Nov 8, 2017 in Opinion

Issues of Human Transplantation

In the recent years, growing tissue for the purpose of human transplantation has become inevitable in most parts of the world. It usually arises due to the factors such as organ and tissue failures caused by injury or any other notable damage of human beings. For instance, in the U.S., tissue and organ failure among the citizens usually accounts for over 50% of total expenditures experienced in the health care system (Holmes, de Lacall, Su, Liu, Rich & Zhang, 2000). It should be noted that in the end of 20th and beginning of the 21st centuries, the transplantology became an area of medicine that was concentrated on the advanced achievements of surgery, resuscitation, pharmacology, and other medical and biologic sciences.

Knight & Evans (2004) indicate that in tissue engineering treatment options mainly include transplantation, artificial prostheses, drug therapy, and surgical repairs among others. However, it is notable that major damage in a given tissue cannot be repaired. Furthermore, long-term recovery cannot be well administered in this case. Therefore, tissue engineering is coming up as a crucial complementary solution or alternative (Knight& Evans, 2004). It happens due to the fact that organ or tissue failure is tackled through implanting natural semi synthetic or synthetic  tissues or organs mimics that are usually functional from the initial point or in other cases they acquire the functionality that is required. As indicated by Mikos & Temenoff (2000), tissue engineering can be termed as the use of combination of given cells, materials, and engineering methods as well as physic-chemical and sustainable biochemical to improve or in some cases to replace biological functions. Moreover, Davis et al. (2005) term tissue engineering as ”the creation of new tissue for the therapeutic reconstruction of the human body, by the deliberate and controlled stimulation of selected target cells, through a systematic combination of molecular and mechanical signals.” This paper will critically evaluate the ethical and technical issues concerned with growing tissues for human transplantation.

Background of Tissue Engineering

Mikos and Temenoff (2000) indicate that TE (Tissue Engineering) is a new development in the field of medicine. TE is the generation of human tissues used for clinical applications and based on human cells. The main aim of TE is the regeneration of the body and the restoration of a complete physiological activity mainly through implantation of engineered products into human tissues referred to as HTEPs. In the past, tissue engineered cartilage and skin implant for knee have been successful while HTEPs for areas such as the heart valves, bladder and heart muscles are developed. The main target for HTEPs currently is the irreparably and degenerating tissue (National Science Foundation (U.S.A.), 2004). In the European region, the number of diseases resulting from the degeneration of organs or tissues increases, especially among the aged population. Therefore, the therapeutic benefits that can be derived from the TE is now under consideration. In this region, the benefits of the TE become increasingly popular. Nerem (2000) argues that the development of the TE has been recently slow because of the technical and scientific difficulties as well as regulatory, ethical, and economic challenges. As argued by the National Science Foundation (U.S.A.) (2004), the TE is a very promising field in the area of medical technology. However, it is notable that like any other kind of technology it is not completely free of ethical and legal challenges. Thus, identifying these challenges at early stages is a part of responsibility of the society. Moreover, it would enhance the development of the field of the TE.

Growing of Tissues

Explantation is a method of the durable preservation of cages, fabrics, small bodies, or their parts allocated from a human body, animals, or plants in a live condition. First successful experiments on the tissue culture were carried out in 1907 by an American scientist R. Harrison who placed a slice of a rudiment of nervous system of a frog germ into a drop of lymph. Rudiment cages remained alive for some weeks and nervous fibers grew from them (Davis et al., 2005). The method of culturing fabrics was improved by a French scientist A. Carrel, an American researcher M. Burrows, a Russian scientist A. Maksimov, and others who used blood plasma and an extract from the germ fabrics as environment. The basic condition of the successful realization of the tissue culture is the strict observance of sterility (Davis et al., 2005).

