Bioprinting Human Organs: Saving Life or Redefining It?

3d printerJust because we, as a human race, have the ability to do something, should we? Bioprinting, though a fairly new concept, has a very promising future. The waiting list for an organ transplant is over 120,000 people! Bioprinting would drastically decrease this number. However, if we were to allow people to use this as a new means to replace failing organs, what would it mean for the future of our society? Will humans become irresponsible with their bodies and therefore dependent on their ability to have these organs? Are humans an inherently greedy species that will take advantage of any opportunity given to them? Bioprinting could also be used to medically enhance someone’s body. Should we therefore regulate how people are using this process? If we allow people to further enhance their already working bodies, will this increase the divide between the healthy and unhealthy? The desire to enhance one’s body would not only create a new standard for humans, but it would potentially subject people deemed “unhealthy” to even more ridicule than they already face. Knowing all of this, should we allow bioprinting to continue to develop, or should we stop it before it gets out of hand?


Introduction

Imagine you have been waiting for five years on the organ recipient waiting list. Your kidney is failing and you are in dire need of a new one. As you continue to wait on the list, you get more and more sick. Eventually, you lose your fight because no kidneys became available that would fit your body and match the antibodies in your blood. This paper will discuss a new technology that could potentially eliminate this problem altogether and will analyze the ethical issues that accompany its use.

The technology whose use could potentially eliminate the problem of organ scarcity is called bioprinting: the process of 3D printing human organs to use for people who need them. Bioprinting could help decrease both the number of people on the organ recipient list and the number of donors needed. According to the Organ Procurement and Transplantation Network, there are over 120,000 people in need of a life-saving organ donation.  Twenty-two people die each day because they are not able to receive these treatments. Not only would bioprinting increase the number of organs available for donation because organs could be produced instead of being taken from others, but it would also lessen the pressure on people to donate organs, such as kidneys, while they are alive. However, bioprinting is not that simple. Many questions have been raised surrounding bioprinting and the ethics of using the new technology. These questions range from accessibility to cost to distribution.

It is not yet known how quickly bioprinting technology will advance, but research shows that it will happen rather soon. The chart below shows that, within a couple of decades, scientists are hoping to be able to create new organs for those in need. Within the next couple of years, as shown in the chart, scientists are hoping to be able to print smaller scale, less complex, tissues and nerves.
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(http://www.washingtonpost.com/wp-srv/special/science/how-bioprinting-works/)

GOAL OF THIS PAPER
The goal of this paper is to address the ethical issues surrounding bioprinting technology and the questions raised as to how this new capability will affect our society. Specifically, I will be discussing questions regarding how this technology may affect our views on what constitutes being “human” and briefly describe how different factors affect our “human-ness.”  I will also discuss how humans might use this technology.  For example, patients might seek an organ transplant for treatment of a medical problem; or, they may wish to enhance their appearance or performance capability. Based on these potential uses of bioprinted organs, I will also examine whether this technology should be regulated and, if so, how.  My analysis of possible regulatory oversight of bioprinted organs will also examine whether the recipient’s personal and medical history should be taken into account when determining whether to approve the organ transplant.

FRAMEWORK FOR ANALYSIS

How does bioprinting work?

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(http://envisiontec.com/envisiontec/wp-content/uploads/DeveloperSeriesMachine.jpg)

While this paper’s goal is to analyze the ethical issues stated above, it is important to have at least a brief understanding of the bioprinting process in order for the ethical issues to be fully clear.  The process was divided into steps and clearly explained the The Washington Post:  

Health & Science.  Before a new organ can be printed, an MRI or CT scan must be taken of the recipient’s own organ in order to get the proper size and perfect shape to fit back into the recipient’s body. This is essential because it will minimize the chance of rejection from the recipient’s body. Often, someone on the waiting list cannot get a new organ because the organs that are being donated are not the correct size or shape. The process of scanning the organ first would help fix this issue. Next, a blueprint of the organ is created layer by layer so that the printer will know exactly where to place the cells. This is the step during which scientists would modify the original blueprint to eliminate the parts that were not working. The last pre-printing step involves taking cells from the recipient’s body and mixing them with a dissolvable gel that is made in the body as well.  The gel helps the cells keep their shape while being printed. This mixture is then allowed to sit while the cells multiply. Recipient’s bodies frequently reject the new organ because their antibodies do not match up with the new organ’s antibodies.  Since the printer uses cells from the recipient’s body, however, the chance of rejection is decreased greatly.

After the prep work is done, the process of printing can begin. The printer deposits 1/2 millimeter thick layers of a gel-like mixture of cells. A technique called cross-linking is used between each layer so that the cells can harden into the correct shape. Usually, ultraviolet light is used in cross-linking because it is the quickest way to solidify each individual layer, but heat or chemicals can also be used. The following is a visual aid diagram of how the layering process works.

