Plastination and its importance in teaching anatomy. Critical points for long-term preservation of human tissue.

Most medical curricula rely on human bodies for teaching macroscopic anatomy. Over the past 20 years, plastination has become an important means of preservation of organs, for well dissected specimens or for body slices. Here, several critical points regarding body donation with legal and ethical considerations for long-term preservation, the use of cadavers in teaching and the preparation of plastinates as an additional teaching tool will be discussed. Silicone S10 is the gold standard in the preparation of plastinates. An important point to respect is the preparation of specimens, since only very well dissected body parts or excellent tissue sections should be plastinated to show the extraordinary aspects of the human anatomy. The preparation of thin and transparent sections and preservation with P40 polyester provides an additional technique to prepare resistant body slices. A selection of samples prepared by S10 and P40 are shown and compared. In addition, Prussian or Berlin blue staining of brain slices is shown to discriminate better between gray and white matter and demonstrate neuroanatomical structures. These plastinates have been used for many years in teaching first- and second-year medical students and have not lost their appeal. Students and staff appreciate the use of such plastinates. One of the advantages is that their use is not restricted to the dissection hall; slices and body parts can be used in any lecture room or in small group teaching. Therefore, ethical and legal questions need to be addressed regarding their specific use. Plastinates do not replace the traditional dissection courses, since students learn best the anatomical features of a given region by hands-on dissection and by exploratory anatomy. Furthermore, plastinates are more rigid and do not allow demonstration of hidden structures; they also become more cumbersome for endoscopy or are too rigid for demonstrating mechanical features of joints. However, although not a replacement for traditional dissections, plastination provides an additional tool for long-term preservation and for teaching human anatomy.

An ethical framework for the disposal of autologous stem cells.

The disposal of haematopoietic stem cells stored for autologous transplantation purposes becomes a problem for hospitals when the conditions for their preservation cease to exist. When these cells have been stored for a considerable time the problem often becomes an ethical one involving informed consent and is linked to at least two simultaneous circumstances: (i) the indications regarding disposal contained in available informed consent papers are either absent or too generic; (ii) the person who provided the sample can no longer be traced. This article proposes and discusses some of the ethical criteria for addressing this problem on the basis of the so-called "principles" of North American bioethics, and compares them with some of the principles and values proposed in other models of bioethics.

A survey on the intentions and attitudes towards oocyte cryopreservation for non-medical reasons among women of reproductive age.

BACKGROUND: Although cryopreservation of semen is a routine procedure for preserving male gametes, an efficient method of preserving fertility through oocyte freezing has only recently become available for women. In view of the limited female reproductive lifespan, oocyte freezing can now offer women some protection against the decline in fertility with aging. METHODS: A survey was performed in Belgium among 1914 women of reproductive age (21-40 years) to assess public attitudes towards the phenomenon called 'social oocyte freezing'. Women were questioned on their awareness of the age-related fertility decline and their views and intentions towards considering undergoing oocyte cryopreservation. RESULTS: The electronic questionnaire was completed by 1049 women, giving a response rate of 55%, and 25 were excluded as they were incomplete/inconsistent. Our results demonstrate that 31.5% of respondents consider themselves as potential social oocyte freezers, of which 3.1% would definitely consider the procedure. Just over half of the women (51.8%) would not consider the procedure while 16.7% indicated they had no opinion. Potential oocyte freezers are characterized by a higher number of desired children and more openness to oocyte donation. The decision to actually embark on such treatment would primarily depend on conditions, such as the procedure not affecting their natural fertility and the health of future children. CONCLUSIONS: We conclude that a significant proportion of young women would consider safeguarding their reproductive potential or are at least open to the idea of social oocyte freezing.

Legal and ethical implications of inherited cardiac disease in clinical practice within the UK.

Increasing genetic knowledge over the last decade has enabled hundreds of genetic variants associated with inherited cardiac conditions to be identified, many of which cause increased risk of sudden cardiac death. While individually these conditions are rare, taken together they impose a significant burden. The severity of these conditions--the possibility that they might cause sudden unheralded death of a teenager or young adult--juxtaposed with uncertainty about the pathology linked with many of the genetic variants is significant in terms of professional practice because, increasingly, clinicians have been encouraged to cascade out genetic testing from the proband or consultand to other family members who may be at risk of developing the same condition. This process often involves sharing human tissue samples, DNA or personal information. This paper reviews the legal and regulatory frameworks which may apply when tissue and DNA samples are collected, used and retained, both for the purpose of diagnosis and for benefiting other family members, when a suspected or definitive diagnosis of an inherited cardiovascular condition is made. Sometimes the interests of family members may conflict, and it may be difficult for practitioners to reconcile the interests of one family member with another, particularly if the balance of benefits and harms from testing is unclear. The paper then examines some of the ethical tensions which may arise in practice and concludes that all involved should be conversant with the legal and ethical frameworks that apply.

