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At least 19 recordsLinked to original sources
PubMed1990

Ethical considerations in fetal tissue transplantation.

Recent research using fetal tissue transplants has expanded possible treatment options for several traumatic and degenerative neurologic disorders. However, the expectations of therapeutic benefit to be gained from these methods have been challenged by an equivalent degree of controversy. Fundamental viewpoints regarding abortion, physical autonomy and the principle of harm have been raised against continuing research and the use of fetal tissue transplants. In this article, we first attempt to elucidate the practice, potential and limitations of such techniques. The critical, yet unresolved issues of supply and sources of fetal tissue are also discussed. In light of these concepts, we examine certain pertinent obligations and ethical concerns that may clarify the nurses' role in dealing with cases involving the use of fetal tissue transplants.

Abortion, Legal↗
PubMed1991

Fetal tissue transplantation: can it be morally insulated from abortion?

Ethical controversy over transplantation of human fetal tissue has arisen because the source of tissue is induced abortions. Opposition to such transplants has been based on various arguments, including the following: rightful informed consent cannot be obtained for use of fetal tissue from induced abortions, and fetal tissue transplantation might result in an increase in the number of abortions. These arguments were not accepted by the National Institutes of Health (NIH) Human Fetal Tissue Transplantation Research Panel. The majority opinion of the panel stated that abortion and fetal tissue use are entirely separate issues, and that tissue use is ethically acceptable because it can be morally insulated from the issue of abortion. In support of this view, panel members and others have replied to the arguments put forward by opponents of fetal tissue use. However, replies to the two arguments mentioned above have been unsatisfactory, and the shortcomings of those replies are identified herein. Examination of the arguments pro and con suggests that fetal tissue use cannot be completely insulated from the issue of abortion. Thus, in seeking an ethical justification for fetal tissue transplantation we must consider reasons other than those put forward by the NIH panel. In this paper it is argued that whatever wrong is involved in using fetal tissue from induced abortions must be balanced against the benefits for patients, and it is on this basis that fetal tissue transplantation can be ethically justified.

Abortion, Induced↗
PubMed1987

The ethical options in transplanting fetal tissue.

Fetal tissue transplants have now been successful in primates, raising the possibility of treatment for Parkinson's disease and other chronic illnesses. Whether or not abortion is morally justified, use of human fetal tissue for research or therapy is justified in certain circumstances. The rationale, both for permitting transplantation of fetal tissue and for limitations in exercising the technology, is based on the same set of ethical principles that supported restrictive legislation in the past: respect for autonomy and a balancing of harms and benefits that gives priority to those most affected.

Aborted Fetus↗
PubMedDate not supplied

Neurotransmitter receptors in fetal tissue transplants: expression and functional significance.

Numerous studies have examined receptor expression in neural transplants and their possible role in transplant-induced functional recovery from lesion-induced deficits. Herein we attempt to summarize the results of these studies, especially those from studies involving striatal transplants. Autoradiographic studies indicate that dopamine D1 and D2, muscarinic, cholinergic, 5-HT2, opiate mu, beta adrenergic and cholecystokinin (CCK) receptors are present in striatal transplants. Many of these receptors are present regardless of the transplant location and surrounding environment. This suggests that the expression of these receptors is determined by intrinsic properties of transplanted tissue, and is independent of transplant location and environment. Some transplant receptors, such as dopamine D1 and D2 and muscarinic receptors in striatal transplants, or 5-HT2 receptors in cortical transplants, display a patchy distribution which is dissimilar to that in the corresponding adult host tissue. This manuscript discusses this "abnormal" receptor distribution and possible explanations. Electrophysiological studies have indicated that some of the transplant receptors respond to physiological and pharmacological stimulation, suggesting that they are functional. However, the association of receptor expression with behavioral recovery is uncertain. The expression of neurotransmitter receptors in neural transplants may not be essential for the functional recovery associated with trophic mechanisms. However, neurotransmitter receptors may play an important role when functional recovery requires neuroanatomical integration between the host brain and the transplanted tissue.

Animals↗
PubMed1993

Ethics of fetal tissue transplantation.

