Schaub 4:00
R10
BIOPRINTING: THE ETHICS OF 3D PRINTED ORGANS
Katie Poduska (ksp37@pitt.edu)
THE SCENARIO
The year is 2030, and I have been working as a
bioengineer for the same company, BioTech, for the past 10
years. We are currently working on a project that will allow
organs produced by 3D printers to be used as transplants
instead of donor organs. BioTech just printed the first
vascularized kidney suitable for a transplant. We took cells
from a patient whose illness is causing his kidneys to shut
down and used these cells as the material input for the printer.
This patient has been on the top of the transplant list for quite
a while, but we have been unable to find a match. The patient
only has a few more weeks before his other organs start
shutting down. For this reason, we thought he would be an
excellent candidate for the first 3D printed organ transplant.
The news has been covering this story since the beginning
because of not only the revolutionary technology at work, but
also because the deathly ill patient is only twelve years old.
I am the head of the project committee that created the
kidney for this boy. We used cultured cells as the material in
the 3D printer, and, because cells are living, we also had to
use a specific amount of bioink. Bioink is a gel that contains
all of the necessary nutrients and oxygen that the cells need to
thrive properly [1]. Without this gel, the cells would not be
able to survive the printing process. The machines we used
are from Organovo, a company which has been using 3D
printers to create different types of tissue ever since the first
time cells were successfully used as 3D printer ink in 2003
[2]. We loaded the calculated amount of bioink and cells and
printed the kidney for the patient. The 3D printer took the
bioink that was loaded into the reservoirs and a 3D computer
aided design (CAD) file of the patient’s kidney and was able
to generate aa tangible organ from it. The process took about
4 weeks to fabricate the entire kidney, and it was finished just
in time.
Now, just days before the scheduled transplant, the
engineer who calculated the amount of bioink needed to keep
the cells at an optimal state has come forward to tell me he
made a mistake. When looking at the results again, he realized
he hadn’t double checked his calculations, which is the
protocol at our company, so he redid the calculations and
discovered the amount he calculated the first time was not
enough bioink. This means that some of the cells in the newly
fabricated kidney could be damaged, dying or mutated due to
a lack of oxygen and food. Ultimately, it means that the
kidney is not suitable for transplant and we must print a new
one. However, the patient might not live long enough to print
a new kidney. So, I am faced with a huge decision: do I allow
the transplant to go on as planned and possibly save a little
boy’s life? Or do I report the incident, restart the process and
hope that the patient can hang on long enough to print a new
kidney?
University of Pittsburgh, Swanson School of Engineering
2014-10-28
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THE ETHICS OF THE DECISION
Ethics guide us to make the best possible decisions in the
view of the society. Ethics are important to all lines of work,
but especially in engineering. When working with advanced
technologies and machines it is important to make a clear set
of guidelines because nothing like them have ever been made
before; many of the projects engineers work on are
unprecedented. The American Society of Civil Engineers
wrote in the article “The Importance of Understanding
Engineering Ethics,” that learning about ethics is a lot more
than just learning a set of guidelines; it’s about understanding
how situations test how an engineer adheres to the code in
“times of ethical challenge” [3]. This is exactly what my
situation is doing; it is testing me to see how well I will follow
the principles I am supposed to perform under.
When making my decision, there are many different
ethical codes I must keep in mind. Working as a bioengineer,
there are two separate, yet overlapping, codes of conduct I
must abide by. The first is the National Society of
Professional Engineers (NSPE) code of conduct. This code of
conduct must be followed by any and all types of engineering;
it is the blanket code for the general engineers. The second,
more specific code of conduct catering towards biomedical
engineers is the Biomedical Engineering Society Code of
Ethics. This code of ethics involves engineering as it relates
to the medical field. For example, the confidentiality rules that
doctors follow must also be observed by biomedical
engineers. These codes of ethics will aid me in deciding what
to do about the 3D printed kidney.
NSPE CODE OF ETHICS
Cannon 1
Often times, when a set of rules or guidelines is written,
the most important or most commonly referred to principle is
the first one on the list. The NSPE code of conduct is no
exception. In almost every ethical decision engineers make,
the first fundamental cannon is referenced. The first cannon
reads “engineers shall hold paramount the safety, health and
welfare of the public” [4]. In this situation, the general public
being referred to means I have to consider how my actions
would affect everyone who needs a transplant. By allowing
the transplant to take place, I would be undermining the whole
system of organ donation. I, also, must think about the safety
of the patient. Transplant surgeries put the body under a lot of
stress, and at his stage of illness it will be extremely painful.
