By Laura Kimberly, Brendan Parent

Every article about the organ transplant crisis starts something like this: In the United States in 2018, over 116,000 individuals were on the waiting list for an organ transplant. Yet of those on the waiting list, only 36,000 (31%) received a much-needed transplant to treat their end-stage organ failure, and over 6,000 people died while waiting. These numbers largely reflect a supply issue – the limited availability of transplantable donor organs. But what if we didn’t have to rely on donated organs?

Bioengineered organs – lab-created organs tailored to individuals – present a potential option to increase supply, and encouraging evidence emerging from research in animals suggests that the technology is progressing rapidly.

Before making the leap from animal to human testing, which will pose higher risks and greater ethical challenges, we must first consider other means to get preliminary data about how bioengineered organs will actually work in the human body. One way is to test manufactured organs on bodies that are recently deceased via a declaration of death by neurological criteria – brain death – and are being maintained on artificial organ support.

Although there is precedent for this and it does not constitute human subjects research, experimentation on the newly deceased may be unsettling to some. In the United States, there is a long history of acquiring deceased bodies in deceitful ways, and doing things to them that would have horrified the person and their family members. These associations may loom large.

Any such research efforts should be undertaken with the utmost care to respect the previous wishes of the deceased, and the rights and dignity of family members or other authorized decision makers. Before research on the deceased proceeds, there must be clarity and transparency regarding the role of hospitals, Organ Procurement Organizations and other involved institutions. There also needs to be a plan for communicating with the public. Assurance that organ donation for transplantation will be prioritized above research on the newly deceased may help to dispel some concerns.

Bioengineered organs could one day resolve the organ shortage. Ethical choices made during the research phase will strongly affect when and how these innovations are brought to fruition.

Paper title: The ethics of testing and research of manufactured organs on brain-dead/recently deceased subjects

Authors: Brendan Parent,¹ Bruce Gelb,² Stephen Latham,³ Ariane Lewis,¹ Laura L Kimberly,^1,4 Arthur L Caplan,¹ NYU Medical Ethics Working Group on Research on the Recently Deceased

Affiliations:

1 Division of Medical Ethics, New York University School of Medicine, New York City, New York, USA

2 Transplant Institute, New York University School of Medicine, New York City, New York, USA

3 Interdisciplinary Center for Bioethics, Yale University, New Haven, Connecticut, USA

4 Hansjörg Wyss Department of Plastic Surgery, NYU School of Medicine, New York City, New York, USA

Competing interests: None

Social media accounts of post authors:

Twitter: @parent_brendan; @ArthurCaplan; @StephenLatham

LinkedIn: Brendan Parent, Laura Kimberly, Arthur Caplan