Human tissue should not be bought or sold for profit. Agreed? But it's OK to pay “legitimate expenses,” “handling charges,” “processing costs,” and so on. So the boundaries are blurred. How far can this be stretched?
Figure 1.
Eds Stuart J Youngner, Martha W Anderson, Renie Schapiro
Oxford University Press, £27.50, pp 216 ISBN 0 19 516284 6
Rating: ★★★
The answer, perhaps inevitably, comes from the United States. The US situation is the sole subject of this book. Furthermore, the “tissue” under consideration is largely restricted to musculoskeletal tissues and skin; whole organs are specifically excluded. Publication was stimulated by a furore in the American popular press about commercial companies “selling” human tissue, which had been freely donated after death, apparently for huge profits.
Numerically this industry dwarfs organ transplantation in terms of donors, recipients, and raw cash—approaching $1bn in 2003. The book nicely dissects the practical aspects and clearly delineates the major ethical dilemmas. Inevitably, nothing is as simple as it seems in a banner headline. Are “not for profit” companies necessarily so different from “for profit” companies, apart from the former paying less tax? When “for profit” companies invest huge sums in state-of-the-art clean facilities for tissue preparation and high tech engineering equipment to produce precisely machined bone transplants for spinal surgery, are they not entitled to some return on their investment? In practice, commercial finance has raised standards all round and improved outcomes for many patients; is that wrong?
Two fascinating chapters, rightfully in the centre of the book, are by relatives of deceased “tissue donors.” One is a doctor, the other a lawyer. They are articulate—but are they representative? In fact, one cares little about commercialisation of his dead son's tissues, as long as something good for other patients emerges from an otherwise relentlessly black disaster. The other's main objection is not that profits are being made, but that companies are describing and marketing human tissue as a “product,” with no mention of the gift that invariably starts the long, complex process.
The analysis of the ethical issues is accessible; this is not a book just for philosophers. The emphasis of the conclusion is on practical solutions. Improved information is central—surprise, surprise!—but so is explicit acknowledgment throughout the process of the essential donation at the beginning, and more openness from tissue processing companies about exactly what they do. Can they prove that they do not process donated skin for “vanity” surgery at the expense of burns patients? “Commercially sensitive information” should not be an excuse for secrecy.
As other countries struggle with how to regulate new and existing uses of human tissue they have much to learn from the United States' experience, some of which is well described in this slim volume. For me, the core message is that the unthinking application of simple, unbending “ethical rules” to such complex issues could have disastrous consequences for patients.