Bioprinting Organs on Demand: From Sci-fi to Reality and the Ethical Dilemma of Designer Bodies

Nephrologist: “Hello. We've got a set of failing kidneys. Please, how soon can we get a new set created and ready to implant?”

Biotechician: “We’ll come for the patient's biomaterials and have them ready in the next two months”.

That could have saved the life of a family friend after her kidneys failed 5 years ago—worst, she had a rare blood type. After being on the waiting list for 3 years undergoing excruciatingly painful dialysis, she caved into the verdict she dreaded the most.

However, this article is not just a sob story of a friend. This is a revelation of how regenerative medicine, which you might have thought belonged to the fictitious world of Sci-fi, could be the savior of many lives like hers now and in the future.

I’m talking about “3D Bioprinting”.

The Back Story

The number of humans with failing organs on the waiting list for organ transplants is overwhelming for the medical field.

Organdonor.gov states that in the U.S. alone, over 103 thousand men, women, and children are on the national transplant waiting list.

Every 10 minutes, one person is added to the list and 17 people die each day waiting for an organ transplant.

In 2023, out of 88,551 awaiting kidney donors, only about 24% received transplants. That is in the U.S. alone, we can only try to imagine what the numbers could be in other parts of the world.. Or can we even imagine the reality in third-world countries with no structured organ donation system?

Dr. Jennifer Lewis, a professor at Harvard University's Wyss Institute for Biologically Inspired Engineering, in an interview with CNN, has an insight into the problem.

In her statement, she mentioned that on a yearly average, there are only around 6,000 living donors open to offering their organs and about 8,000 deceased donors who could each provide approximately 3.5 organs.

Dead donors are people who die from catastrophic health events or accidents, making some of their organs salvageable before they completely stop living.

However, because of such events, their organs may not be of high quality for a donation or they may not even be on the organ donor list or it may be hard to find a good match.

For living donors, there is a scare as to what their life is worth, if it is the right choice to make if they are willing to let go and embrace the possible complications that may arise from donating their organs and the surgery involved - especially if the patient is not related to them.

There is a two-step delirium that raises the most fear for a patient clinging onto the last thread of hope. First, finding a donor match, then hoping the patient's body doesn't reject the donated organ. And from all the premises stated above, this is a tough call.

A wait list could just as well be a death row.

What if it could be different? What if organs could be printed from biodata, materials, and cells of a patient instead of waiting for months to years to find a donor that would match?

What if regenerative medicine is the solution staring into our eyes?

A handful of medical conditions would meet their end if this could happen. Ordering a newly generated body part from the cells of the patient to replace the old one could easily be more effective and faster than organ donations.

This brings us to the 3D organ bioprinting.

What is 3D Bioprinting?

The idea of 3D bioprinting is like that of conventional 3D printing. However, it is premised on the use of organ regenerative actions which involve the manufacturing and development of organs, tissues, and body parts such as the liver, skin, heart, eyes, bones, etc.

While conventional 3D printers use computer files to extrude and create objects with complex structures, 3D bioprinters make use of bioinks containing living viable cells, biomaterials, and biomolecules to create bioartificial organs of a human.

This works by assembling layer-by-layer multiple cell types, biomaterials and molecules, and other growth factors that would be a replica of the natural prototypes.

In this case, it is beyond just mere perception that creating a new component for a body by using its cells is much more reliable than taking a component with a completely different cell structure from another body to replace a component in a body.

This way, a patient, on-demand, can have personalized replacement body parts with a very low possibility of their body rejecting the new parts.

This technology is driven by the need to find the accurate organ and tissue types that would be a match for patients who need organ replacement and is opening new avenues for future organ transplantation programs.

How Does 3D Bioprinting Work?

For bioprinting, every procedure starts with the biological cells of the person involved and applies the concepts of biomimetics and biomimicry. This simply means using a patient's cells to grow the needed organ.

Biotechicians choose cells based on their physiology and functions. They consider the cells’ differentiation and proliferation by paying attention to features such as the cell type, size, and shape

These different types of cells are rendered into a printable bioink, which involves mixing them up in materials like alginate or gelatin; before they are loaded into a nozzle.

To continue, each cell is placed, layer by layer, in precise locations to form a cellular attachment and build a complex tissue that would develop the organ.

For the cell's culture to grow, it is transferred to a scaffold where blood vessels are integrated into the tissue and the setup is connected to a pump that would deliver the right amount of oxygen and nutrients to keep it alive.

With time, the tissue will begin to develop on its own, forming an organ that will increase both in maturity and function.

This is a phase of 3D tissue engineering and although this is dramatically simplified, the process requires more technicalities only applicable to experts in the biotech field and could evolve with time.

From the looks of things, 3D bioprinting is already here for good.

Cases of 3D Bioprinting

It is no longer a myth or a fictional idea; this regenerative medicine technology has become a reality.

In this decade, research institutes, researchers, and doctors have dedicated time and resources, working actively on experimenting with organ bioprinting—some are already recording success.

The First Ear Bioprint

In 2022, the U.S. witnessed the implantation of a new ear on a 20-year-old lady born without her right ear.

Of course, a new ear could have been artificially constructed and placed, but this time, Dr. Arturo Bonilla, a pediatric microtia surgeon, changed the rule of the game by implanting a 3D bioprinted ear developed out of the cartilage cells of the lady's left ear.

