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AN ETHICAL DILEMMA IN BIOPRINTED ORGANS
Edward Skorpinski (ejs96@pitt.edu)
GROWING HEALTH CRISIS
The United States faces a health crisis that continues to
grow. Each year, thousands of people die who could have
been saved by an organ transplantation. According to the
National Kidney Foundation, an average of 12 people die
every day awaiting a lifesaving kidney donation. [1] Adding
on to the difficulty of the situation, the number of transplants
needed in the United States continuously increases. Longer
life spans due to the effects of modern medicine unfortunately
contain the side effect that organs are more likely to
deteriorate over time. As the length of the average American
life increases, so does the possibility of an organ failure.
Figure 1 shows how the organ shortage has grown over time.
a patient. How would a responsible, ethical engineer go about
solving these problems?
BIOENGINEERING WITH 3D PRINTING
Additive engineering
Additive engineering is a manufacturing method of
producing extremely precise parts, while additionally
eliminating much of the waste produced by standard
manufacturing practices. The procedure of 3D printing
involves the layering of material to form objects of any shape
or size. Products are formed after the application of numerous
layers, which can be as thin as 0.05 mm. [3] Many different
materials can be utilized in additive engineering such as
multiple resins, plastics, metals, and ceramics. 3D printing
allows for advanced precision and the ability to create unique
shapes. Manufacturers gained the ability to create complex
products with relative ease as compared to traditional
engineering methods. [4] Additive engineering also cuts
down on the amount of waste produced during the
manufacturing process. In traditional manufacturing methods,
products are often made through the removal of material to
form a desired shape.
Advances in 3D Printing
FIGURE 1 [2]
The number of organs needs for donation increases steadily
every year while the number of organs available remains
stagnant.
In order to combat the problem, doctors need a drastically
increased supply of organs, and biomedical engineers have
found a possible solution. Currently the technology to
produce artificial organs through additive engineering is in
development. Engineers working with biomaterials have
made great strides in developing 3D printing organs available
for transplantation. The ability to readily produce artificial
organs will effectively end the organ donation crisis.
However, the situation also could lead to ethical dilemmas.
Artificial organs would be an extremely lucrative industry; an
industry in which an entrepreneurial businessperson could
earn a fortune. When a person’s live is at stake, one must be
careful not to cross the fine line between business and
extortion. Also, the consequences of failure could be fatal to
University of Pittsburgh, Swanson School of Engineering 1
2014-10-28
In 2011, the industry experienced a 30% growth after
starting the year valued at around $1.9 billion. [5] Additive
engineering spread very quickly around numerous industries.
Industries such as health care and aerospace engineering are
especially involved in the development of 3D printing
because of its high precision. According to the World 3D
Printing to 2017 report, the market is anticipated to continue
to grow at a rate of over 20% per year to reach a net worth of
over $5 billion in 2017. [6] As the industry continues to grow,
the number of applications will only continue to grow. One
such advancement in the industry is the ability to print human
tissue and organs.
Bioengineering Process
The concept of creating functional living organs adds a
unique and challenging aspect to the regular additive
engineering process. Similar to regular 3D printing,
bioprinting involves the layering of material in succession in
order to produce a finished product. However, the material
used in bioprinting must be compatible with natural living
tissue while also containing all of specified tissue’s structural
and operational properties. This requirement is known as
biocompatibility. Certain types of materials need to be used,
Edward Skorpinski
such as polymers derived from human or animal specimen or
specifically designed synthetic molecules. Natural polymers
are advantageous in the aspect of easy compatibility with the
human body, and some examples of natural polymers used are
alginate, gelatin, and hyaluronic acid. Synthetic polymers can
be designed for specific uses depending on their use in the
body. However, they are harder to make biocompatible. [7]
3D bioprinting is comprised of three major aspects:
biomimicry, autonomous self-assembly, and mini-tissue
building blocks. The purpose of biomimicry is to create exact
replicas of living human tissue. In order to achieve this,
engineers must develop the polymers on a microscopic scale.
