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ss nucleus - autumn 1996,  Fetal Tissues in Transplantation

Fetal Tissues in Transplantation

Those of us who have been involved in pro-life debates have at regular intervals been confronted with the arguments relating to the use of fetal tissue in transplantation. Does a Christian belief allow us to become involved in fetal transplantation or should we oppose its use? Before considering the moral perspective of this issue it is important to have a basic grasp of what is involved as the techniques of the procedures do have an impact on the morality of the issues. I also believe that to enter the debate fully and give an informed opinion, we must have an understanding of the medical and scientific aspects in addition to our views on the morality.

What is possible/probable?

The first clinical fetal neural transplantation was performed in China in 1985 but not reported until 1987. It was in April 1988 that the first UK fetal transplant took place in Birmingham.[1] It was performed as the first of a progressive series of clinical trials in the use of human fetal brain transplantation to relieve the suffering from Parkinson's disease. Animal experimentation has progressed in many spheres and reached a point where it was suggested that fetal ovaries might be used to help those with infertility problems - but Parliament has now legislated against this.

We are all aware of the increased success of transplantation from adult donors (often road traffic accident victims or individuals with cerebral haemorrhage) which has occurred due to better understanding of the immunology of rejection, together with the development of new anti-rejection therapies. The attraction of using fetal tissue, particularly haemopoietic stem cells, is that they are immunologically immature and so are less likely to give rise to rejection problems. The reason that fetal brain transplants were among the first, is that the blood-brain barrier makes the brain a relatively immunologically protected site and so rejection is not a major issue.

Research has advanced and the range of what appears feasible is now large, with animal experiments progressing in many fields. Animal results have been encouraging and now not only is fetal brain tissue being considered for the relief of Parkinson's disease, but also for the repair of other brain damage including traumatic spinal cord injuries and even cerebral infarction. Fetal pancreatic tissue, with its source of insulin producing islet cells, could be of benefit to the many diabetics. In early fetal life (7th - 19th week) the liver is the main organ of haemopoiesis and therefore an important source of blood stem cells. These could be used to relieve a wide range of blood, metabolic and immunological diseases. A further development in this area has been the prospect of fetal-fetal transplantation for the treatment of hereditary blood disorders such as thalassaemia. One of the main reasons for the importance of this source of blood stem cells is that before 14 weeks of gestation there are no post-thymic T cells present and so there would be no problem of graft-versus-host disease. Furthermore prior to 18 weeks of gestation there is tolerance to foreign antigens, so allowing the prospect of fetal-fetal transplantation. Already fetal-fetal transplants have been done across major HLA incompatibilities with the production of stable chimerism.[2] This technique would be suitable for many other inherited blood disorders.

There have been animal experiments where fetal intestine has been transplanted into other animals and both fetal retina and kidney have also been transplanted. In an attempt to modify the immune response to a grafted organ, scientists transplanted cardiac myocytes into the thymus of a newborn rat. This produced immunological tolerance in the animal and allowed the subsequent successful transplantation of the heart 10 weeks later, with no evidence of rejection. Tissue culture techniques are continually advancing and already there are experiments where bone and cartilage cells can be grown onto an artificial framework to produce a potentially transplantable organ.

Is it ethical?

We have to consider the morality of two distinct areas in the use of fetal tissue. The first is where the relevant tissue is extracted from a recently aborted fetus and used more or less immediately for transplantation into the recipient. The second is where cells from an aborted fetus are harvested and grown in tissue culture. At some subsequent time, which may be many years in theory, these cells are then used for transplantation.

Let us first concentrate on the direct use of fetal tissue. The most common argument in favour, is that the baby will be aborted in any case, therefore why not make use of the tissue and at least gain some benefit from this evil act. Furthermore, some argue that the doctors involved in the transplantation are not those who are responsible for the abortion and therefore are free of any moral responsibility for that act. In addition it is further argued that the aborted baby is already dead, and therefore the ethical principles which govern cadaveric organ transplantation apply. The government commissioned the Polkinghorne report which reported in 1989 and established a Code of Practice for the use of fetal tissue.[3] Prior to that, the recommended Code of Practice was based on the Peel Report of 1972.

Let us look at these arguments in reverse order. I accept that the use of tissue from spontaneous abortions is ethically acceptable. However, research already carried out shows that this is not a practical option for several reasons. In spontaneous miscarriages the fetus often dies some time prior to expulsion, so the tissues will not be viable. In spontaneous abortions there is a higher incidence of chromosomal and genetic abnormalities, especially those in early pregnancy. There is also a major problem of bacterial contamination during natural delivery. Even if an individual was willing to try and carry out research to overcome these problems it would be surprising, in the current environment, if funding could be found to support such research which in scientific terms would be less likely to achieve results compared with the use of surgical abortions. So we have to consider the use of surgical/medical abortions.

