justbioe/ September 24, 2019/ Healthcare Technology

The Ethics of 3D Bioprinting

While 3D bioprinting appears to be a promising technology for overcoming some of the most challenging obstacles which healthcare faces globally, e.g. the organ shortage crisis, or eradicating animal testing, it is still in its infancy of development and has generated new ethical and social challenges through its research and potential application. These challenges require careful consideration and deliberation prior to the integration and development of 3D bioprinting into the global healthcare arena. The aim of this post is to address the ethical and social challenges which 3D bioprinting generates.

The Impact on the Concept of Personal Identity

When a person considers who or what he/she is, there exists a predefined and accepted self-definition and perception of what it means to be that individual. This can be understood as a person’s concept of their personal identity; i.e. what makes them who they are. Although the soul or personality of a person is usually equated as the major element of personal identity, each person has a close affiliation with their biological body. Any removal or addition to this biological artefact will have consequences on a person’s self-perception and comfort in their own skin.

A potential issue which 3D bioprinting generates is understanding how 3D bioprinted organs or limbs (‘artefacts’) could impact an individual’s preconception of his/herself. For example, an individual who has had a 3D bioprinted limb added to their body may begin to find it difficult to accept themselves as the same person, even though the 3D bioprinted limb can be said to ‘add’ to their bodily function and assists them to fully function as a ‘normal’ person.

The exact extent of this difficulty to accept the new self could be reliant on how the individual relates to the 3D bioprinted organ or limb. This is especially relevant if the organ or limb has been printed using the individual’s own cells as the living ink; if the individual’s own cells are used as the source of ink then perhaps the level of discontinuity will be less than expected and no issues of personal identity will exist. However, if for some reason an individual’s own cell line cannot be used as a source of ink and cells from another human are utilised to bio-print an organ, this could have far-reaching impacts on how an individual perceives the new limb as being part of their being.  

A secondary element at play would also be in relation to society’s perception of people who have had biological artefacts 3D bioprinted and added to/inserted into their bodies. Key questions would revolve around whether society would accept these individuals as people; would they consider them as still deserving of the same level of human rights; or would a chasm between the two types of ‘human’ occur; natural human and 3D bioprinted human? Would those who have received bio-printed limbs be seen as enhanced in comparison to those who retain their original organs? This could be cause to revisit the definition of what it means to be a person and the impact which society’s perception can have on it.

As 3D bioprinting is still in the very early stages of its development and implementation, close examination and research on the impact on personal identity and societal acceptance will need to occur.

Justice and Accessibility

A central objective of the development of 3D bioprinting is the eradication of the organ shortage crisis and the black market. However, bioprinting healthy and viable organs, while highly ambitious, is not without its own ethical and social pitfalls in this regard. 

A central ethical issue is that of distributive justice and access to this boundless technology. The prospective costs alone associated with successfully printing a viable organ would only be manageable by those countries with enough income to fund such ventures, never mind the high tech labour market required to adequately execute the bioprinting process. In essence, middle-to-high income countries would enjoy the high-tech advances made by science, while lower income countries would both be unable to afford the technology and integration of the new scientific breakthrough and also be less able to execute it due to the high-tech labour associated with its implementation.

In this way, 3D bioprinting would seem to only enhance the already high standard of living of first world countries, leaving the organ shortage crisis and black markets thriving for the remaining lower-income countries.

The Safety, Security and Risks

A central concern in relation to this perceived utopia (the never-ending supply of 3D bioprinted organs) would be that the widespread accessibility of 3D bioprinters could lead to serious quality and security concerns for the public. The reasoning behind this would be that although the technical knowledge of printing an organ could be learnt or a step-by-step procedure followed, the relevant medical skills required to operate with the printed artefacts could be severely lacking or non-existent by the person offering the service. As well as this, the spec related to how to print/create the biological artefact at hand could be outdated or grossly inaccurate. Both of these elements could lead to seriously dangerous back-alley operations which offer lower costs for 3D printed organs and their insertion.

In conjunction with the above, it is essential to note the issues raised by the bio-ink used for 3D bioprinting. Indeed, with the aim to cut already high printing costs, those offering the service might be more inclined to source questionable bio-inks which have yet to be medically tested and approved, and which in turn might have unknown health implications for the individual receiving the bioprinted artefact. Yet again, the individual could potentially be exposed to unknown grief with untested and unregulated bioprinted artefacts.

