For people with end-stage organ disease, a transplant is often the only treatment option. Despite increasing numbers of organ donations and optimized organ recovery, the current supply is not sufficient to meet current and future organ needs. Bioengineered organs could be a promising way to produce functional alternatives to those offered by donors; however, to evaluate their efficacy, researchers would need a complex model system to test how bioengineered organs would function in a living human. A study published in the Journal of Medical Ethics investigated the ethical, legal, and social considerations of performing this type of organ research on recently deceased or brain dead subjects.
When approaching the use of recently deceased human subjects for organ research, consent from the subject’s family or loved ones is a primary ethical concern. In some cases, the donor may have specified intentions for transplantation or research. If not, family or loved ones must be consulted and authorization from them must be obtained to carry out postmortem research. Although the researchers acknowledge that attitudes on short-term use of a body vary, they note that families may take comfort in that their loved one has aided in life-saving research.
Besides the ethics of identifying a potential research subject, there are some additional considerations on the matter. The Uniform Anatomical Gift Act sets legal requirements for donation. Although organ and tissue donation is prioritized under this act, when there are no stated preferences, the Uniform Anatomical Gift Act allows decision makers (family members by hierarchy) to authorize anatomic gifts. The researchers note that most hospitals and universities in the United States have no oversight body to review research on recently deceased subjects. The authors believe that guidelines should be developed to define appropriate methods of donor recruitment and ensure that the research being undertaken is done so with dignity, respect, and privacy in mind for the deceased and his or her loved ones.
Those conducting research on the recently deceased should also bear in mind public perceptions of their research. Some reports have demonstrated that the public is more trustful of research conducted by academic parties rather than by private researchers. The authors caution that potential demographic differences and factors that may pertain to exclusion criteria for research should be anticipated and addressed.
Research on bioengineered organs using recently deceased subjects is an important step toward living human trials to ensure the effectiveness of the organs. Although this kind of research poses various ethical, legal, and social challenges, the authors hope that existing research models can be reworked to ensure that these concerns are addressed, and they are optimistic that a long-term solution to organ failure can be gained through this research.
Parent B, Gelb B, Latham S, et al. The ethics of testing and research of manufactured organs on brain-dead/recently deceased subjects [published online September 28, 2019]. J Med Ethics. doi:10.1136/medethics-2019-105674