Currently, and rightly so, consent is required for organ transplantation. This is normally obtained from the relatives although it might be valid to argue that a person carrying a donor card has already given permission, and that wish should be respected. But whichever way you look at this topic, there is a common consensus that consent must be given. The fetus is obviously unable to give prior consent, and so people look to the woman for her consent. This immediately raises several problems. The voluntary predetermined death of the fetus is in no way comparable to the death of an accident victim whose organs may be suitable for transplantation. There are many Scripture passages which by implication condemn abortion, including on grounds of handicap (Jer 1:5; Jb 10:8-12; Ps 22:10-11). The sanctity of life ethic does not give any person, and especially the mother, authority to end the life of her unborn child. I therefore find it perverse that she should then be asked to give consent, on behalf of her unwanted unborn child, for its tissues to be used for transplantation.

There is also a further issue here. A study of womens' views showed that overall 12% (and 17% of those who would consider abortion if they were pregnant) of women would be more willing to have an abortion if they could donate tissue for fetal transplantation. This indicates, as many have argued, that fetal transplantation would be used, at least in part, to justify the abortion.

Let us now consider the argument that the doctor involved in the transplantation has nothing to do with the abortion. Polkinghorne stated that the decision for abortion must be separate from the decision for the use of the aborted fetal tissue. However, the reality is that tissue for transplantation must be viable and in as fresh a state as possible. References which discuss the collection of fetal tissue discuss the modification of the abortion procedure so as to maximise tissue preservation. For instance, in early abortions a low suction pressure is used and the abortion cannula is inserted under ultrasound control so that the fetus can be 'selected' - which in some cases led to extraction of an intact fetus.[4] The doctor accepting the fetus would be in the room immediately adjacent to the theatre where the abortion was taking place and would be receiving the tissue virtually immediately. In the pilot series of fetal brain transplantation both donor (mother) and recipient were screened for a range of possible infections, including HIV and so it is difficult to argue that there is not co-ordination between the two groups of doctors. And so from a moral perspective I cannot see how it can be argued that the transplantation doctor is not an integral part of the abortion process.

It is a cardinal principle of moral theology that it is not permissible to perform an evil act so that good may come of it (Rom 3:8). I believe, as argued above, that by implication many would attempt to minimise the evil of the abortion because of the good that may come about as a result of the use of fetal tissue.

But what about the use of tissue culture of fetal tissue obtained from abortion? This has already been debated when it became widely known that the Rubella vaccine, as well as others, were grown on a cell line derived from an abortion more than 20 years ago. Because of the prolonged time since the abortion and because the vast majority, including the medical profession, were unaware of the source of this vaccine, the Catholic hierarchy did state that individuals could accept the vaccine without in any way condoning the earlier abortion. However they did add that it would not be justifiable to carry out further abortions to provide a source of cells for future use. The Catholic bishops also stated that some may feel it appropriate to take a 'prophetic stance' and refuse to accept the vaccine. This, I believe, is the situation that should apply in use of cultured fetal cell lines for transplantation. The research that is currently being carried out is using abortions to obtain the various tissues and I believe that it would implicitly be condoning the abortions to say that it would be permissible at some time in the future to use these cell lines.

For many the most difficult question to answer is: 'So you are quite happy to see these many people continue to suffer just because you are against abortion. The law allows these abortions and they are going to take place regardless of what you say. Are you really saying that you would refuse this treatment which could cure your condition?' In some respects the last question is the easiest to answer and I could without hesitation answer 'yes'. But to explain the purpose of suffering has never been easy. I feel that the following quotation is appropriate - (I do not know its source) 'To those who believe no explanation is necessary, for those who do not believe no explanation would suffice.' The more difficult question is that of imposing our moral beliefs on others. But in reality every single civil and criminal law in some way restricts another individual from doing what they want. The response to this type of accusation is to ask the questioner 'Are you against all laws then? If you can justify a single law then you have accepted the principle that it is justifiable for one group (the legislators, society etc) to impose their views on another.' As Christians our duty is to give witness to the truth however difficult that may be in the current secular environment.

References
  1. Hitchcock E. Stereotactic Neural Transplantation: History and development. Stereotactic and Functional Neurosurgery. 1994; 62:120-133
  2. Westgren M, Ringden O. Fetal to fetal transplantation. Acta Obstetricia et Gynecologica Scandinavica. 1994; 75:371-2
  3. Review of the Guidance on the Research Use of Fetuses and Fetal Material (Polkinghorne Report). HMSO Cm762. 1989
  4. Westgren E et al. Establishment of a tissue bank for fetal stem cell transplantation. Acta Obstetricia et Gynecologica Scandinavica. 1994; 75:385-8
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