A key call out to policy makers would be to consider strict regulation and registration of 3D bioprinters, the CAD files which describe the method of artefact creation, and the sourcing of safe bio-inks.

Moral Degradation

One of the most poignant ethical issues in relation to 3D bioprinting human organs or limbs is that through this act we are inadvertently morally degrading human bodily integrity. Body integrity relates to the respect and innate dignity related to each individual’s body, regardless of capability, age, sex, race, or defining feature. The moral degradation argument affirms that through the ready and easy availability of 3D printed organs to replace our non-functioning or dysfunctional organs, there will be no, or less of a, requirement to respect our bodies. Essentially, the care and concern we place on the unique and irreplaceability of our organs or limbs will disintegrate and a society of use, abuse and replace will thrive. For example, in a world where 3D bioprinted organs are as easy to obtain as a regular medical check-up, what would stop an individual from over indulging in drinking and smoking to the point where both his/her  lungs and liver cease functioning? There is little to no moral or real threat which hinders their acting in this way.

This calls in to question how the availability of widespread 3D bioprinting will be regulated; will it be made available to every person, regardless of the way they treat their body? Or will preference be given to those in dire need of an organ, who are in this position through no fault of their own? This then leads on to the open access and fairness of 3D bioprinting technologies and highlights the urgent need to regulate and create guidelines for this technology’s respectful and humane implementation.

Informed Consent & the Use of a Patient’s Living Cells

An important ethical consideration of sourcing and using an individual’s cells for 3D bioprinting is related to the consent provided by the individual. It may seem like the issue of informed consent is somewhat fabricated, after all the patient consents to the use of their cells to create the 3D printed organ, they receive the organ and on they go with their life; what could be the issue? The issue stems from the fact that the patient must provide fully informed consent. Informed consent relates to the patient’s approval of a procedure which has been formed based on their full understanding of what they are consenting to. The issue which 3D bioprinting generates is that due to its experimental nature, the outcomes of such procedures are currently unpredictable and so information provided to patients is less than adequate for full consent to be provided.

Another element to consider would be what the patient has consented to in relation to the storage and further use of their cells once the 3D printed artefact is has been received and they have left the hospital; are the cells disposed of or stored indefinitely? Who owns these cells now – is it the 3D printing facility or does the individual as a patient still maintain ownership, even though he/she received the agreed ‘goods’ in relation to the transaction?

This could potentially lead to a bio-bank being set up, where patients’ cells are kept for indefinite periods of time. Further along this line of thought, if this occurs, the patients could be expected to consent to their stored cells being used for experimental research to push the boundaries of 3D bioprinting, which could lead to the creation and destruction of organs that they would never see or utilise.

This article has attempted to outline key ethical issues in relation to 3D bioprinting, in an effort to highlight the necessity for better regulation, social consideration and justice in the wake of this novel technology.

For further reading on this upcoming technology, see:

  • Varkey, Mathew & Atala, Anthony. (2015). Organ Bioprinting: A Closer Look at Ethics and Policies. WF J Law and Policy. 5. 275.
  • Gilbert, F., O’Connell, C.D., Mladenovska, T. et al. Sci Eng Ethics (2018) 24: 73. https://doi.org/10.1007/s11948-017-9874-6
  • Gilbert F, Viana JNM, O’Connell CD, Dodds S. Enthusiastic portrayal of 3D bioprinting in the media: Ethical side effects. Bioethics. 2018;32:94–102. https://doi.org/10.1111/bioe.12414
  • S. Vijayavenkataraman, W.F. Lu, J.Y.H. Fuh,3D bioprinting – An Ethical, Legal and Social Aspects (ELSA) framework,Bioprinting,Volumes 1–2,2016,Pages 11-21,ISSN 2405-8866, https://doi.org/10.1016/j.bprint.2016.08.001.
  • Vermeulen N,Haddow G, Seymour T, et al.J Med Ethics 2017;43:618–624.
  • Vijayavenkataraman, S. (2016), A Perspective on Bioprinting Ethics. Artificial Organs, 40: 1033-1038. doi:10.1111/aor.12873
  • Patuzzo, S., Goracci, G., Gasperini, L. et al. Sci Eng Ethics (2018) 24: 335. https://doi.org/10.1007/s11948-017-9918-y
  • Tran, Jasper. (2014). To Bioprint or Not to Bioprint. SSRN Electronic Journal. 10.2139/ssrn.2562952.
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