Then the polymers must organize themselves as a standard
group of human tissue cells. Known as autonomous selfassembly, the 3D printed cells must be able to control their
own function, structure, and future growth. The third strategy
of bioprinting involves using mini-tissues as building blocks
to construct a cellular structure. Engineers recreate the
biological design of a cell and construct its components one
by one. Typically, the construction of a complex biological
object involves a combination of the three approaches. [7]
potential and releasing it before our competitor would give
my company the upper hand. Individually, my career would
take a huge leap forward with this product’s financial success.
Unfortunately, failure of the product could prove deadly to
my clientele. As an engineer, I need to evaluate how to
ethically solve the situation.
ETHICS IN ENGINEERING
Engineering for the greater good
As professionals and servants of the public good,
engineers are bound to follow a strict code of ethics. In 2007,
the National Society of Professional Engineers (NSPE)
released a revised version of their code of ethics. The code is
meant to govern the engineering community as a whole with
a set of standard practices. Through following it, engineers
uphold the integrity of the profession. First and foremost, as
described in the opening canon of the NSPE Code of Ethics
for Engineers, is that engineers must “hold paramount the
safety, health, and welfare of the public.” [8] In this context,
the public should be the primary concern for every engineer.
The general public’s wellbeing shall take precedence over any
other concern. The NSPE Code of Ethics outlines the general
principles of how engineers are meant to take responsibility
for the effects of their actions on society. Nonetheless,
engineering covers such a diverse range of disciplines that one
broad code could not cover the whole spectrum. In response,
different areas of engineering have developed their own
specific codes of ethics. For example, the Biomedical
Engineering Society developed their own code of ethics. It is
meant specifically for engineers who work in the areas of
“engineering, science, technology, and medicine.” [9]
Through consultation of the general and any specific codes of
ethics, an engineer has the resources necessary to make an
ethical decision.
ETHICAL DILEMA
I work for a bioengineering company called B.E.D., which
stands for Biomedical Engineering Design. We have recently
developed an artificial kidney produced through 3D
bioprinting. I am the lead engineer on the design team, so I
take a large portion of the responsibility for the development
of the product. The kidney shows initial promise, but remains
largely untested on human subjects. The initial tests acquired
inconclusive results and showed that the kidney is not
consistently stable. Thousands of Americans are in dire need
of a kidney transplant, and the number is continuously
growing. An artificial kidney which can be easily produced
would make millions of dollars. Clients for the kidney would
not hesitate for a potentially life-saving operation. However,
another rival company is also developing an artificial kidney
and they are very close to completion. The executives at
B.E.D. want to push the kidney onto the market as soon as
possible in order to release it before our competitor. I am
being pressured by my superiors to rush through the testing
process as soon as possible. They want me to ensure that the
kidney will pass through testing no matter the cost, even if I
have to fabricate data. I am hesitant to put a product on the
market that might not be completely ready. The kidney would
drastically improve lives and solve the donation shortage
crisis for the United States. B.E.D. would earn enormous
profits and as lead engineer on the project, I would likely
receive a large promotion. However, a dysfunctional product
would lead to horrific results. Any patient who receives a
faulty kidney would face an enormous health risk. Releasing
the kidney as soon as possible would be hugely beneficial to
B.E.D. financially. If we wait too long and our competitor
releases their product before us, we would lose a large portion
of our expected profits. The kidney has enormous market
Examining Ethics in Developing Artificial Organs
Introducing an artificial kidney to the public would
provide an immense service to humanity. The lack of kidneys
available for transplant stands out as one of America’s largest
problems in modern medicine. With 3D printed kidneys, the
situation would be almost completely resolved. For example,
look at the situation presented by Dr. Anthony Atala in his
TED talk “Printing a human kidney.” In the lecture, Dr. Atala
explains how a procedure involving a transplant of a 3D
printed bladder drastically improved the health of a young
patient named Luke Massella. Through receiving this new
artificial organ, the patient’s livelihood significantly
improved. [10] Due to the success of the procedure, Dr. Atala
took great strides forward in the field of bioengineering. He
exemplifies the professional obligation of a biomedical
engineer to “strive by action, example, and influence to
increase the competence, prestige, and honor of the
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biomedical engineering profession,” set forth in the first
canon and second directive of the BMES Code of Ethics. [9]
Biomedical engineers are not only encouraged, but obliged,
to further the development of their field. In accordance with
my code of ethics, I would be obligated to work on the
advancement of an artificial kidney when presented with the
opportunity.