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(http://www.explainingthefuture.com/images/bioprinting_stages.jpg)

The new organ then spends a few weeks being incubated and being tested to make sure it works properly. Finally, the organ is ready for transplantation.

It is still unclear how long the process from printer to implantation will be, but the time it takes to print the organs will likely still be shorter than the length of time most people spend on the organ transplant wait list.

 

ANALYSIS

I.  FIRST KEY ISSUE: WHAT IS HUMAN?

The advancement of bioprinting technology means that recipients will be putting new organs into their bodies that are made outside of the human body. This raises the question, is the recipient still human? Some people define a “human being” as being fully “natural.” So, to understand this, it is important to find what is defined as natural. The definition of natural, according to Cambridge Dictionaries Online is, “not artificial or involving anything made or caused by people.” A human is defined as a collection of parts that make a whole and if any of those parts are not natural, then they are partially not human. This definition of human would support the view that bioprinted organs are not completely human because the process of making the organs is not a “natural” process that occurs in the body without outside forces acting upon it. However, this raises the question, are all surgeries unnatural? The people who possess this point of view tend to still see people with prosthetics as “natural” because they are not making any alterations to the genetic makeup or structure of their body. While they are adding to their exterior appearance, they are doing so for cosmetic or functional purposes and are not altering their inner bodily functions.

A definition provided by Merriam-Webster Dictionary, however, states that the term “natural” means, “not having any extra substances or chemicals added: not containing anything artificial.” By this definition, in contrast, bioprinting would fit the parameters of a “natural process.”  The collagen that is used to make the gel-like mixture is a natural human-made substance. Therefore, there are no artificial chemicals or substances in the new organ. The new organs would be considered “natural” and therefore, the person would be “human” because there are no unnatural substances being introduced into the body.

These two different definitions expose the danger that comes with using one explanation to describe a very complicated topic. The first definition seems straightforward, but, if taken literally, would make a lot of common things not “natural” and, therefore, not human. Pacemakers would not be considered natural, but most people do not question whether or not people with pacemakers are still human. Bioprinting meets the second definition of “natural,” but according to this definition, using anything made with chemicals would render the recipient “unnatural,” or no longer entirely human. Makeup, nail polish, even shampoo would all be seen as unnatural products because they are made with chemicals. But, just because someone uses them, does this mean they are not human? Or are they still human because these are not changing the inner workings of their body? Looking at it through this lens, it is clear that one definition of “natural” cannot be used alone when deciding what is human.

A third approach to defining “human-ness” is the view that a “human being” is more than just the parts that make up each individual. According to Daniel Zadik on NewPhilosopher.com, “the most notable thing about humanity is that we are able to communicate ideas well enough for each generation to maintain and build upon the understanding of the previous one.” My interpretation of Zadik’s view is that, as humans, we are largely defined by our brain power and competence. This would mean that regardless of the parts you have, you are still a human. People with this viewpoint would generally think that, if you were to participate in the bioprinting process, you would still be human. However, if, in the future, the brain was able to be printed, the person would no longer be seen as human. This belief system separates the idea of being “natural” as what defines us as human and instead sees the ability to acquire knowledge and make decisions as a key factor to being human.

To provide some context for this viewpoint, it is necessary to briefly discuss the brain and its role within the body. Not only does the brain allow us to act and react to things, but it also allows us to think, feel, store memories, and more. Many people also see the brain as being of paramount importance because the brain is what is being questioned when the topic of competence is brought up. Whether or not someone is competent enough to make a certain decision can heavily impact people’s perceptions of that person. If someone was deemed incompetent to make a specific decision, their human right to decide and have freedom would be jeopardized. This further perpetuates the idea that, if one’s brain is being tampered with, so is their “human-ness.”

Conclusion

I definitely respond to the last perspective the most. No one questions whether or not someone receiving a typical organ transplant continues to be human. I do not believe that one who participates in the bioprinting process should have their “human-ness” brought into question because bioprinting simply recreates an existing organ. In addition, I believe the ability to make a decision for oneself is of vital importance. As a child grows into adulthood, his or her ultimate goal is to be able to make decisions for his or herself. It is a rite of passage. Once you are deemed competent enough to make your own decisions, you are now fully “human.” If, in the future, the brain is able to be bioprinted, then I believe the recipient of that brain would not be human any longer because I see the mind and being able to think for oneself as the main component for defining what is human.  Fundamentally, however, I do not think the analysis of what makes a person “human” should be applied to bioprinting. Technology already allows for so many changes to the human body;  bioprinting is in its infancy and should not be mired in a debate over whether it makes someone less human.