Now that the Clinton Administration has overturned the ban on federal funding for fetal tissue transplantation, old ethical issues renew their relevance and new ethical issues arise. Is fetal tissue transplantation necessary and beneficial? Are fetal rights violated by the use of fetal tissue in research? Is there a moral danger that the potential of fetal tissue donation will encourage elective abortions? Should pregnant women be allowed to designate specific fetal transplant recipients? What criteria should be used to select fetal tissue transplants? Whose consent should be required for the use of fetal tissue for transplantation? We review the current state of clinical research with fetal tissue transplantation, the legal history of fetal tissue research, the major arguments against the use of fetal tissue for transplantation, and the new postmoratorium ethical dilemmas. We include recommendations for guidelines to govern the medical treatment of fetal tissue in transplantation.

Aborted Fetus↗
PubMed1996

Neural fetal tissue transplants: old and new issues.

Neural fetal tissue transplantation offers promise as a treatment for devastating neurologic conditions such as Parkinson's disease. Two types of issues arise from this procedure: those associated with the use of fetuses, and those associated with the use of neural tissue. The former issues have been examined in many forums; the latter have not. This paper reviews issues and arguments raised by the use of fetal tissue in general, but focuses on the implications of the use of neural tissue for basic concepts of personhood and personal identity.

Aborted Fetus↗
PubMed2003

Does personality change as a result of fetal tissue transplantation in the brain?

This study examined the effects on personality of transplantation of fetal tissue into the brains of participants in a double-blind placebo control trial for the treatment of Parkinson's disease (PD). Thirty persons with PD (equal numbers of males and females) participated in a larger study investigating the efficacy of transplantation of fetal neural tissue versus placebo surgery. Participants were randomly assigned to receive either the fetal transplant or placebo surgery. The blind was lifted for all patients approximately 13 months after surgery, at which time individuals who had received the placebo surgery could choose to receive the transplant surgery. In this study 12 persons originally received the transplant and 18 received placebo surgery. The NEO Five-Factor Inventory (NEO-FFI), a commonly used measure of personality characteristics, was administered to participants at baseline, 12, and 24 months after surgery. Scores at baseline for the Openness and Agreeableness scales were significantly higher for this sample of PD patients than scores for the normative group. There were no changes on any of the five scales from baseline to 12 months for the total group. The only significant change in the original transplant group was a decrease in Conscientiousness from baseline to 24 months. There were no changes over time among the group who had placebo surgery first and then the transplant. Results indicate that personality, as measured by the NEO-FFI, basically remained stable during the two-year follow-up period of this study. In this case, no change is regarded as a positive outcome.

Brain Tissue Transplantation↗
PubMed1998

The 'more-abortions' objection to fetal tissue transplantation.

One common objection to fetal tissue transplantation (FTT) is that, if it were to become a standard form of treatment, it would encourage or entrench the practice of abortion. This claim is at least factually plausible, although it cannot be definitively established. However, even if true, it does not constitute a compelling ethical argument against FTT. The harm allegedly brought about by FTT, when assessed by widely accepted non-consequentialist criteria, has limited moral significance. Even if FTT would cause more abortions to be performed, and abortion is taken to be a serious moral wrong, this is not sufficient in itself to make FTT wrong.

Aborted Fetus↗
PubMed1987

Augmentation of basal forebrain cell populations with fetal tissue transplants.

Grafted fetal basal forebrain, previously labeled by intraperitoneal injection of gestating female rats with tritiated thymidine, was transplanted into the same area (homotopically) of host animals of various ages. Some animals were serially sacrificed up to 60 days after surgery, while others remained intact for the entire 60-day period prior to sacrifice. Transplants were highly (92%) successful. Early (2-10 days) grafted tissue was mainly composed of a gradient of heavily labeled differentiating cell profiles, strikingly similar to primitive subependymal cells reported elsewhere, which proceeded to mature thereafter. Evidence of cell turnover and tissue continuity at the host-graft interface was also obtained during this time. While many cells bearing label were found at the original implantation site in autoradiograms of all experimental animals, some were found in host tissue as early as 5 days following surgery. At later ages, greater numbers of labeled cells were found at considerable distances into host tissue in apparently specific locations. The lateral ventricle overlying the graft site was occupied by donor-derived tissue in 40% of all experimental animals. Islands of apparent germinal matrix persisted throughout the duration of the experiment. Results obtained in these experiments with transplanted tissue accord well with previous studies of neural genesis in intact animals. They further suggest that cell populations of specific nuclei of the host basal forebrain may be selectively augmented by observing critical embryogenetic time constraints when harvesting fetal donor tissue.

