Organoids as hybrids: ethical implications for the exchange of human tissues

Abstract

Recent developments in biotechnology allow for the generation of increasingly complex products out of human tissues, for example, human stem cell lines, synthetic embryo-like structures and organoids. These developments are coupled with growing commercial interests. Although commercialisation can spark the scientific and clinical promises, profit-making out of human tissues is ethically contentious and known to raise public concern. The traditional bioethical frames of gift versus market are inapt to capture the resulting practical and ethical complexities. Therefore, we propose an alternative approach to identify, evaluate and deal with the ethical challenges that are raised by the increasing commercialisation of the exchange of sophisticated human tissue products. We use organoid technology, a cutting-edge stem cell technology that enables the cultivation of ‘mini-organs’ in a dish, as an example. First, we examine the moral value of organoids and recognise them as hybrids that relate to persons and their bodies as well as to technologies and markets in ambiguous ways. Second, we show that commercialisation of organoids is legitimised by a detachment of the instrumental and commercial value of organoids from their associations with persons and their bodies. This detachment is enacted in steps of disentanglement, among which consent and commodification. Third, we contend that far-reaching disentanglement is ethically challenging: (1) Societal interests could be put under pressure, because the rationale for commercialising organoid technology, that is, to stimulate biomedical innovation for the good of society, may not be fulfilled; (2) The interests of donors are made subordinate to those of third parties and the relational moral value of organoids may be insufficiently recognised. Fourth, we propose a ‘consent for governance’ model that contributes to responsible innovation and clinical translation in this exciting field.

Responsible use of organoids in precision medicine: the need for active participant involvement

“…At the same time, organoid technology is developing rapidly, which has already led to the successful cultivation of many different kinds of organoids, such as stomach, liver, intestine, lung, kidney, and more recently also brain organoids, as well as gastruloids or embryoids that provide in vitro models of the early embryo (Aach et al, 2017;Huch et al, 2017;Schutgens and Clevers, 2020). These developments have raised questions about bodily integrity and identity, and what is considered ethically acceptable use (Boers et al, 2016(Boers et al, , 2019Bredenoord et al, 2017;Munsie et al, 2017;. Moreover, embryoids or gastruloids have led to discussion about whether, and to what extent, they might have moral status (Sutton, 1995;Munsie et al, 2017;Appleby and Bredenoord, 2018).…”

“…Second, organoids have enormous economic value, meaning there are strong commercial interests involved (Bartfeld and Clevers, 2017;Bredenoord et al, 2017;Boers et al, 2019). The application of organoids in precision medicine brings together different stakeholders with potentially conflicting interests (Caulfield et al, 2014).…”

6. Sind menschliche zerebrale Organoide moralisch schützenswert? Ein kommentierter Überblick über die aktuelle internationale Ethikdiskussion

“…Einige dieser Probleme sind bereits sehr intensiv in Bezug auf die Stammzellforschung diskutiert worden (vgl. Bredenoord et al, 2017;Boers et al, 2019;Hyun et al, 2020). Forschungsethische Fragen betreffen sowohl nicht-zerebrale Organoide, wie solche für Augen, Darm oder Nieren, als auch zerebrale Organoide.…”

“…eine moralisch relevante Beziehung aufbauen, gerade weil diese mehr als nur einfache Gewebe wären, dann scheint es nur konsistent, sie vorher um Einwilligung zu bitten. Daher könnte man auch von einem möglichen moralischen Wert von Organoiden sprechen, der zwar nicht dem absoluten Schutzanspruch entspricht, aber die Verwendung für (bestimmte) Forschungsvorhaben einschränken könnte (Boers et al, 2019). Dies könnte auch die Frage nach Eigentumsrechten (engl.…”

What (or sometimes who) are organoids? And whose are they?

“…In terms of their ethical implications, Boers  et al have made an interesting step forward with their model of organoids as hybrids, which seeks to find a balance between subject-like value and object-like value 1. The authors also propose governance principles and structures in order to enable the commercialisation of organoids as instruments for biomedical innovation, while preserving their relational-moral aspect.…”