 

II.  SECOND KEY ISSUE: TREATMENT VS. ENHANCEMENT

One of the key factors that makes bioprinting so revolutionary, as stated earlier, is that there will no longer be a question for people as to whether or not there would be an organ available for them. Donors would no longer be necessary for a transplant to take place. The potential for an endless supply of replacement organs, however, raises the risk for abuse of the transplant process and necessitates an examination of why a patient is seeking an organ transplant and how the bioprinted organ is intended to be used.  Since bioprinting is such a new issue, there are no case studies available, so it is crucial that we look at situations in which similar issues were raised.

What is the difference between treatment and enhancement?

A treatment is defined by The Free Dictionary as, “the management and care of a patient to combat disease or disorder.” Thus, treatment requires that there be a specific need to get a transplant such as a failing kidney, or a lung that has stopped functioning. These patients need a transplant or they will die or be confined to a hospital for the rest of their lives. They could also need treatment because not getting the treatment would cause further health issues. However, this last scenario is where the line between treatment and enhancement becomes blurred.

Enhancement is defined by The Free Dictionary as, “to improve or augment, especially in effectiveness, value, or attractiveness.” This means that the person hoping to receive a transplant does not necessarily need the procedure.

Some people argue that athletes should be able to enhance their bodies to perform better. Others, however, contrast this view with the case of Oscar Pistorius. Oscar Pistorius was the first amputee to attempt to compete in the Olympics in Track and Field. While this seems like an amazing feat for a person with prosthetics, many people had a different perspective on the issue, arguing that Pistorius had an advantage because he did not have the pressure on his ankles that people without prosthetics have. Therefore, with his prosthetic blades, he could run faster and with fewer side effects than people with legs. Despite the arguments against Pistorius, he was still allowed to compete in the Olympics.

The line between treatment and enhancement is further blurred when it comes to cosmetic surgery. Someone seeking a nose job is very different than a burn victim seeking to rebuild damaged tissue. The nose job would be seen strictly as an enhancement, but the burn victim brings up concerns. Technically, the victim may not need the new skin, but covering up the scars or chars could potentially eliminate other medical issues. This would be considered a treatment.  The new skin could also improve the victim’s self-confidence, however, which supports the argument that the procedure would only be an enhancement and not a necessary treatment.

Regulation: treatment versus enhancement

Should transplantation of bioprinted organs be regulated based on how the recipient has come to need or want this new organ?  Does it matter if the organ is being used for treatment versus enhancement?

The first stance on the treatment versus enhancement argument is that we should not worry about regulating it. If people want to enhance their organs, they should have the ability to. Supporters of this position argue that if everyone begins enhancing their organs, then no one would truly have an “advantage” because everyone would be equally enhanced. This would increase the ability standard for humans, which some people see as always being a good thing. For example, because of vaccinations and new medical capabilities, humans have been living decades longer than we used to. People who agree with this stance tend to favor making the human race as dominant and advanced as we possibly can.

However, others argue that allowing organ transplants for enhancement purposes would be unfair to people who need these treatments in order to simply stay alive. It can be thought of this way: imagine you need a new right lung simply to stay alive. Someone else wants a better set of lungs because they are preparing to run track in the Olympics. Even if you both receive your respective lungs, the Olympian will still be “healthier” than you because s/he never really needed the lungs in the first place. This would widen the gap between the “healthy” and the “unhealthy” and could cause even more discrimination about “being different” than is already happening now. The procedure should therefore be restricted to those who need it as a treatment, not those who want it for enhancement purposes.

Conclusion

I believe we should regulate bioprinting technology so that it is kept as a treatment technology. However, I do realize there is a grey line between treatment and enhancement. I think it is very important for doctors to maintain relationships with their patients and to really be sure that the person who is receiving a new organ needs it. While we would have the ability to simply keep printing organs, a level of control is important. If everyone was able to get new organs whenever they felt like it, the people who truly need them would remain separate from those who simply want them.

 

III.  THIRD KEY ISSUE: DOES A RECIPIENT’S BEHAVIOR MATTER?

This section focuses on the issue of greed and irresponsibility, and also discusses whether or not this technology is even “worth it.” What we, as a human race, do with this technology is up to us. Two distinctive views juxtapose each other in how they see the human race, and why they think that the human race is destined for the future they think we’ll have.

Some people view a recipient’s lifestyle and behavior as a huge issue when it comes to approving an organ transplant. They feel that this new technology will encourage the human race to be even more reckless and irresponsible with their bodies than they already are. If you knew you could get a new liver whenever you needed it, would you be more likely to be a heavy drinker? What about if you could get new lungs? Would you try your first cigarette knowing you could get hooked? This viewpoint argues the human race is destined for greed and feel that, if given this option to replace worn out parts with ease, people would take advantage of it. This perspective uses the abuse of prescription drugs as a way to back up their argument. People take advantage of these drugs. Whereas illegal drugs are also abused, the use of prescription drugs specifically backs up this argument because prescription drugs are intended to treat a medical condition, but people misuse and abuse them, often to the detriment of their health.

