My interests lie within sustainability and how we can be better for our environment, which led me to think about the sustainability of prosthetic limbs currently, and what research is being carried out to improve them. Prosthetic limbs use a great deal of plastic, which is made up of hydrocarbons mined from the ground. These pollute our environment and are a massive contributer to the enhanced greenhouse effect, and therefore global warming. While they do not cause as much of an issue as single use plastics do, due to their long term use, they still impact the planet once they are no longer needed. They will end up in landfil where they will slowly be broken down into microplastics that pollute terrestrial and aquatic environments. These can lead to disruptions in food chains, and sometimes even the increase in death of organisms.

Biologically Derived Plastic

Researchers have been looking into the use of polyhydroxyalkanoate, which is a bioplastic, meaning it does not origniate from petroleum, and is biodegradable. These have similar properties to plastic and are already used in many industries, therefore are a good candidate as an alterantive material. These properties include being durable and versitile, which are important when applied to prosthetics. This material is not only better due to its reduce carbon footprint and lower energy consumption, but it is also a cheaper alternative, which will make prosthetics more accessible to those needing them.

Recycled Plastics

Recycling plastic bottles is another avenue of research that is currently being explored by researchers. These researchers are hoping to produce polyester yarn from bottles that can then be moulded into artificial limbs. This is a great way of moving towards a circular economy, by taking plastic waste and upcycling it into something new, with a much longer term use. However, there are issues with this method, which include the plastic being degraded into microplastics and polluting the environment. Although, if these plastics had not been recycled, they would have degraded anyway.

Agricultural Waste

Researchers in Malaysia and the UK are attempting to use natural fibres generated within agricutlure, as a composite material in prosthetic limbs. By using waste material, this method also promotes a zero waste and circular economy, and in a low cost way. The researchers want to further this zero waste goal by using left over materials and energy and use it in other stages of production. This method won’t fully remove plastic though, and will just reinforce the plastic. Despite this, the method still reduces plastic while removing waste where possible. This is a method that could hopefully be furthered in the future and help to fully remove plastic.

Whilst making prosthetics more sustainable is important for our planet, it should not come at a cost to the wearer. Function and comfort are some of the most important aspects, but hopefully the researchered being carried out can lead to a solution that also benefits the planet. Removing waste from the environment while reducing plastic production are great ways of achieving this goal.

My first well-formed academic interest took shape in the form of bright-eyed awe at the beauty, diversity, and complexity of every life-form that I set sights on. How wonderful the pattern of that tree’s branches! I would wonder at the factors driving the formation of that pattern.

This might all seem to be getting away from the topic of tissue-engineering, but morphogenesis (how the shape of organisms arises during development) is of great relevance in research and the clinic! There are two main views of how development occurs, with the classical ‘mosaic’ view, in which cells obey a deterministic programme, their fates determined genetically, and the ‘regulative’ view, in which cell-cell interactions and multidirectional information transfer affect the developmental trajectories of the cell, with evidence pointing that both have their place in different developmental stages, as the cells take in physical, electrical, and chemical cues to “decide” how to arrange themselves. The way that organs and tissues form is at the core of many regenerative medicine issues, from birth defects, to genetic diseases, to cancer. Contrary to the intuitive assumption that organisms with higher regenerative capacity would also have higher propensity for cancer due to their higher cell proliferation, they actually have lower cancer incidences, implying the competent morphogenetic pathways used for regeneration may also prevent cells from falling into the disorder which can lead to tumorigenesis.

Indeed, this ability of cells to self-organise into tissues and organs has been exploited in the form of organoids, mini 3D structures which can be derived from Embryonic Stem Cells (ESCs) and induced Pluripotent Stem Cells (iPSCs), which can have very similar functions to in vivo organs, having incredible potential for drug testing, disease models, and even the possibility of becoming an alternative for organ transplants, overcoming barriers such as long waiting times and tissue rejection in patients; an organ grown from the patient’s own iPSCs, maybe edited genetically into a healthy form if applicable. This might even be an alternative to xenotransplants, bypassing several of the ethical issues associated with using animals for organ harvesting. Of course, organoids come with their own suite of ethical concerns, from source of the stem cells to the moral and legal status of organoids, especially in the cases of multi-organ and brain organoids, but the benefits of organoid research are worth the extra necessary steps to ensure such research follows our moral values.