Animals↗
PubMed1996

Quo vadis? Fetal tissue transplantation.

The epidemiology and biologic characteristics of fetal tissue harvested from elective and spontaneous abortions are reviewed. The use of fetal bone marrow obtained from second trimester lost pregnancies is discussed. Allogeneic fetal tissue transplantation carried out in utero is reviewed. Data on intrauterine transplantation of human fetal bone marrow obtained from second trimester lost pregnancies into baboon fetuses are presented. The viability of this tissue, its clonogenic efficiency, engraftment, use in the future, and banking are discussed.

Abortion, Induced↗
PubMed2001

Fetal tissue transplantation for patients with Parkinson's disease: a database of published clinical results.

Over the past 13 years approximately 300 patients with Parkinson's disease have received transplants of human fetal dopamine cells in an attempt to reduce or control disease symptoms. Many of these patients have had improvements in their motor skills and a reduction in their daily levodopa administration. However, improvements are far from guaranteed and questions need to be answered before this technique can be widely applied. To help address some of these issues, a search of all the published results of patients with Parkinson's disease transplanted with human fetal tissue was conducted. This generated a database of 70 transplant recipients who had their levodopa administration and clinical benefit reported both prior to transplant and at least 6 months post-transplant. Furthermore, the number of years of disease onset prior to transplant was available for all recipients. This database was examined for motor improvement and reduction in levodopa dosage for up to 2 years post-transplant to determine the effects of time on transplant outcome. The database showed that most recipients had significant improvements in motor skills and levodopa administration, and that most benefits were observed in the first 6 months post-transplant. In addition, the database demonstrated that the number of years of disease onset prior to transplantation was not a predictor of patient outcome 1-year post-transplant. Current and future directions in fetal tissue transplantation research and replacements for fetal tissue are discussed.

Animals↗
PubMed2002

Status of fetal tissue transplantation for the treatment of advanced Parkinson disease.

In the first double-blind, placebo-controlled randomized study of fetal tissue transplantation for the treatment of patients with advanced Parkinson disease (PD), investigators found that implanted dopaminergic tissue can produce measurable improvement in young PD in the absence of medication (that is, the "off" state). The results of the study, however, also highlighted several serious limitations of transplantation. In the group of older patients in the study (in the typical age range of individuals afflicted with PD) no improvement was derived from the implant despite positron emission tomography-documented scan evidence that the graft survived and produced dopamine. Patients in the study were selected because they experienced motor fluctuations, and the transplant did not improve dyskinesias or the time required to remain "on" medication for any subgroup of patients, including young patients. Five of 33 implant-treated patients developed involuntary movements (dyskinesias or dystonia) that could not be eliminated by reducing antiparkinsonian medications. These included four patients with the best responses to transplantation. Finally, some sham-operated patients experienced a dramatic placebo effect lasting at least 1 year, which justified the controversial sham surgery. The authors believe that these problems must be solved before fetal tissue transplantation can be considered a therapeutic option for PD.

Brain Tissue Transplantation↗
PubMedDate not supplied

Ethical and policy issues in human fetal tissue transplants.

A review of human fetal tissue policies over the past 40 years reveals an increasing awareness that the use of this tissue raises unique ethical and policy issues. Initially it was believed that the use of fetal tissue was no different from using any other abandoned surgical waste specimen. Then state laws were passed requiring fetal tissue to be treated with the same respect and protection as tissue obtained from cadaver donors generally. Most recently, a few state and federal policies suggest that the use of fetal tissue requires a unique set of provisions, that it is unlike either the use of tissue from a routine cadaver donor or the use of tissue from abandoned waste specimens. In this paper we identify four central features of fetal tissue donation that make it a unique type of tissue donation requiring its own framework of respect and protection for the parties involved. We then critically review the most important current state and federal fetal tissue policies, including the NIH Revitalization Act of 1993.

Ethics, Medical↗
PubMed2002

A preliminary psychosocial study of Parkinson's patients after fetal tissue transplantation.