Others, however, see bioprinting as an opportunity to improve the human race. We, as humans, do these things anyway, even without the option of printing an organ whenever one is needed. They feel that the advantages of this new technology greatly outweigh the chance that some people may take it for granted and just print a bunch of new organs for themselves. They argument that the recipient could make changes in their life because finding out they needed a new organ was a wakeup call enough. For example, in regular organ donation, former alcoholics have to agree to comply with certain medical standards and pledge that they will not continue to abuse alcohol if they receive the new organ. This results in a grey area of who is changing their life around and who isn’t because there is no guarantee that the person will stick to their commitment.

I feel it is very important that we acknowledge both sides of this issue. I understand that there are always people who are going to take advantage of everything and we should strive to decrease the likelihood of this happening. However, it is also important to realize that this technology is very important to people who need it. Is it ethical to deny those people access to it just because some people take advantage of it?

Regulation: Does the recipient’s behavior matter?

There are two fundamental positions on whether bioprinting regulations should be based on how an individual ended up needing a transplant.  The first is that the cause of the illness is unimportant.  Since the technology exists to create a new organ virtually on demand, regulations should not deny the use of the technology because the need arose from poor choices on behalf of the patient.

The second position recognizes that if humans are presented with an opportunity for a “do-over,” they will likely take it, but not necessarily fix their actions. In other words, if people know there is a ready fix for an illness resulting from poor choices, they are likely to continue to make those poor choices.

Conclusion

I initially supported the idea of regulating bioprinting based on the circumstances which led to the need for a new organ. Upon reflection, however, I thought about my grandmother.  She was a smoker, like many people of her generation. Several years ago, she was diagnosed with lung cancer.  While I initially supported taking behavior into account when regulating organ printing and potentially denying organs to patients whose behavior had caused their illnesses, I could never support denying my own grandmother a cure.  As a result, I do not support restricting bioprinting technology based on behavior.  I prefer to trust that a patient whose life has been improved or possibly saved by a bioprinted organ would cherish his/her newfound health and safeguard the health of that organ and the rest of his/her body.

 

CONCLUSION

This paper discusses the ethical issues raised by 3D bioprinting human organs and whether or not, in light of these issues, we should continue with this technology. Experts can only speculate at this point as to the possible outcomes of this technology and how soon in the future the technology could be developed. Scientists believe complex organs, skin, and cosmetic apparatuses will all be able to be printed in the not-too-distant future.

While the existence of bioprinted organs may change society’s definition of the word human, there is already enough debate about what makes us human. I believe this technology can do so much good and help so many that we should not deny people this opportunity simply because they may somehow not fit the definition of human anymore because they have an engineered organ.  The same argument could be applied to those with cosmetic implants, prosthetics and pacemakers. I wonder if the outcomes of this technology will not only have effects on the people who use it, but also on people who have other medical alterations such as cosmetic surgery, prosthetics, and other surgeries. Will the perceptions of these people be altered?

Enhancement is a more difficult ethical issue. While advancing mankind is a worthy and laudable goal, the use of bioprinting simply to enhance performance or wellbeing creates the potential for further separating the “haves” from the “have nots.”  For example, is someone with a perfectly healthy set of lungs equally as eligible for a bioprinted lung as someone who suffers lung disease simply because we have the technology to create those lungs?

Another troubling issue is the potential for people to take the technology for granted and fail to maintain their health knowing that “replacement parts” are available.  The life-saving possibilities bioprinting presents must not be denied because of such potential misuse. Indeed, the overwhelming promise this new technology presents far outweighs the possible downsides.  Not only will bioprinting allow recipients to receive organs they need and might otherwise not receive, but it will also relieve the burden on the current organ donor system.

Bioprinting is a significant health care issue, many aspects of which have not yet been explored. This paper focused on two main ethical issues: how bioprinting will affect the “human-ness” of its recipients, and whether it should be regulated based on two subcategories: treatment versus enhancement, and how the person has come to need the organ. However, there are so many other areas of concern that need to be analyzed as this technology continues to be developed.

Additional inquiry

Throughout this paper I spoke about regulation as if every person could get an engineered organ to start with, and how to regulate from that point. However, even typical organ transplants are quite expensive.  The National Foundation for Transplants states that they can range from $25,000 to $1.3 million. Cost and accessibility will definitely need to be taken into consideration as bioprinting technology continues to develop.

By Reagan McRae

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