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ENGINEERING THE KIDNEY: CHALLENGES, ETHICS, AND EDUCATION
Hailee Kulich (hrk6@pitt.edu)
ETHICAL ENGINEERING
One of the main goals of bioengineering is to provide
improved or expanded treatment for commonly encountered
medical disorders [1]. A condition such as renal failure is an
example of a situation where the application of
bioengineering may lead to an improvement in the treatment
of a common medical condition where there is currently a
limited number of available treatments. There are two means
by which kidney function can be replaced in humans:
dialysis and kidney transplantation [2]. While these
processes can be lifesaving, they also are expensive,
invasive, and rarely a permanent solution. The development
of an artificial kidney would potentially solve many of the
problems associated with these interventions and, if
successful, lead to improvement in the quality of life for
thousands of patients suffering from renal failure.
While engineers have a responsibility to improve
the lives of those around them, they must do this in an
ethical manner. According to the NSPE Code of Ethics for
Engineers, engineering has a direct impact on the quality of
life for many people; therefore, engineers must approach
their jobs with honestly, integrity and fairness [3]. In tissue
engineering, it is imperative that engineers treat all forms of
life with respect, are mindful patient rights, and continuously
work to better the lives of others [4].
As a freshman engineering student, it is important
to be familiar with the expectations of an engineer. By
researching topics of interest, young engineers will gain a
better understanding of the area of engineering that interests
them. Also, through studying ethics, engineering students
are made aware of their responsibilities to society early on in
their careers. Education is vital to the development and
success of an engineering student, and exposure to the
challenges and ethics of engineering should be introduced as
early as possible.
FIGURE 1 [8]
BASIC TUBULAR SEGMENTS OF THE NEPHRON.
RENAL FAILURE
There are three stages involved in renal failure:
reduced renal reserve, renal insufficiency, and end-stage
renal disease. During the reduced renal reserve stage,
nephrons begin to fail but patients are asymptomatic. If more
than 75% of the nephrons fail, renal insufficiency is said to
occur, resulting in clinical symptoms (excessive urination)
and detectable laboratory abnormities (elevated nitrogenous
waste in the blood). When more than 90% of the nephrons
fail, end stage renal disease has occurred, leading to dilute
urine, low urine output, severe fluid and electrolyte
imbalances, and an inability to maintain homeostasis [9].
KIDNEY STRUCTURE AND FUNCTION
The kidney regulates internal electrolyte and water balance,
secretes hormones, and eliminates toxins [5]. It serves as a
filter and receives about 20% of cardiac output. The basic
functional unit of the kidney is the nephron [6]. Each
nephron is composed of a series of tubes that receives
filtered blood and regulates electrolyte and water balance by
active secretion and reabsorption important materials [5]. A
deterioration of kidney function caused by the loss of
nephron function, leading to a loss in the organs ability to
perform its critical functions, is termed renal failure [7].
University of Pittsburgh
Swanson School of Engineering
November 1, 2011
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Hailee Kulich
donor organs and rejection of the foreign organ by the
recipient’s immune system. This may require the recipient to
be placed on expensive immunosuppressive drugs, making
them much more susceptible to opportunistic diseases [12].
Even when successful, the transplanted kidney has a limited
life span, lasting on average kidney approximately seven
years [13].
Thus, while dialysis and transplantation may
provide relief to renal failure patients, both have their
drawbacks. The development of a better therapy, specifically
an artificial kidney, may greatly improve the lives of patients
with renal failure. However, engineers must carefully
approach tissue engineering of the kidney by researching
and experimenting in an ethical manner [3].
BIOENGINEERING OF THE KIDNEY
The main purpose of tissue engineering is to mimic the
function of damaged organs through replacement, repair, or
enhancement [2]. However, the kidney is a complex organ
consisting of many different cell types making the task of
creating a bioengineered alternative treatment difficult, but
not impossible. Three approaches to solve this problem
include engineering nephrons to integrate into the kidney,
stem cell engineering and development of the artificial
kidney. If successful, this new medicine will lead to a better
quality of life for thousands of people. However, while
researching, engineers often run into many ethical issues
involving animal testing, responsibility towards patients, and
public welfare. The invention of such a device would make
society better off, fulfilling an ethical obligation engineers
have to the world.
FIGURE 2 [9]
EFFECTS OF RENAL FAILURE.
DIALYSIS AND KIDNEY TRANSPLANT
Currently, there are two main treatments available for renal
failure: dialysis and kidney transplantation [7]. Dialysis is a
process that involves removing the blood from the body,
filtering it, and returning it back to the body. This process
removes harmful toxins from the blood and regulates
electrolyte balance. However, it is an invasive procedure that
must be done on a regular basis [2].
Nephron Integration
In theory, kidney function could be improved using tissue
engineering to generate new nephrons to replace the
patient’s diseased nephrons. In this process, developing
nephrons are implanted into a host kidney, where they grow
and differentiate. When the nephrons are fully mature, they
are implanted into a diseased kidney with the hope that they
will become a functioning part of the kidney, increasing
renal function [2].
