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A Socioethical View of Bioprinting Human Organs and Tissues Niki Vermeulen,1 Gill Haddow,1 Tirion Seymour,1 Alan Faulkner-Jones,2 Wenmiao Shu2

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A Socioethical View of Bioprinting Human Organs and Tissues Niki Vermeulen,1 Gill Haddow,1 Tirion Seymour,1 Alan Faulkner-Jones,2 Wenmiao Shu2 Global medical ethics J Med Ethics: first published as 10.1136/medethics-2015-103347 on 20 March 2017. Downloaded from PAPER 3D bioprint me: a socioethical view of bioprinting human organs and tissues Niki Vermeulen,1 Gill Haddow,1 Tirion Seymour,1 Alan Faulkner-Jones,2 Wenmiao Shu2 ► Additional material is ABSTRACT induced pluripotent stem cells (iPSCs)) to print 3D published online only. To view In this article, we review the extant social science and constructs composed of living organic materials. please visit the journal online (http:// dx. doi. org/ 10. 1136/ ethical literature on three-dimensional (3D) bioprinting. These new forms of printing, should they be rea- medethics- 2015- 103347). 3D bioprinting has the potential to be a ‘game-changer’, lised, will, it is argued, have the same revolutionary printing human organs on demand, no longer and democratising effect as book printing in their 1Department of Science, necessitating the need for living or deceased human applicability to regenerative medicine and industry. Technology and Innovation donation or animal transplantation. Although the Individually designed biological structures or body Studies, University of Edinburgh, Edinburgh, UK technology is not yet at the level required to bioprint an parts will become as available as text in modern lit- 2Department of Biomedical entire organ, 3D bioprinting may have a variety of other erate societies. Engineering, University of mid-term and short-term benefits that also have positive There are obvious links drawn between 21st Strathclyde, Glasgow, UK ethical consequences, for example, creating alternatives century 3D bioprinting and the development of the to animal testing, filling a therapeutic need for minors 15th century printing press in terms of process as Correspondence to and avoiding species boundary crossing. Despite a lack well as similarities in the nascent development Dr Niki Vermeulen, Department of Science, Technology and of current socioethical engagement with the stages regarding the effect of resources and access Innovation Studies, University consequences of the technology, we outline what we for both printing technologies. of Edinburgh, Old Surgeons’ see as some preliminary practical, ethical and regulatory Long-term 3D bioprinting has the potential to be Hall, High School Yards, issues that need tackling. These relate to managing a ‘game-changer’, providing an alternative source Edinburgh EH1 1LZ, UK; of organs no longer necessitating the need for niki. vermeulen@ ed. ac. uk public expectations and the continuing reliance on technoscientific solutions to diseases that affect high- living or deceased human donation as human Received 30 December 2015 income countries. Avoiding prescribing a course of action organs would be printed on demand. Nonetheless, Revised 6 February 2017 for the way forward in terms of research agendas, we do there are key differences between printing and 3D Accepted 13 February 2017 briefly outline one possible ethical framework bioprinting. The latter is distinctive in terms of the Published Online First ‘ ’ 20 March 2017 Responsible Research Innovation as an oversight model technological process of printing, the organic pro- should 3D bioprinting promises are ever realised. 3D ducts that are involved, the therapeutic purpose bioprinting has a lot to offer in the course of time and, finally, in terms of placing the printed organ should it move beyond a conceptual therapy, but is an within a human body. The technology is not yet at http://jme.bmj.com/ area that requires ethical oversight and regulation and the level required to bioprint an entire organ. A debate, in the here and now. The purpose of this article realistic and short-term goal is for 3D bioprinting is to begin that discussion. to create alternatives to animal testing. For example, drug testing can be accomplished via bio- printed structures embedded within lab-on-a-chip BACKGROUND: ‘GROW YOUR OWN ORGANS’ devices and even improved by the dramatic increase 4–6 Recent media headlines suggest that scientists will in throughput the technology enables. on September 27, 2021 by guest. Protected copyright. in the future have the ability to create or ‘biofabri- Furthermore, a mid-term gain still to be realised cate’ personalised organs such as livers and hearts however, relates to the creation of tissue compo- through a process known as three-dimensional (3D) nents such as human heart valves, especially for – bioprinting.1 3 This is the biological variant of the younger members of the population (eg, paediatric recent trend towards 3D printing; small-scale