Faculty Bibliography

In December 2002, a conference was held in Philadelphia to discuss public concerns about living organ transplantation with the goal of reaching a consensus about new strategies for such transplants. The conference was hosted by the Hospital of the University of Pennsylvania and the Center for Bioethics. A multidisciplinary group of leading experts and stakeholders was called to assess the current status of living donation and suggest productive changes to ensure safer and more ethically sound procedures for both donors and recipients. Prior to the meeting, the research team from the University of Pennsylvania, Center for Bioethics, conducted literature reviews and extensive background research on living organ transplantation. Summary briefs were prepared for all conference participants. Issues were divided into four subcategories; two or three experts led the discussion on each topic. At the conclusion of the conference, the points raised were summarized and discussed, and additional comments were offered before general agreement was reached on each subject. Transcribed minutes and summary statements were reviewed and circulated among participants to allow for additional comments and clarification. All feedback was incorporated into the statement, and a draft of the article was recirculated. Participants who have endorsed the following statements have agreed that these points represent the intent and spirit of the discussion, yet each participant reserves the right to disclaim the document in its entirety. The views represented in the consensus points are held by members of the consensus group and do not necessarily represent the views of the sponsor. A consensus was reached to propose new strategies and make improvements on existing practices and protocols. Specific attention was paid to the widely accepted needs of consistent and responsible communication with the public and press, standardization in donor assessment, a national living donor registry and new research focusing on larger sample numbers and long-term donor follow-up. These consensus points support the work carried out by other advisory transplant organizations and should assist in advocating for living organ donors, the live donor transplant process and the concerns of the public.

While the Holocaust is often placed at the genesis of bioethics, this relatively young field has not yet seriously explored the conduct of German scientists and physicians involved in the human subjects experiments of the Holocaust. We comfort ourselves with the beliefs that the individuals involved in the events of the Holocaust were mad or evil and unlike other scientists and physicians. Yet the evidence is that these professionals were educated and capable members of a technologically sophisticated society who believed they were somehow behaving morally within the context of their social-political situation. The first defendants at Nuremberg were physicians and public health officials. An examination of the trial transcripts provides data about what motivated these medical scientists to engage in human experimentation and mass murder and the extent to which ethics rationales were given for unparalleled moral wrong-doing in biomedicine. Bioethics must still address these beliefs and subject them to close scrutiny.

Both adult women and prepubertal girls facing cancer treatment may have the option to harvest and cryopreserve ovarian tissue. If they have successful therapy for their disease, the tissue may be autotransplanted back into the woman's body or follicles may be harvested and matured in vitro. These techniques all remain experimental, however, and should be performed only by specialized centers that can provide a multidisciplinary team. The procedures should be done under approval from an Institutional Review Board with proper assurance of informed consent. Although the costs for research could be assessed to patients if no research funds are available, clinical fees should not be charged at this stage in the development of these technologies. Consideration should be given to the protection of minors by ensuring parental informed consent and child assent whenever possible. Disposition of cryopreserved gonadal tissue in the event of the participant's death should be formally designated. A registry should be established to follow the health of participants and their eventual offspring.