This experiment has been successfully performed in
mice, proving that it is possible to incorporate new nephrons
into a healthy kidney. However, nephrons must be able to
integrate into a diseased kidney to be an effective treatment
for those with renal failure [2]. Because those with end stage
renal disease have small, fibrotic kidneys, it may be difficult
for nephrons to function in this microenvironment, as
evidenced by the fact that nephron integration has never
been successfully reported in the context of an end-stage
kidney [2], [8]. Elucidation of the mechanisms that would
allow for successful nephron integration in an end-stage
FIGURE 3 [10]
THE PROCESS OF DIALYSIS.
Another option for those suffering from renal
failure is transplantation. A functional kidney is removed
from a donor or cadaver and transplanted into the recipient.
While this process may seem like a great solution, kidney
transplants are wrought with problems, such as a shortage of
University of Pittsburgh
Swanson School of Engineering
November 1, 2011
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Hailee Kulich
kidney has the potential to revolutionize treatment for those
with renal failure since, unlike kidney transplantation,
nephrons can be engineered specifically for the individual,
eliminating the need for immunosuppressive drugs and their
deleterious side effects [2].
Additional testing is necessary before this process
could be successfully integrated into the human kidney.
However, much of the testing that would be required would
be performed on animals, which is a sensitive subject in the
bioengineering community. Engineers are to treat every life
with respect, whether it is human or nonhuman [4]. Several
measures must be taken to ensure that animals involved in
research are treated properly.
If nephron integration was to be successfully
performed in a human kidney with renal failure, treatment
options would become much more manageable for patients
suffering from this disease. It would eliminate most of the
painful side effects associated with dialysis and
transplantation, leading to a better quality of life for many
people [2]. As an engineer, one strives to better public health
and welfare [3]. By successfully completing this project,
engineers could treat renal disease in a more ethical manner.
A successful artificial kidney would be much more
efficient than both dialysis and transplantation. It would
drastically reduce harmful side effects caused by these
procedures and would be longer lasting [2]. Because this
would lead to a better quality of life for others, an artificial
kidney would be a much more ethical treatment than dialysis
or transplantation.
TISSUE ENGINEERING: ETHICAL?
Because of the research necessary for tissue engineering, one
may argue that the alternatives to dialysis and
transplantation are not ethical. However, so long as the
engineer respects all forms of life and patient rights, these
procedures provide safer, more effective options for those
suffering from renal disease. This would improve overall
public health and, therefore, be a more ethical option than
both dialysis and transplantation.
Tissue engineering deals with many sensitive
subjects, such as animal testing, patient rights, and public
health. As a bioengineer, it is vital that these areas are
approached very carefully. Research involving experiments
on animals can be difficult to manage. It is an engineer’s
responsibility to treat all life forms with respect and in the
most humane way possible. A bioengineer must also take
care to be constantly aware of patient rights. This includes
obeying all patient privacy laws, keeping all research
regarding a patient confidential, and respecting patient
decisions [4].
Perhaps the most important goal for bioengineers is
to improve public health and welfare [3]. The development
of a better alternative to renal failure treatment would benefit
thousands of patients around the world. While there are
some downsides to the research that is required to develop
better medicine, the potential benefits outweigh the
negatives. Because the health and welfare of the world
would greatly improve through the research to provide better
alternatives to renal failure treatment, it is both ethical and
necessary to continue research in this field.
The Artificial Kidney
The goal of an artificial kidney is to replace all the functions
of the human kidney. While several attempts at this have
been made, the most popular device is a renal tubule cellassist device (RAD). The RAD contains 1) a series of tubes
lined by cells from the potential RAD recipient designed to
replace the failing kidney’s endocrine and metabolic
functions and 2) a hemofiltration cartridge, designed to
replace the failing kidney’s filtration [2]. As in nephron
integration, the cells in the device belong to the recipient,
eliminating the complications caused by rejection and
immunosuppressive medication.
EARLY EDUCATION
Because of the many ethical issues engineers face on a daily
basis, early education is essential for young engineers. By
introducing the problems professionals face, engineering
students gain a better understanding as to what issues they
will face in the future. Also, by allowing students to delve
into a topic of interest, it allows them to reaffirm their
interest and will most likely give the students an easier time
choosing the engineering field that suits them best.
Early education is necessary for the development of
a young engineer. When exposed to the experimental and
ethical concerns, it allows engineers to strengthen their
critical thinking skills as well as fully understand their
responsibilities to society. The process of understanding the
achievements of engineering and the ethical concerns with
FIGURE 4 [14]
MODEL OF A RENAL TUBULE CELL-ASSSIT DEVICE (RAD)
University of Pittsburgh
Swanson School of Engineering
November 1, 2011
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Hailee Kulich
[11] Torpy, Janet. (2011) “Kidney Transplantation” The Journal of the
American Medical Association. [Online article]. Available: jama.amaassn.org
[12] (2008) “Kidney Transplant Overview” The New York Times. [Online
article]. Available: http://health.nytimes.com\
[13] Fillmore, Cathleen. (1987) “The Problems of Pioneering Patients” The
Toronto Star. [Online article]. Available: http://www.lexisnexis.com
[14] (2008) “New Kidney on the Block” University of Michigan Health
System.