As an engineer, one must work in conjunction with
numerous other fields of study as well as other disciplines of
engineering. To quote Josep Basart and Montse Serra in their
paper on the complexities of engineering ethics, engineers
must be able to “exist and operate as a node in a complex
network of mutual relationships with many other nodes. [11]
In the field of bioengineering, professionals must also assume
the responsibility of a health care provider. The products
which bioengineers create directly influence the health of a
patient as well as the physician who implements the
aforementioned product. In doing so, they assume the
responsibilities of a patient’s health and wellbeing. I
consulted a physician, Dr. Edward W. Skorpinski, MD, on the
responsibilities of his profession. He responded:
more easily evaluate a current dilemma or scrutinize it from a
different viewpoint. Also, engineers can view past precedents
through studying previous ethical situations. Through
reference and comparison to previous cases, an engineer can
make a much more highly educated decision.
To Release, or Not to Release: An Engineer’s
Perspective
The case study presents a hypothetical situation where a
company known as X Medical wants to introduce a new
medical device to the market. However, not every qualitycontrol procedure was followed correctly and the product may
not be completely ready for commercial use. [15] The case
presents the questions of the potential consequences of a
dysfunctional product and how the situation should be
addressed. The Health Care Obligations section of the BMES
Code of ethics states the patient health is the foremost priority
and the overall consequences of one’s work must always be
in consideration. [9] Under the circumstances, the engineer’s
ethical duty should be to ensure the safety of the new product.
If the device requires greater confirmation that it will be
effective, the engineer is responsible for it. If the product is
unsafe for the public, then the engineer must take
responsibility in ensuring that the device is not prematurely
released.
Those in the medical profession have been
entrusted with the responsibility of putting
the needs of their patients first, and while it
is important to bring new medical
developments to light one must also be
certain that it is done in a manner which
guarantees that due diligence has been
performed and that patient safety is
foremost. As stated in the physicians’
Hippocratic Oath, “I will take care that they
suffer no hurt or damage. [12]” [13]
Overly Ambitious Researchers – Fabricating Data
The case study recounts two scenarios in which students
fabricated experimental data in order to achieve quick,
accurate results without having actually completed the work.
Each student’s misconduct was discovered and any
significance placed upon their work was removed. In
addition, each student’s respective reputation was tarnished.
[16] The falsification of data is strictly forbidden in both the
NSPE (I.1.a.) [8] and BMES (Research Obligations, 2) codes
of ethics. [9] Under no circumstances is the fabrication
considered ethical, as the faulty research could lead to a
dysfunctional product. In the medical field especially, such a
product could prove extremely harmful to the public.
Dr. Skorpinski explained the medical profession’s
responsibility to prioritize patients’ needs. Similarly, the
second canon, second directive of the BMES Code of Ethics
defines an engineer’s duty to “Regard responsibility toward
and rights of patients, including those of confidentiality and
privacy, as their primary concern.” [9] This similarity with
engineering and medical ethics exemplifies the
multidimensionality of engineering and how ethics from
different professions blend together.