A novel and promising approach currently available is the grafting of fetal nigra tissues into the brain of a Parkinson's patient. However, the degree of success for such treatment has mainly been evaluated by histological, radiological and physical assessments, with little or no attention paid to its effects on the patient's psychosocial status. In order to provide a more comprehensive profile, a survey was conducted using questionnaires and interviews to examine the physio-psycho-social progress of six Parkinson's patients who underwent fetal tissue grafting in Taiwan. Results indicated that the physiological effects varied among patients. Noticeably an improvement in walking was the most gratifying, but progress in dressing and writing ability seemed disappointing. From the psychological point of view, depression was commonly felt by patients. Other feelings included fear, ambivalence, and change in body image. In addition, all six patients found that their relationship with spouse became worse; they also reduced social interaction to the minimum. From the findings, we also noticed that inadequate knowledge contributed to part of the results. Therefore, some nursing suggestions especially educating the patients and family about the facts and outcome of fetal tissue transplantation are highly recommended. These may help Parkinson's patients adjust better after undergoing this novel treatment.

Brain Tissue Transplantation↗
PubMed1989

Meeting report: human fetal tissue transplantation research panel.

On September 14 through 16, 1988, a meeting on the use of human fetal tissue in transplantation was held at the National Institutes of Health, Bethesda Maryland, USA. The meeting sponsored by NIH for the Human Fetal Tissue Transplantation Research Panel, a consultant group to the Advisory Committee to the Director. The consultant group was convened to deal with the scientific, judicial and moral questions associated with research involving transplantation of human fetal tissue obtained after induced abortions. The first day of the meeting was devoted to presentations addressing scientific issues. Included among the speakers was Dr. Lars Olson, Professor of Neurobiology, Karolinska Institute, Stockholm, who described the use of transplanted human fetal tissue in the treatment of patients with Parkinson's disease and Dr. Eugene Redmond, Professor of Psychiatry, Yale University School of Medicine, who showed results of work with transplantation of tissue to correct induced Parkinson-like disease in monkeys. Other speakers addressed the present, past or potential use of fetal tissue in the treatment of diabetes, immune disorders, and other diseases, as well as the use of fetal cells in the production of biologicals. At the conclusion of the meeting the panel did not recommend that research be halted on fetal tissue within the context discussed, although the recommendation of the committee is not binding, and an additional assembly of the panel will probably occur before the final recommendation to an NIH advisory committee is made in November. Other meetings on this subject include a meeting on the use of fetal tissue sponsored by the American Association of Tissue Banks, March 6-7, 1989, in Washington D. C. (Crystal City) and a meeting June 10, 1989, the day before the annual meeting of the Tissue Culture Association, USA, in Orlando, Florida, on fetal cells and ownership of cultured cells and products derived from clinical specimens. Following are statements to the Human Fetal Tissue Transplantation Research Panel presented September 14, 1988, by Dr. David Barnes, Associate Professor of Biochemistry and Biophysics in the Environmental Health Sciences Center at Oregon State University, USA, who was asked to address for the panel recent advances in cell culture related to fetal tissue, and Dr. Robert E. Stevenson, Director of the American Type Culture Collection, President of the Tissue Culture Association, USA, and Chairman of the Committee on Cells and Tumors of the American Association of Tissue Banks.

Cells, Cultured↗
PubMed1990

Medical applications of fetal tissue transplantation. Council on Scientific Affairs and Council on Ethical and Judicial Affairs.

Fetal tissue transplantation has been attempted for a limited number of clinical disorders, including Parkinson's disease, diabetes, immunodeficiency disorders, and several metabolic disorders. Fetal tissue has intrinsic properties--ability to differentiate into multiple cell types, growth and proliferative ability, growth factor production, and reduced antigenicity--that make it attractive for transplantation research. At this time the results from fetal tissue grafts for Parkinson's disease and diabetes have not demonstrated significant long-term clinical benefit to patients with these disorders. Further research will be necessary to determine the potential value of fetal tissue transplantation. For these clinical investigations to proceed, specific ethical guidelines are needed to ensure that fetal tissue derived from elective abortions is used in a morally acceptable manner. These guidelines should separate, to the greatest extent possible, the decision by a woman to have an abortion from her consent to donate the postmortem tissue for transplantation purposes. Such ethical guidelines are offered in this report.

Aborted Fetus↗