[Online
Picture].
Available:
http://www.med.umich.edu/insideview/volume3/issue5/new_kidney.html
those achievements is vital for a successful engineering
student and should be introduced as soon as possible.
ENGINEERING, ETHICS, AND EDUCATION
Currently, 300,000 individuals suffer from renal failure in
the United States [2]. The mainstays of therapy are dialysis
and kidney transplantation, both of which are costly and
have undesirable side effects. As illustrated above, many of
the problems associated with the current therapies could be
solved through bioengineering, leading to the development
of better way to treat renal failure, potentially improving the
quality of life of thousands Americans.
While this process could benefit many people,
engineers must take care to approach this problem in an
ethical manner. This includes respecting all forms of life,
obeying patient rights, and working to better public health
and welfare. The development of better medicine to treat
renal failure would greatly improve public health, making it
an ethical procedure worth pursuing.
Because the world of engineering requires
knowledge of achievements and ethics, early exposure to
these ideas is vital. If given the opportunity to research
challenges and ethics, the engineers of tomorrow will
develop into more successful engineers.
ADDITIONAL SOURCES
Amadei, Bernard. (2011) “Engineering for the Developing World” National
Academy of Sciences on behalf of the National Academy of Engineering.
[Online
article].
Available:
http://www.engineeringchallenges.org/cms/7126/7356.aspx
Revkin, Andrew. (2008) “How Many Grand Engineering Challenges are
Really Policy Changes?” The New York Times. [Online article]. Available:
http://dotearth.blogs.nytimes.com/2008/02/20/how-many-grandengineering-challenges-are-really-policy- challenges/
Richardson, Jim. (2002) “Effects of a Freshman Engineering Program on
Retention and Academic Performance”.[Online Article}. Available:
citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.20...rep...
FMpgqBQFpc8w42dygMau2lI0lRjJs2txpo5fdYNENd_S8BB&sig=AHIEtb
Q2Rgzed2J_lqO4_OPkzHUPc1pW1g
Unger, Stephen. (2010) “Responsibility in Engineering: Victor Paschkis vs
Wernher von Braun. IT Professional, University of Pittsburgh Swanson
School of Engineering Volume 12 Issue 3, 2010, p. 6-7,
DOI10.1109/MITP.2010.94
(2011) “The Grand Challenges” National Academy of Engineering Grand
Challenges
for
Engineering.
[Online
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Available:
http://www.engineeringchallenges.org/
REFERENCES
[1] (2011) “Introduction to the Grand Challenges for Engineering.”
National Academy of Engineering Grand Challenges for Engineering.
[Online:
Web
site].
Available:
http://www.engineeringchallenges.org/cms/8996/9221.aspx
{2] Hammerman, Marc. (2003) “Tissue Engineering the Kidney.” Kidney
International, Vol. 63. [Online Article]. p1195-1204. Available:
http://web.ebscohost.com/ehost/detail?sid=c2b680cf-7649-42ff-bca499c2b88b3148%40sessionmgr113&vid=1&hid=105&bdata=JnNpdGU9Z
Whvc3QtbGl2ZQ%3d%3d#db=aph&AN=9267388
[3]”NSPE Code of Ethics for Engineers.” National Society for Professional
Engineers.
[Online
Article].
Available:
http://www.nspe.org/Ethics/CodeofEthics/index.html
[4]”Biomedical Engineering Society Code of Ethics” Biomedical
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Society.
[Online
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Available:
http://www.bmes.org/aws/BMES/pt/sp/ethics
[5] Gattone, Vincent. (2009) “Kidney Structure and Function.” Microscopy
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America.
[Online
Article].
Available:
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid
=5912220
[6] Chmielewski, Christine. (2003, April) “Renal Anatomy and Overvie of
Nephron Function.” Nephrology Nursing Journal. [Online Article].
Available:http://pitt.summon.serialssolutions.com/search?s.dym=false&s.q=
Author%3A%22Chmielewski%2C+Christine%22
[7] Costa, Jonathan, Crausman, Robert, Weinberg, Marc. (2004). “Acute
and Chronic Renal Failure” Journal of the American Podiatric Medical
Association.
[Online
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[8] (2011) “What is Renal Function?” Kidney Care Center. [Online
Picture]. Available: http://kidneycares.com/forPatients.aspx
[9] Kelly, Maryann. (1996) “Chronic Renal Failure” American Journal of
Nursing. [Online article]. p 36-37. Available: http://ovidsp.tx.ovid.com/sp3.4.2a/ovidweb.cgi
[10] (2011) “Dialysis” Health and Fitness. [Online Picture]. Available:
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ACKNOWLEDGEMENTS
I would like to thank Beth Bateman Newborg and Deborah
Galle for their helpful insight into the requirements of this
assignment. I would also like to thank the staff at the
Benedum Library for their assistance in finding the reliable
information used to write this paper. Finally, I would like to
thank Dr. Scott Kulich for his expertise on kidney function
and his proof-reading abilities.
University of Pittsburgh
Swanson School of Engineering
November 1, 2011
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