ transplantation.

Commercialisation of regenerative human tissue: regulation and reform in Australia and England, Wales and Northern Ireland

The commercialisation of therapeutic products containing regenerative human tissue is regulated by the common law, statute and ethical guidelines in Australia and England, Wales and Northern Ireland. This article examines the regulatory regimes in these jurisdictions and considers whether reform is required to both support scientific research and ensure conformity with modern social views on medical research and the use of human tissue. The authors consider the crucial role of informed consent in striking the balance between the interests of researchers and the interests of the public.

Ovarian tissue cryostorage and grafting: an option to preserve fertility in pediatric patients with malignancies

Fertility preservation in childhood cancer has become an important area of investigation due to increasing survival rates after cancer therapy. For these patients with an increased risk of infertility and premature ovarian failure, cryopreservation of ovarian tissue is a promising tool to preserve at least part of the reproductive potential. In recent years significant improvements have been achieved in this area, and 2 live births after autografting of frozen-thawed ovarian tissue have been reported. However, further research is needed to assess the clinical effectiveness of ovarian cryopreservation, to optimize the technique, and to limit the risk of reintroducing cancer cells in the patient with the graft.

Reforming the Human Tissue Acts

The Human Tissue Acts of the various States and Territories that were enacted following the 1977 Report of the Australian Law Reform Commission on Human Tissue Transplants are in need of an overhaul as a result of rapid advances in medical science and biotechnology, as well as growing public expectations regarding the ethical use of tissues and organs obtained from autopsies and other sources. The author argues that the time is ripe for a comprehensive review and revision of the Acts throughout the country in order to maintain a consistent approach.

Facial Transplantation: A Comprehensive Review of the Literature

PURPOSE

Composite tissue allotransplantation has become a clinical reality and a major breakthrough in reconstructive surgery. The current boundary of dispute on composite tissue allotransplantation is regarding the full-face transplantation. The aim of this article is to provide a comprehensive overview of how facial allotransplantation has been approached in the scientific literature.

MATERIAL AND METHODS

The selection of articles was conducted using PubMed at between January 2000 and September 2005. The search terms were "facial graft," "facial transplantation," and "facial allotransplant." The criteria of analysis were the category of articles and the presence of 6 items: 1) issues regarding the donor; 2) psychological impact on the recipient; 3) surgical risks; 4) immunologic risks; 5) socio-cultural aspects; and 6) expense.

RESULTS

Thirty-eight articles were included. The first article was published in 2002. Most articles over the last 4 years dealt with issues of medical ethics. The annual rate of basic research articles was relatively stable. Conversely, the rate of 'view points,' notably regarding ethics aspects, increased dramatically in 2004. The issues regarding the donor were found in 26% of the articles, the psychological echo on the recipient in 53% of the articles but in 81% of the medical ethics papers, the immunologic risks in 81% of the articles, the surgical risks in 66% of the articles, socio-cultural aspects in 34% of the articles, and expense problems in 5% of the articles.

CONCLUSION

Psychological, immunologic, and surgical risks are the problems addressed most in the literature. Cost, donor, social, and cultural aspects are least addressed. There is a lack of hard data in the literature regarding those problems.

Facial transplantation: adding to the reconstructive options after severe facial injury and disease

The ability to reconstruct complex facial injuries is still a considerable challenge despite the development of microsurgical techniques. The reconstructive options for conditions such as panfacial burns are severely limited. The result after multiple surgical procedures in this group is often poor in terms of function and cosmesis. Facial transplantation provides a potential solution, but opinion is currently divided about the extent to which the potential benefits to the quality of life can be justified when weighed against the technical, psychological and immunological risks. This paper reviews the current status of the debate and argues that a rigorous research strategy is the only logical basis for countering the ethical objections to a procedure that offers considerable benefits over existing reconstructive options.

Allotransplantation of the Face: How Close Are We?

Reconstruction of patients with severe facial disfigurements due to burns, trauma, or cancer is a challenging task for plastic surgeons. Currently, available reconstructive options rarely result in satisfactory functional and aesthetic outcomes. In this article the authors present the rationale and experimental basis for the introduction of composite facial allograft transplantation in humans. They outline the ethical, social, and media-related issues in facial allograft transplantation.

Ethical considerations in allograft tissue transplantation: a surgeon's perspective

Methods for procurement, processing and distribution of allograft tissues have changed rapidly and many of the advances have resulted in widespread use of allograft tissues for reconstruction. However, unlike other types of orthopaedic implants, these human graft tissues are not simple commodities delivered to the surgeon or operating room in prepackaged sterile containers, but rather are more akin to gifts from a donor to a patient in need. As such, ethical behavior and responsible stewardship on the part of each surgeon and each of those involved throughout the allograft enterprise is required. Surgeons using donated tissues should be aware of the advances and changes within the field and the ethical considerations surrounding human tissue transplantation. The following remarks focus on the generosity of donors and their families and the subsequent responsibilities for the medical community, in particular, the surgeons who use these grafts.

Face transplantation: Part II-an ethical perspective

In May 2004, researchers at the University of Louisville Medical Center in Kentucky submitted a 30-page detailed document to the University's Institutional Review Board (IRB) that outlines their plan for the first face transplant. Despite the fact that both the Royal College of Surgeons in England in 2003 and France's Comite Consultatif National d'Ethique in 2004 issued reports saying that the risks of this surgery far outweigh the benefits tojustify it at the present time, the IRB at the University of Louisville is presently studying the proposal. Even though the microsurgical skills and anatomical knowledge is well established, face transplantation is more than a matter of technical achievement. The psychological impact on recipients and donor families as well as the long-term risks of a lifetime of immunosuppressant drugs must also be considered. More time is needed to perfect this surgery so that the rejection rate can be lowered and the patient's immune system can be taught to permanently tolerate the transplanted face. An ethical analysis will show that more time is needed to perfect this surgery so that the rejection rate can be lowered and the patient's immune system can be taught to permanently tolerate the transplanted face. To permit this surgery now, when there are so many unknown, life-threatening dangers would be medically irresponsible and ethically objectionable.

