The yet-to-be-defined Ethics of 3D Printing of Organs

or, ethical questions that didn’t exist three years ago

3D printing has been written about extensively, for good reason. The Economist has billed digital manufacturing as “The Third Industrial Revolution.” As the process becomes more specialized and cheaper at the same time, manufacturing for export in developing economies could shrink, if not be eliminated, as they lose their comparative advantage of cheap labor. Globalization would shift the other way around — developed economies would sell the manufacturing capabilities to developing countries.

Google searches of “3D Printing” — developing countries, beware

The possibilities of 3D printing are obviously hugely vast and important. But aside from the economic potential of this technology, we may be able to solve some of the greatest human problems as well. Take the printing of human organs, for example.

One of the first mainstream discussions of 3D Printing of Organs came from Anthony Atala’s 2011 TED talk on solving organ donor shortages. In it, he discusses that there are many people who die every day waiting for organ transplants, especially kidneys. The technology to reproduce entire organs, like kidneys, is close to becoming possible. A kidney can be imaged, then rebuilt layer-by-layer by a 3D printer to reconstruct a fully operable organ. No donor needed.

And recently, Fast Company did a profile on the partnership between Autodesk and Organovo. The article describes how the technology is moving toward a stage where clinical testing can begin, though currently, two issues are holding up progress. First, the design tools to create body parts does not yet exist — that is, there is no human organ CAD software. Second, the FDA is likely to get in the way.

There is some way to go before this technology is scalable and cost efficient, but what are the implications of this technology? What are some of the ethical questions that surround this technological development? Moralization exists in all developments dealing with the intersection of the body and science (see: birth control, heterologous artificial insemination, IVF, stem cell therapy, gene therapy, cognitive enhancement, gene mapping, etc.), so why should this be any different?

First, let’s define some of the ethical or moral objections to the 3D printing of organs.

For religious folks, there is already a dichotomy between Determinism and Free Will, but that is usually presented in the context of behavior and actions, not biology. That is, when a person dies, and it was determined that “God decided it was their time.” Does that mean any “unnatural” extensions of life — like printing an organ from one’s own cells (as opposed to keeping somebody on life support, which is allowed, but is a temporary extension of natural life — not the permanent extension through a non-natural organ) are interfering with the deterministic belief? The Catholic Church has not made any statements on 3D printing of organs [yet], but because religious beliefs often come into contrast with Utilitarian beliefs, it’s not entirely certain they will be ok with it.

What about the sale of organs? Currently, if you need a new kidney, you will be placed on a donation list or it will be specifically given to you by a live family member — neither of which involve a monetary transaction. But if you need a new kidney, is it ok to “buy” a “kidney”? The entire point of the current system (which is imperfect) is to ensure that organs don’t become commoditized, so that the wealthy or powerful cannot put themselves ahead of those of lower socioeconomic status. But 3D printing of organs makes organs commodities. Should, then, organ transplants become a commercialized transaction? What happens to the supply of natural organs if there are alternatives available?

If organs can be printed, does that reduce the number of potential live donors, thus reducing the total number of organs available? Robert Becker, in his paper “Introducing Incentives in the Market for Live and Cadaveric Organ Donations,” discusses the moral impact of paying for organs.

The opposition to paying for organs… might reduce the supply of organs from altruistic reasons. Although paying for organs does not prevent persons from supplying organs out of altruistic motives, usually to help relatives, altruism clearly has been an insufficient motive under the present system. Otherwise, the demand for organs would not be so much larger than the supply.

Granted, he wasn’t specifically discussing manufactured organs, but the economics of the transaction should work the same.

Jonathan H. Todd is the author of the book Crisis+5: A survey of the American economy five years post-Lehman Brothers, and follow him on Twitter: @yontodd

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