patients) who suffer specific problems with current manufacturing of computer-designed forms bioprosthetic or mechanical heart valve (MHV) through laying down successive layers of material options. The required tissue components are until the entire object is created. This development created from the patient’s own cells (thus reducing draws on longstanding printing technology, which the risk of rejection) and the geometry (size and after the invention of the printing press in the 15th shape) of the components can be customised to century made books, and thereby knowledge, match perfectly with the patient’s requirements. widely available and affordable. Later in the 20th Unlike mechanical implants, such engineered tissue century with the development of the photocopier components that are 3D bioprinted have the ability and inkjet printers, the hardware component was to grow with the patient, eliminating the need for set. While 3D printing is working with inorganic further operations to replace components which materials, the intention of bioprinting is to work are no longer suitable.7 To cite: Vermeulen N, with organic materials (including living cells) to Given the promise of the technology to solve Haddow G, Seymour T, et al. create structures approximating body parts. entrenched ethical issues relating to supply and J Med Ethics Specialised bioprinters use biological inks (bioinks demand of human or non-human animal trans- 2017;43:618–624. —such as differentiated, human embryonic or plants, a thorough review of any specific 618 Vermeulen N, et al. J Med Ethics 2017;43:618–624. doi:10.1136/medethics-2015-103347 Global medical ethics J Med Ethics: first published as 10.1136/medethics-2015-103347 on 20 March 2017. Downloaded from socioethical pitfalls is instructive. In order to scope the existing After outlining extant literature and given we found little ethical social science literature in the field of bioprinting, literature or social commentary from an arts, social science and humanities searches of articles and book references were undertaken on the perspective, we offer a comparative ethical analysis weighing up databases PubMed, Web of Science and JSTOR in March and a few of the benefits and challenges 3D bioprinting may cause April 2016, and undertaken again in June 2016 in order to iden- should its promise be realised. There are different frameworks tify any extra articles (figure 1). In addition to this, the Institute for engaging with social science and ethical aspects of new of Physics journal Biofabrication was searched as a leading technologies and we outline and discuss whether Responsible journal in this area of biofabrication and bioprinting. This Research Innovation (RRI), currently favoured, may be a way to review exercise found that with only a few notable exceptions deal with and reflect on 3D bioprinting, especially around inter- – from the areas of law or social sciences,8 15 the current literature disciplinary ethics. 3D bioprinting may have a lot to offer in the on bioprinting specifically (rather than traditional 3D printing) course of time, but as an area, it needs ethical oversight and is located entirely within the biological sciences and medical regulation as well as debate. A debate we hope to begin. sciences. Much of the medical and scientific literature, however, does focus on some social aspect of the technology within dis- 3D BIOPRINTING AND BIOFABRICATION cussion to some extent. This allows analysis of both what is 3D printing is undoubtedly proven successful and 3D printers fi already being highlighted within scienti c articles, and allows are now widely used and commercially available. Bioprinting as a fi the identi cation of areas where social science research might particular area regularly discussed in both academic literature fi build on existing themes or ll gaps in understanding. The latter and the media in connection alongside 3D printing techniques we will address through offering both positive and negative ana- that use non-biological materials (eg, plastics, metals, fabrics or lysis of the socioethical challenges that might lie ahead. ceramics). 3D printing of objects has rapidly developed from Although bioprinting can avoid ethical dilemmas associated being a niche and expensive development on two-dimensional with xenotransplantation and clinical organ transplantation, it is (2D) printing technology in the 1980s to now being an extremely not without its own challenges, practical, ethical and regulatory, rapidly developing industry with ever-increasing applications. which we will need to address. These relate to managing public Bioprinting is a far more complex matter, which is explored ’ expectations and the ethics of biomedicine s continuing reliance in the emerging field of biofabrication. Although the terms bio- fi on costly technoscienti c solutions. For example, the expense of printing and biofabrication are often used interchangeably
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