Rights, Symbolism, and Public Policy in Fetal Tissue Transplants

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Rights, Symbolism, and Public Policy in Fetal Tissue Transplants

Fetal tissue transplants hold great hope for many patients. Extensive work with animal models has shown that human fetal brain cells transplanted into the substantia nigra of monkeys with exogenously produced Parkinson's disease have restored their function. Physicians expect similar results in humans, to the benefit of thousands of patients. [1] Experimental evidence is also strong that fetal islet cell transplants will restore normal insulin function in diabetics. [2] And fetal thymus and liver transplants may have utility for blood and immune system disorders.

Clarifying the Issues

As with many issues in bioethics, careful analysis will help elucidate the normative conflict, showing both areas of agreement and irreducible conflict. An essential distinction in the fetal tissue controversy is between procuring tissue from family planning abortions and procuring tissue from abortions performed expressly to provide tissue for transplant. Although opponents of fetal tissue transplants have often conflated the two, tissue from family planning aboritons may be used without implying approval of abortions to produce tissue. Indeed, with ample tissue available from family planning abortions, the latter scenario may never occur.

A second important distinction is that between retrieving tissue for transplant from dead and from live fetuses. Only the use of tissue from dead fetuses is at issue. Researchers are not proposing to maintain nonviable fetuses ex utero to procure tissue, or to take tissue from them before they are dead, practices that current regulations and law prohibit. [3]

A third set of tissues concern tissue procurement procedures. If fetal tissue transplants do occur, questions about the timing, substance, and process of consent must be addressed, as well as the role of nonprofit and for-profit agencies in retrieving and distributing fetal tissue. As with solid organ transplantation, effective tissue procurement may occur without buying and selling fetal tissue.

At present there are few legal barriers to research or therapeutic use of donated fetal tissue for transplant. The Uniform Anatomical Gift Act (UAGA) in all states treats fetal remains like other cadaveric remains and allows next of kin to donate the tissue, though a few states have laws banning experimental use of aborted fetuses. [4] Federal regulations for fetal research, enacted in 1976 after careful study by the National Commission for the Protection of Human Subjects of Biomedical and Behavorial Research, permit research activities "involving the dead fetus, mascerated fetal material, or cells, tissue, or organs excised from a dead fetus...in accordance with any applicable state or local laws regarding such activities." [5]

The most immediate public policy question is whether these rules should be changed to prohibit experimental or therapeutic fetal tissue transplants, as the most extreme opponents urge. A second public policy issue is whether federal funding of fetal tissue research should occur. A third set of policy issues concerns the circumstances and procedures by which fetal tissue will be retrieved.

Tissue From Family Planning

Abortions

Fetal tissue transplant research for Parkinson's disease, diabetes, and other disorders will use tissue retrieved from the one and a half million abortions performed annually in the United States to end unwanted pregnancies. Nearly 80 percent of induced abortions are performed between the sixth and eleventh weeks of gestation, at which time neural and other tissue is sufficiently developed to be retrieved and transplanted. [6] Abortions performed at fourteen to sixteen weeks provide pancreatic tissue used in diabetes research, but it may prove possible to use pancreases retrieved earlier. [7]

No need now or in the foreseeable future exists to have a family member conceive and abort to produce fetal tissue. …

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