Challenger Disaster
The Space Shuttle Challenger Disaster unfortunately
resulted in the deaths of seven astronauts and exemplifies the
consequences of not following ethical procedure. Prior to the
shuttle launch, engineers brought crucial information about a
possible launch failure to mission directors. The engineers
warned that low air temperatures could cause malfunctions in
the O-rings of the solid rocket boosters, but the directors
disregarded their warnings as negligible. [17] The
consequential rocket explosion shows that negative side
effects of an ignorance of ethics. The engineers who revealed
the possible failure were following section III.1.b of the NSPE
Code of Ethics, “Engineers shall advise their clients or
ANALYZATION OF CASE STUDIES
Benefit of case studies
“Case studies give young engineers an opportunity to see
ethical precepts at work in actual situations and, through,
discussion, to benefit from the views and experiences of other
professionals,” says Tara Hoke, assistant general counsel for
the American Society of Civil Engineers. [14] She was
commenting on the effectiveness analyzing ethical situations
through the use of case studies. Case studies can be used to
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Edward Skorpinski
employers when they believe a project will not be successful.”
However the executives who ignored the advice then as a
result violated the first fundamental canon of the code by not
prioritizing the safety of the public. The case study
exemplifies the possibilities of engineers who do not follow
ethical procedure. Engineers are responsible for the
consequences of their actions. Since the ramifications of an
engineer’s work can prove dire, the importance of following
ethical code should always be an engineer’s top priority.
and earn massive profits, I cannot ethically do so. I hold an
obligation to my profession as an engineer to provide the best
service to the public as I possibly can.
REFERENCES
[1] (2014) “Organ Donation and Transplantation Statistics.”
National
Kidney
Foundation.
(online
article).
http://www.kidney.org/news/newsroom/factsheets/OrganDonation-and-Transplantation-Stats
[2] (2014) “The Need is Real: Data.” Organdonor.gov.
(online article). http://www.organdonor.gov/about/data.html
[3] (2014). “3D Printing Materials, Terminology, and
Specifications.” Genesis Framwork. (online article).
http://3dprototypesandmodels.com.au/3d-printingterminology-specifications/
[4] (28 Feb. 2013). “Additive Manufacturing and 3D
Printing.” Chemical Industry Digest. (online article).
http://go.galegroup.com/ps/i.do?id=GALE%7CA320677245
&v=2.1&u=upitt_main&it=r&p=AONE&sw=w&asid=b329
71350b2f0fb46c6fa48d1b18b30b
[5] (28 Feb. 2013). “Additive Manufacturing and 3D
Printing.” Chemical Industry Digest. (online article).
http://go.galegroup.com/ps/i.do?id=GALE%7CA320677245
&v=2.1&u=upitt_main&it=r&p=AONE&sw=w&asid=b329
71350b2f0fb46c6fa48d1b18b30b
[6] (Dec. 2013). “World 3D Printing to 2017.”
ReportsnReports.
(online
article).
www.reportsnreports.com/reports/272154-world-3dprinting-to2017.html
[7] S. Murphy, A. Atala. (5 August 2014). “3D bioprinting
of tissues and organs.” Nature Biotechnology. (online
article). DOI: 10.1038/nbt.2958
[8] (2007). “NSPE Code of Ethics for Engineers.” National
Society for Professional Engineers. (online article).
http://www.nspe.org/sites/default/files/resources/pdfs/Ethics/
CodeofEthics/Code-2007-July.pdf
[9] (February 2004). “Biomedical Engineering Society Code
of Ethics.” Biomedical Engineering Society. (online article).
http://bmes.org/files/2004%20Approved%20%20Code%20o
f%20Ethics(2).pdf
[10] (March 2011). “Anthony Atala: Printing a human
kidney.” TED. (online video).
http://www.ted.com/playlists/144/should_we_redesign_hum
ans
[11] J. Basart, M. Serra. (15 July 2011). “Engineering Ethics
Beyond Engineers’ Ethics.” Science and Engineering Ethics.
(online article).
http://link.springer.com/article/10.1007/s11948-011-9293z/fulltext.html
[12] (28 August 2014). “Hippocratic Oath (Modern
Version).” Johns Hopkins Sheridan Libraries. (online
article). http://guides.library.jhu.edu/bioethics
[13] E. Skorpinski. (26 October 2014). Interview
COMPARISON TO CASE STUDIES AND
ETHICAL DECISION
After analyzing the precedents set forth by the case
studies, I can make comparisons between them and my
current ethical predicament. The case study in which an
engineer is being pressured to push a product to the
commercial market to early shares a current resemblance to
my current situation. It established that I must follow the
Health Care Obligations of the BMES Code of Ethics by
placing my patients’ health care as my number one priority.