Imagine multi-layered skin, cartilage, and muscle structures born out of laboratory-grown cells to form an ear. Amazing! This was a worthwhile revelation that bioprinting could change the way new body parts and organs were sourced.

Ongoing Research on Bioprinting

The race to find more potentially relieving 3D bioprinted tissues and organs surged even more.

Still in 2022, this abstract and Dr. Michal Wszola, creator of Bionic Pancreas, revealed that some researchers in Poland were able to achieve the 3D bioprint of pancreas in pigs within a two-week window period, enabling stable blood flow in these pigs.

Hope is alive as the National Institute of Health’s Advanced Research Projects Agency for Health (ARPA-H), in September 2023, awarded some Stanford researchers about $26 million in contract to bioprint a human heart and transplant it into a pig in the next five years.

However, the 3D bioprinting of human lungs with 4,000 kilometers of capillaries and 200 million alveoli, capable of carrying out oxygen exchange in animal models, which is a critical step towards the development of tolerable, transplantable lungs has been achieved by United Therapeutics Corporation. The goal is to have the lungs cleared for human trials within five years.

Another research institute with impressive strides is the Wake Forest Institute for Regenerative Medicine.

Researchers in this institute have been able to develop the following:

• A skin bioprinting system for patients suffering from skin cancers, burns, and other non-healing or deprecated kin conditions.

• A 3D bioprinting skeletal muscle system was shown to effectively contract in rodents and enable an 80% regain of lost muscular function in an anterior leg muscle within a space of 8 weeks.

• Printing of tubular structures like blood vessels or hollow, non-tubular organs like a bladder.

• 3D biocreation of a mini-kidney and a mini-liver.

The challenge for Wake Forest scientists is the creation of larger and more solid organs that can fully mimic the functions of their prototypes. This is because these large organs, like the brain and heart, have so many cells per centimeter, and there is the challenge of vascularity and nutrition.

The brain is a very complex tissue that is difficult to repair or replace when damaged. However, some Oxford researchers believe that the bioprinting of stem cells can reverse brain damage and injuries.

These researchers have gone on to prove this verdict by creating 3D bioprinted stem cells which developed a biomimicry of the complex structure of the human cerebral cortex, having six layers (two “deep” layers and four “upper” layers), each with its type of neuron.

When the tissues were implanted into slices of mouse brains, they successfully integrated into the mouse tissue, structurally and functionally.

The Problems and Ethical Considerations Surrounding the Creation of Bioprinted Body Parts and Organs

As much as this concept looks like a lifesaver for many hopeless medical cases in the world today, there are still some problems this could pose.

The bioprinting of organs is based on individual medical care rather than a basic universal treatment plan like that of organ donation.

There is an assumption that due to its personalized medicine status, the cost of this service may just be more expensive than a public treatment plan would be, and this could prevent financially unstable people from getting access to this service.

Is it safe? We can't say for sure.

The 3D printing of organs and parts of the body using bioink is not considered neutrally ethical and even if it is generated from the patient's cell, there are still problematic aspects in terms of cell reprogramming, differentiation, proliferation, and of course mutation which may usher in the much-dreaded apocalypse.

There is the risk of tumorigenicity, which is the property of a cell to form tumors when inoculated. While bioprinting is considered an incoming savior of the sick and deprived, this technology cannot be rushed.

The efficacy of its procedures has to be tried and tested severally before it can be rolled out as clinically applicable. If this is not done, it can lead to several deaths that may be beyond control.

There are also additional ethical and legal concerns related to patients' genetic information collection, which also include the storage and use of these cells.

Advantages of Bioprinting and Designer Bodies

Every technology has a downside, but it so happens that compared to the downsides of this technology, if it is put through all processes of long years of research and experiment with a high success rate, 3D organ bioprinting could nearly nullify the cause of concern.

There are issues the bioprinting of organs and body parts would solve:

1. The endless waiting list that could spell ‘doomsday is awaiting’.

2. The torture that comes with getting a transplant; only for the patient's antigens to reject the organ.
3. The need for immunosuppression to prevent organ rejection, which leaves patients at higher risk of infection.
4. The risk of a living donor (even though willing) experiencing some possible complications that could arise during surgery.

Body parts manufactured through bioprinting can be enhanced to improve performance.

Bones can be made stronger and more flexible, the brain can be made smart and alert, the lungs can be made to increase oxygen efficiency in the blood, etc.

In terms of cost, while critics claim that the price of bioprinted parts would be expensive, the fact remains that compared to waiting years for an organ to finally get to a patient who is at risk of losing their life any moment, this is fair.

Most times these donated organs come at a very high cost (although sometimes illegal) because of the demand. However, the price of a bioprinted organ could reduce considerably when they clinically pass trials and patients wouldn't have to wait for several months, to a couple of years to get them.

How close are we to the future?

Brain, kidneys, muscles, skins, livers, pancreas, and so much more are in the laboratory phase of 3D experimentation. In the next 5 to 10 years, there is a high expectation of breakthroughs in these experiments, some passing clinical trials and being fully implementable.

Needless to say, a few decades from now, people like Cynthia  (my late friend whose story I narrated at the beginning of this article) won't have to accept the cruel death verdict while waiting for the right organ match.