During the cultivation of the body slices, such issues as the ones of histogenesis, genetic relations between the tissues, their sensitivity to different influences are essential among others (Davis et al., 2005). Novak wrote: “The increase in a number of performed transplants, the group of patients waiting for organ or tissue, grows all the time. The supply of organs never satisfies demand for them. Therefore, problems concerning distribution of donated organs taken from human corpses, and the question of choosing the right recipient, emerge” (Davis et al., 2005) There are two notable types of the methods that are used to grow cells using the TE method, namely the stem cells and therapeutic cloning methods (Semino, Kasahara , Hayashi & Zhang, 2004).

Stem Cells

The most current strategies that are used in the TE depend on the auttologous cells collected from the host diseased organ.  However, it is notable that for many patients who have an extensive failure of organs, tissue biopsy may fail to produce a lot of normal cells for the purpose of transplantation as well as expansion.  In other cases, pluripotent human embryonic cells are envisioned as significant sources of healthy cells (Knight& Evans, 2004).

Therapeutic Cloning

Nuclear cloning that is also termed as nuclear transfer or nuclear transplantation entails the introduction of the nuclear from the donor cells into a well enucleated oocyte that generates embryo and has a genetic makeup of the donor (Ma, 2004).

Technical Issues

Technical maintenance occupies an important place in the transplantology development (Davis et al 2005). Besides working out a technique of imposing a vascular seam, it was necessary to develop the following techniques: optimum preservation conditions of the donor body in terms of avoiding thermal ischemia, a technique of capturing a body together with vessels, and a technique of preservation and body transportation in the surgical branch (Davis et al 2005). Creation of special centers for transplantation has allowed to make lists of the recipients waiting for transplantation that contain detailed characteristics of the histocompatibility, to organize a donor service of allogeneic bodies, to concentrate means necessary for identifying the histocompatibility of fabrics of the donor and the recipient, and to establish a communication facility and delivery of donor bodies. McKay (2000) indicates that quality control of all the materials with different surgical applications is one of the main technical problems facing the TE industry. For instance, it deals with exploiting the living human cells that are used for the purpose of scaffolds while repairing the structural damage in tissues. These kinds of materials need to be cultured and produced under the GMP (Good Manufacturing Practice) conditions in order to meet the FDA standards. Consequently, the TE industry strives to come up with necessary quality control standards as well as the means of their evaluation (McKay,2000).

Another challenge is the one of acquiring the fundamental understanding regarding the mechanism of tissue differentiation that can be harnessed in order to develop tissue-engineered products. One of the products that are pursued in this industry is a bone-on-demand that is to be employed in areas with the need for the new bone formation. One of the crucial components is the  BMP (bone morphogenetic protein) that can induce the formation of an extraskeletal bone at a concentration 1,000-fold  lower as compared to the individual constituents (Davis et al., 2005). Another technical challenge is the development of the tissue-engineered products that can be used for various surgical-related applications like vasculature.  

Ethical Issues

Although the applications of the TE are still limited, there is a great need for governments as well as stakeholders to think about the technical considerations encountered in this field (Nerem, 2000). The reason of this is associated with the complexities and abilities of the efficient regeneration of tissues that was not a well-known field in the past. Various approaches can be employed to address ethical considerations of the TE. They include socioeconomic issues, anthropological issues, and research ethics (Davis et al., 2005).

Research Ethics

When addressing this area, experts should consider some crucial aspects. For instance, one is the need to ask for the consent of cell donors as well as to inform them about the purpose of the tissue. Besides, there is the need to think whether it is necessary to subject the human body as well as its parts to legal aspects such as property rights (Nerem, 2000).

Socioeconomic and Political Issues

These areas look at aspects such as the cost of the tissue engineering treatment and products. Other areas include the source of financing the research as well as the priority to be given when receiving treatment using the TE (Nerem, 2000).

Anthropological Issues

This ethical issue looks at the aspect whether it is morally good to fight negative effects of aging using the TE. Furthermore, it looks at the need to enhance human capabilities using the TE (Semino, Kasahara, Hayashi & Zhang, 2004).

Conclusion

It is clear that tissue engineering has significantly changed the medical field. However, there is a need to address technical and ethical issues of the TE for it to become more acceptable in the 21st century. 

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