Face value: challenges of transplant technology

What is the value of a human face? It is a vexing question with no simple answer. The question, however, is no longer fanciful given the trajectory of biomedical science that simultaneously captures our imagination and challenges our essence. Essential to each of us and to the whole of humanity, the face is primal in its individuated image and identity. It is intrinsically connected with us in a way that defied question—until now, given the highly anticipated next step in transplant science and technology, facial transplantation. This Article examines the value of the face in this context, along with a range of related issues.

The human face has rich significance. It is intrinsic and instrumental to the ontology of a person. A portal for emotions and expressions, the face reveals an inner-self essential to identity and is inscribed with an inherent dignity of human life.

Face transplantation: a medical perspective

In May 2004, researchers at the University of Louisville Medical Center in Kentucky submitted a 30-page detailed document to the University's Institutional Review Board (IRB) that outlines their plan for the first face transplant. Despite the fact that both the Royal College of Surgeons in England in 2003 and France's Comite Consultatif National d'Ethique in 2004 issued reports saying that the risks of this surgery far outweigh the benefits to justify it at the present time, the IRB at the University of Louisville is presently studying the proposal. These medical professionals believe they have the microsurgical skills and the anatomical knowledge needed to perform this surgery as well as the pharmaceutical recipe needed to suppress the immune system while ensuring tolerable levels of toxicity in the patient. However, with the number of serious unknowns about this surgery, the risk of further injury and even death to the recipients, and the viable option of reconstructive surgery, face transplantation, a the present time, is not a just use of medical resources, in the best interest of the patient, or an effective way to accomplish the goals of medicine.

Organ and tissue transplantation in Greece: the law and an insight into the social context

Advances in biological sciences and medicine have revolutionized current practice and opened new horizons. Tissue and organ transplantation is a miracle and an action of love and sacrifice for the sake of fellow human beings. Organ transplantation has been commonplace over the last decade but Greece still remains the lowest numerically among European countries in this field because of the lack of organ donation although it is highest in traffic accidents. Despite this, the legal framework regulating transplantation was enacted late in comparison to other European countries, and was not the only obstacle to the development of organ donation. Several other factors such as philosophy, culture, traditional and religious attitudes, lack of public information and lack of the relevant social fabric, have all contributed to the current sad situation. This article aims to present a critical view on the evolution of the legal framework in the field of tissue and organ transplantation in Greece. Issues that still deter organ donation are discussed along with an insight into the current situation in the Greek social context in order to make a constructive contribution to future perspectives.

Applications of ovarian tissue transplantation in experimental biology and medicine

Nowadays, high-dose chemotherapy and radiotherapy treatments for cancer are more effective but can severely affect the ovarian follicular store, compromising the fertility of surviving young patients. A promising alternative to prevent fertility loss in these patients is the cryopreservation and transplantation of ovarian tissue. Slices of animal and human ovarian tissue have been shown to survive the cryopreservation process. After transplantation, follicular development and restoration of hormone secretion have been observed in animal and human studies. This review addresses recent developments on ovarian tissue transplantation in animals and humans. We also illustrate the indications and technical difficulties of the procedure and the ethical issues that should be considered.

The special case of property rights in umbilical cord blood for transplantation

In this Article, Professor Stephen R. Munzer makes a case for limited property rights in umbilical cord blood. Professor Munzer proposes that the unique nature of cord blood distinguishes it from body wastes and qualifies it as a body part in which property rights vest. Employing a theory of property, based in part on the articulation of the principles of utility and efficiency, justice and equality, and "labor-desert," he explores legal and philosophical arguments that justify the acknowledgment of such rights. He also discusses concerns over alleged generous granting of patents in the area of cord blood stem cells in light of these principles. Significant aspects of health policy are explored with particular focus on the potential value of using cord blood to treat various diseases and disorders. Professor Munzer discusses various difficult cases involving the exercise of property rights in umbilical cord blood with respect to the interests and/or motives of newborns, parents, and other parties. He argues that some of the concerns associated with the commercialization and commodification of cord blood are not serious enough to warrant significant barriers to market exchanges of property rights in cord blood. In addition, he concludes that the particular nature and harvesting of cord blood do not make its commodification morally problematic. Finally, Professor Munzer reinforces his treatment of property rights in cord blood by addressing objections that view property as "propriety," as a pragmatic institution, or as social relations.

Hand transplantation: current status

The hand is a very special organ, with unique functions and versatility in the human body. Our hands are pivotal in manipulating our environment, receiving feedback from our surroundings and communicating our unspoken words by gestures. Thus, the loss of a hand is a tragic, disfiguring event with profound personal, vocational, financial and social implications. Transplantation of life-saving solid organs is now widely accepted in both the medical and lay communities. The technical skills and prerequisites for hand transplantation have been honed over recent decades, culminating in the recent commencement of hand transplantation in several centers around the world. However, unlike life-saving solid organ transplantation, hand transplantation has been greeted with less enthusiasm in the professional community because it is not yet clear what the long-term risks-to-benefits ratio is. The scientific background, and the potential risks, benefits, and ethical aspects of this procedure are discussed. Successful transplantation to amputees of fully integrated and functional hands is a worthy goal. Hopefully, at some point in the future, hand transplantation will become another safe and viable option for amputees to consider.