The Future of Organ Transplants May Be Printed—But for Whom?

As 3D bioprinting becomes a reality, equitable access is not

Published on June 5, 2014by Joshua Brooks

Imagine using a 3D printer to save lives instead of creating curios. The thought that failing organs might someday be printed from our own cells on a 3D printer and transplanted into our bodies is a compelling one.

After all, eighteen people die each day in the U.S. waiting for an organ to replace their failed or failing one. The same want for organs exists globally, creating a gap that fuels an illegal organ trade generating an estimated $600 million to 1.2 billion per year worldwide.

So, using extracted cells to construct organs through 3D printing is an amazing prospect to reduce dependency on available donors, made all the more enticing by the sci-fi nature of the pursuit. The fact that it sounds like something out of a movie is most likely one the reasons it’s getting such heavy press.

“We’re basically taking cells from some patients and putting them back into the same patients so the tissue becomes their own in the end,” Dr. Anthony Atala, a leading physician-researcher in the field and director of Wake Forest Institute for Regenerative Medicine, said of the technology.

But, 3D printing of organs for transplantation is still in its infancy, with many hurdles to overcome. Researchers and physicians project five to twenty years for human studies on lab-grown organs, depending on who you ask and the complexity of the part.

While printing organs outright from a 3D printer may be relatively far off, early procedures leading to this next step have had success. Stem cells extracted from transplant patients have been grown to create conduit vessels used in the heart, urethras, trachea and, most notably, bladders built on degradable composite scaffolds. These lab-grown organs have been successfully transplanted back into the same patients.

Undoubtedly, the potential is enormous. Namely, there is no need to wait on the organ wait list or track down a donor, and the recipient will not likely reject an organ of his or her own cells.

But, how much would 3D printed organs really change the paradigm?

3D printing is groundbreaking from a medical standpoint and represents a new world of possibilities. But, the greatest of the ethical debates it poses is the lack of equitable access of this future technology.

The current cost of organ transplantation in the U.S. can vary from $20,700 for a cornea to $1,121,800 for an intestine, according to a report from consulting firm Millman, Inc. With such prohibitive costs, the wait time is not the only barrier to care for the majority of patients. Those with means can afford transplants others cannot. The same socioeconomic divide that drives a portion of the medical tourism contributing to the illegal organ market may also make bioprinting a life-saving technology for the elite only. The introduction of new health technologies is accompanied often by inequitable access.

Meanwhile, biotech companies like Organovo and TeVido are struggling to be some of the first commercial ventures to make 3D bioprinting a reality. Organovo has bioprinted liver tissue that can be used to test drugs before proceeding to clinical trial. The sliver-sized 3D cultures are a possible jumping off point for printing a full liver. TeVido hopes to print breast tissue as an implant for women produced from their own cells—a means of lumpectomy repair for women with breast cancer.

Despite the appeal, both are looking at years of costly research and design (R&D) for what may be a relatively small portion of the projected $1.9 billion 3D bioprinting market. If they make their breakthroughs, it’s unlikely that these companies will be fighting to reduce the price of their 3D bioprinting technology and services to cater to the less fortunate.

For now, vanity and war (fortunately or unfortunately, depending on how you see it), may bankroll the ongoing innovation. Dr. Atala, is leading a consortium of over 30 academic institutions and industry partners funded by a $75 million grant from the Armed Forces Institute of Regenerative Medicine. The five-year project aims to develop clinical therapies including restoration of severely traumatized limbs, skull and facial reconstruction, and skin regeneration of burns. TeVido’s well-meaning solution to lumpectomies may underwrite costs of R&D by eventually entering the $10 billion world of cosmetic plastic surgery—bioprinting implants and nipples for elective surgeries.

3D printing is groundbreaking from a medical standpoint and represents a new world of possibilities. But, the greatest of the ethical debates it poses is the lack of equitable access of this future technology.

Like most medical advances, it’s not always clear which factors can help reduce their cost. We’re not there yet, but for a technology with such “wow” factor and fanfare, physicians, patients and healthcare advocates need to watch closely.

As more 3D bioprinting transplant procedures are proven successful, advocates should develop parallel plans to make them accessible to all by monitoring 3D bioprinting’s actual effect on health care spending, reducing proprietary overreach, building capacity for extracted cell growth and anticipating large-scale 3-D printer demand. Otherwise, the reality might mirror a less optimistic sci-fi future of the healthcare haves and have-nots, not unlike that recently put to film.

Edited by Dana March