Genetic research on stored tissue samples from minors: a systematic review of the ethical literature.

The potential benefits of biobank research are well known. Also, the ethical implications of genetic research on stored tissue samples are well discussed in existing literature. The inclusion of tissue samples from minors may have significant scientific value. However, this inclusion raises specific ethical questions. We have performed a systematic search of the literature and found 21 theoretical and empirical articles dealing with the issue. After review, we distilled five clusters of themes: consent, risks, benefits, return of results, and ownership. We have described the different components of these themes, as they occurred in the literature and have provided a discourse on the topic.

[Guidelines on research on human biological materials]. / Zasady prowadzenia badan na ludzkim materiale biologicznym.

Poland has no operational and ethical guidelines on research using human biological material (RHBM) although such recommendations are included in Declaration of Helsinki and Recommendation of the Council of Europe on RHBM. Polish Bioethics Committees have the right to assess projects of physicians and dentists only. RHMB might be carried by other scientists than physicians and dentists. Who and how should evaluate projects of RHBM conducted by non-doctors is not defined yet. RHBM should normally seek informed consent. RHBM might be carried on identifiable or anonymised biological material. Recommendations might differ accordingly to the categories of human biological material: identifiable or anonymised. It is appropriate to develop guidance on sampling and collecting human biological material for research and on conducting RHBM. Genetic research is a special type of RHBM in which broad categories of harms (like: physical, psychological or social) may occur.

Pro/con debate: in patients who are potential candidates for organ donation after cardiac death, starting medications and/or interventions for the sole purpose of making the organs more viable is an acceptable practice.

Several hospitals have been developing programmes for organ donation after cardiac death. Such programmes offer options for organ donation to patients who do not meet brain-death criteria but wish to donate their organs after withdrawal of life-support. These programmes also increase the available organ pool at a time when demand exceeds supply. Given that potential donors are managed in intensive care units, intensivists will be key components of these programmes. Donation after cardiac death clearly carries a number of important ethical issues with it. In the present issue of Critical Care two established groups debate the ethical acceptability of using medications/interventions in potential organ donors for the sole purpose of making the organs more viable. Such debates will be an increasingly common component of intensivists' future practice.

The ethics of research on stored biological samples: outcomes of a Workshop.

Research is often conducted using laboratory samples and data. The ethical issues that arise in a study involving residual samples are considerably different from those arising in a prospective study. Some of these ethical issues concern the risks to confidentiality, individual autonomy, trust in and credibility of the researcher or the research, commercialisation and even the nomenclature involved.

Research involving storage and use of human tissue: how did the Human Tissue Act 2004 affect decisions by research ethics committees?

BACKGROUND: Little is known about the types of issues research ethics committees (RECs) raise in their letters about research involving the storage and use of human tissue. AIMS: To classify the issues that appear to trouble RECs and to identify how the implementation of the Human Tissue (HT) Act in September 2006 might have affected REC decisions. METHODS: 100 letters relating to applications about research use of human tissue were randomly selected from the National Research Ethics Service database, of which half were issued before the implementation of the HT Act and half post-implementation. Ethical issues raised by RECs were classified with a coding scheme developed using ethnographic content analysis. RESULTS: Many letters raised issues about informed consent, including specific concerns about the information to be provided to participants about the taking, using and storing of their tissue samples. However, RECs appeared to be less likely to raise concerns about informed consent to use or store tissue after the HT Act, and there was some evidence that RECs were more comfortable allowing archived tissue samples to be used without additional patient consent after the HT Act than before. CONCLUSIONS: In the wake of the HT Act, RECs do not appear to be more cautious about approving research to use or store tissue without consent when responding to applications for ethical approval. The HT Act has provided clarity and authority to RECs and may indeed facilitate the process of gaining ethical approval for tissue-based research.

Responsibilities and obligations of using human research specimens transported across national boundaries.

Research collaboration beyond national jurisdiction is one aspect of the globalisation of health research. It has potential to complement researchers in terms of research skills, equipment and lack of adequate numbers of potential research subjects. Collaboration at an equal level of partnership though desirable, may not be practicable. Sometimes, human research specimens must be transported from one country to other. Where this occurs, there should be clear understanding between the collaborating research institutions regarding issues of access and control of the specimens as well as the duration of storage of specimens. The researchers have the duty to inform the research participants about specimen storage and transport across national boundaries. While obtaining informed consent from study subjects if specimens are to be stored beyond the life of the present study could be the ideal, there still remains significant challenges in a multi-cultural world.

Current challenges of human tumour banking.

