Who Needs Bionics? Recycled Humans are Here
by Jeffrey P. Kahn, Ph.D., M.P.H.
University of Minnesota
Feeling worn out? We can make you better, faster, stronger than you ever
were before. Well, maybe not all of the above. But surgeons are on the
cusp of being able to transplant nearly any body part we can
think of -- arms, legs, knees, hips, muscles, even ears, throats, tongues
and whole faces. These are promising therapies for victims of disfiguring
accidents or disease, effectively taking the next steps in reconstructive
surgery, from creating often poor facsimiles or artificial body parts to
replacing them with the real thing -- albeit from someone else's body. Such
advances don't come without costs, however, both medical and financial. How
much health risk should patients take in return for a transplant that may be
life-enhancing but not lifesaving? Will people be willing to donate all
their body parts when they die, or only those that can save lives? Who
should bear the financial costs, and are they worth it?
How much risk for how much benefit?
The major obstacle to transplanting any tissue from one person to another is
the body's natural rejection response. Our immune systems, which protect
our bodies from foreign invaders such as bacteria, viruses and other
infectious agents, view other people's organs in the same way -- as unwelcome
intrusions into our body that must be attacked. To combat these natural
defenses, powerful drugs that suppress the immune system must be taken every
day for the remainder of the transplant recipient's life. Suppressing the immune system to allow foreign organs to survive lowers the body's
defenses against illness and infection.
Since transplants usually save the lives of the patients receiving
them, the benefits of heart, liver, lung or kidney transplants outweigh the
side effects of a lifetime of drugs and the chances of complication and organ
rejection. But what about transplants that may only improve function,
appearance, or both? Are the benefits of such non-lifesaving transplants
sufficient to outweigh their risks? Restoring basic life functions may
offer sufficient benefit, say transplanting a hand to a
double amputee or a voice box to a throat cancer patient. But why shouldn't
the gain in self-esteem of an accident victim who gets a new nose count as
much? When the risks are made clear, and as long as claims are reasonable
that the benefits outweigh the risks, then patients are in the best position
to decide. Purely cosmetic transplants -- one can envision requests for
newer knees or smaller ears -- wouldn't meet these standards.
Limited resources on limited benefits?
The extreme expense of heart, liver and other lifesaving transplants hasn't
raised questions about their value. But the experience with non-lifesaving
transplants is likely to be different. Spending increasingly limited
resources for transplants of increasingly less value will force questions
about their worth. In the end will we see such transplants available only
to those can pay for them out-of-pocket or who have the foresight to buy
special body part replacement insurance?
Are parts just parts?
Are we approaching a time when we perceive people as made up of
interchangeable parts that can be swapped out once they're finished being used
by one person and needed by another? We may well need to allow donors to
choose whether to be universal donors or to select which parts they'll donate.
At least we don't have to worry about incompatibility among manufacturers. A Ford transmission won't work in a Toyota, but ears are ears. In a way, it's comforting to know that we're all of the same stuff. And from the
standpoint of replacing body parts, it's also convenient, if controversial.
Of course, I write these last few sentences with tongue planted at least
partly in cheek -- and don't worry, it's my own.
Feeling worn out? Surgeons are on the cusp of being able to
transplant nearly any body part we can think of. Such advances don't come
without costs, however. How much health risk
should patients take in return for a transplant that may be life-enhancing
but not lifesaving? Will people be willing to donate all their body parts
when they die, or only those that can save lives? Who should bear the
financial costs, and are they worth it?
Post your opinion here.
"Ethics Matters" Archive
where you'll find other columns from Jeffrey Kahn
on a wide range of bioethics topics.
"Ethics Matters" is a biweekly feature from the
Center for Bioethics and CNN Interactive.
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