Ethical issues in bone repair and bone tissue engineering

Of the approaches toward bone repair, bone tissue engineering elicits some of the more complex ethical questions, owing to the incorporation of living, considerably altered cells in the product. We discuss three areas where ethical issues occur: cell sourcing, clinical trials and therapy. Cells are key components of all bone tissue engineered products. Embryonic stem cells may be used in the future, but this remains ethically controversial. Non-embryonic cells are not controversial but cell donation and the informed consent procedure accompanying it raises questions: both the cells' material value and their informational value for the donor need to be examined when deciding on the conditions of cell donation for tissue engineering purposes. Regeneration through the creation and implantation of metabolically active constructs is a new medical approach which requires a profound analysis of the implications of the new approach for the design of clinical trials and of therapy to protect the safety and autonomy of vulnerable persons. This includes assessments of efficacy, risks and safety. It also requires an evaluation of informed consent procedures. This may not only benefit bone tissue engineering, but other bone repair interventions as well. A third issue is safeguarding the access of patients. The economic thresholds for this therapy will be considerable. However, the presence of living cells may also create a biological threshold owing to immunological requirements. Tissue engineered products may be unavailable for some persons, unless biological diversity is taken into account from the design of bone tissue engineered products and through accurate cell sourcing strategies. © 2009 Woodhead Publishing Limited All rights reserved.

ISBN:978 1 84569 385 5

Jaar van publicatie:2009