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Ethics Matters

Who Needs Bionics? Recycled Humans are Here



by Jeffrey P. Kahn, Ph.D., M.P.H.
Director, Center for Bioethics
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?

Center
for Bioethics

What's your opinion?
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.



Visit the
"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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