He could go through all of the pain of surgery and still end up
deteriorating if the kidney is too damaged. On the other hand,
Katie Poduska
if the transplant goes smoothly and the calculation error was
not significant enough to change anything, then the patient
could heal completely. There is no way to know for certain
how much of the kidney is damaged, so there is nothing we
can do to determine how the patient will respond.
stated in the BMES code apply to my situation and will help
me reach my decision.
Professional Obligations
Similar to the first fundamental cannon of the NSPE code,
one of the guidelines outlined by the BMES code of ethics
reads: biomedical engineers shall “use their knowledge, skills
and abilities to enhance the safety, health, and welfare of the
public” [6]. As discussed previously, the best decision for the
public would be to announce the mistake and start from
scratch. This would be the most honest approach and could be
better in the long-run; for example, if the transplant is
completed and the damage to the kidney is too extensive, it
would reflect poorly on 3D printed organs, as well as my
company and my team. This patient is just one of many that
will have the option of accepting a 3D printed organ. My
decision not only affects his life, but the lives of everyone
waiting on the organ donation.
Another professional obligation listed in the BMES code
says that biomedical engineers must “strive by action,
example, and influence to increase the competence, prestige,
and honor of the biomedical engineering profession” [6]. This
also applies to my situation because what I decide could affect
the honor of my profession. Choosing to ignore the problem
is essentially lying to my peers, and no matter what my reason
is, this would not be beneficial in any way.
Cannon 5
Another cannon that I must keep in mind is the fifth
cannon of the NSPE code of conduct. It states: “engineers
shall avoid deceptive acts” [4]. It is clear that if I allow the
surgery to take place without revealing what I know I will be
deceiving everyone. I will be lying to the patient, the patient’s
parents and everyone else keeping track of this case. By not
saying anything, I am indirectly claiming that everything went
according to plan. In addition, when our work is published
and made available to other engineers at the end of this
project, there is a very strong possibility that someone else
will discover the mistake and point it out. That gives me
another decision; if the transplant takes place, I have the
option to publish the actual calculations, or I could falsify
them so no one knows about the mistake made by my
colleague. This would be considered yet another act of
deception. The fifth cannon, unlike the first cannon, leans
heavily to one option – tell the truth. Knowing this will weigh
heavily on my final decision.
Profession Obligations
Perhaps the most relevant and straightforward part of the
NSPE code of conduct relating to my situation is the first
professional obligation. It simply states: “engineers shall be
guided in all their relations by the highest standards of
honesty and integrity” [4]. It then goes into further detail by
saying “engineers shall acknowledge their errors and shall not
distort or alter the facts” [4]. This quite clearly tells me exactly
what I should do. I should tell my supervisor about what
happened and restart the process of fabricating a kidney. The
only thing stopping me from doing it is the patient’s life being
on the line. He has suffered so much already, and we got his
hopes up by telling him we would make him a new kidney.
Without proof that the kidney is damaged, it will be very
difficult to tell a family that they must wait another four weeks
while knowing the patient probably won’t make it. However,
as stated in the article “Ethical Considerations in
Bioengineering Research,” biomedical engineers do not deal
with moral and legal issues very often [5]. We instead must
separate our emotions from our logic and remain completely
objective. This is the part of the decision I am struggling to
accept.
Health Care Obligations
Very few engineers deal with the medical field; therefore,
health care obligations are not listed in the NSPE code of
conduct. However, they are discussed in the BMES code of
ethics. The first health care obligation that must be observed
states engineers must “regard responsibility toward and rights
of patients, including those of confidentiality and privacy, as
their primary concern” [6]. The patient, and, in this case, the
patient’s parents have a right to know what happened
regarding the kidney. Not sharing this information violates
their rights as well as my code of ethics. In my opinion,
because the patient is a minor, it is even more crucial to make
sure the parents know everything. The patient is deemed too
young to make proper, educated decisions about his surgery;
he does not have the power to refuse the surgery, therefore,
keeping the parents in the dark is taking advantage of this.
Research Obligations
Printing the kidney had many different steps, all of which
have been recorded and published as research after the project
is completed. The BMES code of ethics has guidelines
involving research that must be followed. Specifically,
“biomedical engineers involved in research shall publish
and/or present properly credited results of research accurately
and clearly” [6]. Publishing the exact results will not be a
problem if we start over and fabricate an entirely new kidney,
but, if we use the kidney we have, I have another decision to
make. Publishing the actual results risks being found out, but
altering the research violates the code of ethics. In this aspect,
BMES CODE OF ETHICS
Because the Biomedical Engineering Society (BMES)
Code of Ethics is merely a more specific code than the NSPE
code, some of the cannons overlap or say the same thing with
an added twist relating it back to biomedical engineering
instead of the general engineering public. Many of the ethics
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Katie Poduska
it seems like a better idea to start a new kidney and publish
the truth.
the lives of many more people in the future. We knew when
we started this project that it might not work, but we all had
hope. Now the only thing we can do is hope that the patient
can hang on for another four weeks.