Therefore, I should take all measures necessary to confirm
that B.E.D.’s artificial kidney is completely ready for patient
use before the product is released. Also if the company plans
to release the kidney anyway before my confirmation, I am
obliged by section III.1.b of the NSPE Code of Ethics to
“advise my client or employers when I believe a project will
not be successful.” [8] I must be responsible for only releasing
quality products to the public. Therefore, I must pledge to
keep B.E.D. from selling a questionably finished product.
In addition, I must resist the pressure put upon me by my
superiors to possibly falsify data. As seen in the case study
about the students’ fabricated lab results, any falsified
scientific data is not permitted by the BMES Code of Ethics.
Therefore, I may not publish any deceitful and dishonest
reports for the purpose of releasing the kidney to the
commercial market sooner.
Thirdly, the potential causes of transplanting
malfunctioning kidneys into patients parallels the ethical
dilemma of the Challenger case. When an engineer makes a
mistake, he must take responsibility for that mistake. I may
not allow any harm to come to the public because I allowed
them to use an unsafe product. The Space Shuttle Challenger
disaster stands as an example of how an irresponsible
engineering mistake can lead to casualties. If B.E.D. decides
to proceed with releasing a possibly dysfunctional artificial
kidney, it is my duty to try and ensure the company takes an
ethical approach.
CONCLUSION
I will in my best effort attempt to benefit my company by
releasing the artificial kidney as soon as possible. However, it
must be done in a thorough manner. Despite the temptation to
sell an unfinished product to gain a jump on the competition
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Edward Skorpinski
[14] T. Hoke. (May 2012). “The Importance of
Understanding Engineering Ethics.” Civil Engineering.
(print article). Vol. 82, no. 5. pp.40-41. 2p
[15] M. Pritchard. (26 October 2014). “Case Study 1: Overly
Ambitious Researchers – Fabricating Data.” National
Academy of Engineering. (online case study).
http://www.onlineethics.org/Education/precollege/sciencecla
ss/sectone/chapt4/cs1.aspx
[16] “To Release, or Not to Release: An Engineer’s
Perspective.” Stanford Biodesign. (online case study).
http://biodesign.stanford.edu/bdn/ethicscases/21releasequesti
on.jsp
[17] “Engineering Ethics: The Space Shuttle Challenger
Disaster.” Texas A&M University Department of Philosophy
and Department of Mechanical Engineering. (online case
study).
http://ethics.tamu.edu/Portals/3/Case%20Studies/Shuttle.pdf
ADDITIONAL SOURCES
S. Glenn. (15 Mar. 2013). “Developments in 3D printing and
additive manufacturing.” Advanced Manufacturing
Technology. (online article).
http://go.galegroup.com/ps/i.do?id=GALE%7CA337816638
&v=2.1&u=upitt_main&it=r&p=AONE&sw=w&asid=8b90
7c8550826ccd3e2c1fa2b2e6239a
D. Richards, Y. Tan, J. Jia, H. Yao, Y. Mei. (2 October
2013). “3D Printing for Tissue Engineering.” Israel Journal
of Chemistry. (online article).
http://onlinelibrary.wiley.com/doi/10.1002/ijch.201300086/p
df
ACKNOWLEDGEMENTS
Foremost, I would like to thank Ben Bucks, my high
school CAD teacher who first introduced me to 3D printers.
Thank you to Dr. Edward Skorpinski for taking time out
of his busy schedule for an interview.
Thank you to Starbucks and Monster Energy for providing
me with the energy with which to write.
Thank you to the Hillman Library staff for creating an
excellent work environment.
Finally, thank you to the residents of Forbes Hall, fourth
floor, who aided in my writing process through peer
advisement and editing.
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