Tumour Banks (TB) are called upon to play a central role in Oncological translational research. TB have been existing since Pathology Departments started storing blocks of tissue samples, but in keeping this role they must face some urgent challenges including: an updated definition of hospital TB, integration into clinical trials and projects of excellence, networking and a new framework for ethics and laws. Current TB definition includes not only tissue storage, but also a series of hospital protocols that allow molecular studies of tumour and normal samples. The real value of these protocols and samples appears with scientific projects of excellence and integrated in clinical trials. Most of these trials need for a large number of cases with homogeneously treated tissue samples in the context of multicentre and multinational projects. Thereby, networking appears the best solution for TB to expand. Networking implies standardised technical procedures, a strict quality control programme, homogeneous ethic requirements and an open mentality for sharing. In the international setting the major challenge for networking is the various laws and customs in the different countries. To bring these diverse legislation together is, perhaps, the most important challenge for TB Networking in the very close future.

Posthumous reproduction and the presumption against consent in cases of death caused by sudden trauma.

The deceased's prior consent to posthumous reproduction is a common requirement in many common law jurisdictions. This paper critically evaluates four arguments advanced to justify the presumption against consent. It is argued that, in situations where death is caused by sudden trauma, not only is there inadequate justification for the presumption against consent, but there are good reasons to reverse the presumption. The article concludes that the precondition of prior consent may be inappropriate in these situations.

New European guidelines for the use of stored human biological materials in biomedical research.

The increasing possibilities for using tissue for research and development in genetics and biotechnology have made stored human biological materials more important than ever. Using stored human biological materials raises many legal and ethical questions. On an international level however, the use of these materials has not been regulated in a detailed manner so far. The Council of Europe recently declassified the text of the proposal for an instrument on the use of archived human biological materials in biomedical research for public consultation. The purpose of this paper is to comment on this document regarding its primary goal, which is to protect the rights and fundamental freedoms of the individual whose biological materials could be included in a research project. The guidelines offer good basic protection for sources of identifiable human biological materials but, surprisingly, offer no protection to sources of anonymous or anonymised materials.

Ethical issues in the collection, storage, and research use of human biological materials.

Human biological materials (HBMs) are samples of blood, DNA, organs and tissues commonly obtained during routine surgical procedures or through direct donation by an individual. This article reviews four of the most pressing issues arising from the collection, storage, and use of HBMs in research: current regulations governing research with human subjects, misuse of genetic information, economic factors, and public knowledge.

La dignidad del embrión humano congelado / No disponible

Introducción: La pregunta por la dignidad del embrión humano es una de las cuestiones clave del debate bioético contemporáneo. La dignidad del ser humano radica en la individualidad original y única que todo embrión posee. Si no hay un respeto y defensa por la corporalidad humana desde el primer momento de su aparición, es imposible afi rmar la dignidad de cualquier ser humano. Por eso, no parece conforme a la dignidad humana el que los seres humanos, en su fase incipiente, padezcan la detención de sus funciones biológicas. Al contrario, la práctica de crioconservación de embriones humanos refl eja una pérdida del sentido del valor de cada ser humano individual. Método: Este artículo se desarrolla desde un estudio descriptivo e interdisciplinar de las claves éticas que concurren en este tema. Conclusiones: 1. El respeto por la dignidad del embrión radica en su pertenencia desde el inicio de su vida a la especie humana. 2. Por ello, el respeto por la dignidad del embrión humano no depende de operación alguna, sino, de manera exclusiva, de la eminencia de su ser. 3. La congelación no sólo es un hábitat no acorde con la dignidad del viviente individual humano, sino expresión de una voluntad que determina y decide la vida humana de los débiles, y por la que la dignidad del embrión se reduce al valor de uso con fecha de caducidad

Purpose: The issue of the dignity of the human embryo is one of the key questions in bioethics debate today. The human being’s dignity lies in the original and unique individuality that every embryo has. If there is no respect and defense of the human body from the very fi rst moment of its appearance, it is impossible to assert the dignity of any human being. For this reason, it does not seem good for human dignity that human beings, in their incipient phase, should suffer from the halting of their biological functions. The practice of cryopreservation of human embryos shows a loss of the sense of the value of each individual human being. Methods: This paper is developed from a descriptive and interdisciplinary study of key ethical concepts in this subject. Conclusions: 1. Respect for the embryo’s dignity must indeed exist from the beginning of its life. 2. For this reason, this respect does not depend on any operation, but on the eminence of its being. 3. Not only is freezing a habitat which contradicts the dignity of life, but it is also the expression of a will that determines and decides the human life of weaker beings. The embryo’s dignity is thus reduced to the value of use where it is not out of date

Células madre embrionarias: regulación de su investigación por la legislación española (II) / No disponible

No disponible