Whenever there is a sticky ethical situation, it often helps
to look carefully at the codes of ethics, talk to people about
the problem, and write down the pros and cons of each
decision; it may be difficult separating emotion from
profession, but it is a necessary evil in these types of
situations.
OTHER SOURCES OF INSIGHT
Family
After reading through the codes of ethics, I am still not
sure about what I should do. So, just like I always do, I turn
to my family for help. I called up my mom, explained
everything to her, and told her why I was having such a
difficult time coming to a conclusion. I told her that the error
made in the lab may or may not have a significant impact on
how the kidney functions and there is no way to tell for sure.
I am letting my emotions cloud my objectivity and we both
know it. I do not want a little boy to die due to a simple
mistake; especially when we do not even know if it had that
big of an impact. However, I do not want to put my integrity
and my job on the line either. My mom did not tell me what
to do, she instead told me I am ultimately the only one who
can make this decision and she cannot do it for me. She told
me she would support me no matter what I decide regardless
of what happens as a result of my decision [7].
At the end of my conversation with my mom, I feel a lot
more sure of myself and what I am going to do, but I am still
a little hesitate. The only thing I know for certain was that I
am very fortunate to have people in my life who support me
the way my family does.
REFERENCES
[1] W. Harris. (2013). “How 3-D Printing Works.” How Stuff
Works.
(Online
Article).
http://health.howstuffworks.com/medicine/moderntechnology/3-d-bioprinting3.htm
[2] Organovo.com
[3] “The Importance of Understanding Engineering Ethics.”
(2012). American Society of Civil Engineers. (Online Article).
http://www.asce.org/Ethics/A-Question-ofEthics/2012/May-2012/
[4] “NSPE Code of Ethics for Engineers.” (2007). National
Society of Professional Engineers. (Online Article).
http://www.nspe.org/resources/ethics/code-ethics
[5] N. Naurato, T.J. Smith. (2003). “Ethical Considerations in
Bioengineering Research.” National Institute of Health.
(Online
Article).
http://www.ncbi.nlm.nih.gov/pubmed/12724954
[6] “Biomedical Engineering Society Code of Ethics.” (2004).
Biomedical Engineering Society. (Online Article).
http://bmes.org/files/2004%20Approved%20%20Code%20o
f%20Ethics%282%29.pdf
[7] L. Poduska. (2030, Aug. 16). Conversation.
Baltimore Marina
Now that I have talked to my family and looked through
all of the codes of ethics, there is only one thing left for me to
do: make a decision. Whenever I have a lot to think about,
there is one place that I go to, and that’s the Baltimore Marina.
Luckily, my favorite time to go is in the fall on days like this.
I go and sit on a bench on top of a hill that overlooks all of the
boats and the ocean. When I was growing up, I was a
swimmer. I love the water and the beach. My best friend
always invited me to her boat in Sandusky, Ohio in the
summer and we would sit on the dock and talk for hours. To
this day I think of marinas as a peaceful place to think or talk.
It also allowed me to see the hospital, so I could focus my
thoughts more easily. I sat there listening to the water as it
splashed the rocks and watched as the boats bobbed gently
with the waves. I thought about everything I had been
worrying about and everything my mom told me. As the sun
started setting, I realize I had been sitting in the same spot for
almost two hours. That’s when I knew it was time to make a
decision.
Reflecting on the code of conduct and the code of ethics,
I can see that the clear choice was to start over and reprint the
kidney. I cannot let my emotions get in my way. Almost every
cannon in the codes of ethics points to starting over, no matter
how difficult telling the truth will be. The patient may only be
twelve which makes this decision a hard one to accept, but,
even if my decision results in his death, it will still allow
biomedical engineers to advance 3D printed organs to save
ADDITIONAL SOURCES
“Ethics Case Studies in Biodesign.” Stanford. (Online
Article).
http://biodesign.stanford.edu/bdn/resources/ethicscases.jsp
“Cases and Scenarios.” Online Ethics. (Online Article).
http://www.onlineethics.org/Resources/Cases.aspx
“Ethics Case Studies.” WebGuru. (Online Article).
http://www.webguru.neu.edu/professionalism/researchintegrity/ethics-case-studies
ACKNOWLEDGEMENTS
I would like to thank my family for always being there
for me and supporting me as I take on all my dragons. I
would also like to thank Jessica Klitsch, Sarah Painter and
Robyn Moyer for putting up with me.
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