And if that sounds fantastical, imagine my surprise when I found this property of cells could lead to the possibility of replacement limbs, not in the form of prostheses or even grown on scaffolds, but grown by the patient themselves! Over the course of a 2022 study, Murugan et al were able to trigger the regrowth of frog legs with the use of a bioreactor which served to protect the site of injury and deliver a drug-cocktail which, among other things, prevented growth of scar tissue by inhibiting collagen and encouraged nerve, muscle growth, and vascularisation, activating the body’s own regenerative abilities and molecular pathways used during embryonic development. Over the next 18 months, the frogs subjected to the 24-hour treatment grew back almost fully functional legs which they could stand and swim with. Of course, this technology is a long way away from clinical application, with mice being currently used to test whether this approach would even work in mammals. This, and other techniques discussed here, are yet in their infancy, with much of the basic groundwork yet to be done. Still, the future landscape of regenerative medicine holds many incredible possibilities that I am excited to witness.

Realising the contribution of science to plastic pollution

I have always been aware of the common sources of single-use plastics and how these are being reduced. One of the most influential discussions around plastic pollution in recent years was David Attenborough’s message in Blue Planet II in 2017. Since then, many beneficial changes to our day-to-day life have been implemented, including the ban on plastic straws in 2021¹ and the introduction of the carrier bag charge, also in 2021². Part of my keen interest in science is due to its ability to improve the sustainability of various sectors. However, a lot of the lecture content on this module has focused on the wastefulness of things I had previously not considered, such as prosthetic sockets, or wheelchairs not appropriate for their use. When I first entered a clean chemistry laboratory as part of my independent research project, I was shocked to see this wasteful side of science first-hand. The pictures below are ones I took. From left to right:

• A tub filling up with single-use pipette tips, which will not be recycled (“please empty when full to general waste bin”).
• A bin full of discarded nitrile gloves, some used for as little as 5 minutes with no contaminating substances on. This is 1 of about 5 of these bins in this laboratory alone. They fill up daily and are “non-recyclable waste”. This one particularly shocked me.
• A rack of single-use sample vials. These vials are being used for one stage of an experiment after which they’ll be thrown away.

This is just the tip of the iceberg: in 2014, it was estimated that research laboratories generated 5.5 million tonnes of plastic waste globally¹.

Digging deeper

Seeing as I thought the plastic waste from one laboratory was excessive, I was interested in the scale of plastic waste from labs both in the UK and globally, and what was being done, if anything, to mitigate the issue. I attended a talk on plastic pollution by Professor Ian Williams, a Professor of Applied Environmental Science, where the issue of science’s contribution to plastic pollution was raised. Professor Williams acknowledged the huge issue of single-use plastic in science, particularly in hospitals where everything is single-use to maintain a sterile environment. However, he also said that there is “intent [to reduce the problem], but we are not quite there yet”. An example he raised was the LEAF project, which I hadn’t heard of and so decided to research further.

LEAF is a new approach to laboratory sustainability, developed by Sustainable UCL. It contains advice for laboratories on how to save plastics and other resources. Laboratories are awarded either a Bronze, Silver or Gold level, depending on their level of sustainability³. Some labs in Southampton have a Bronze Award, but in my opinion, we could do more.

Moving forwards

Luckily, some universities have implemented schemes to avoid wasting as much plastic. When researching more about single-use nitrile gloves, I found out that the University of Edinburgh has a glove recycling scheme in the School of Chemistry that recycled over a million plastic gloves in 2019¹. Additionally, in 2018 the University of Leeds pledged to remove single-use plastic from the entire university, including its research laboratories, by 2023¹.

In the future, interdisciplinary modules are ever-more important in bringing people from different sectors together to critically analyse the world we live in, and discuss how we can improve it. This module has made me think more broadly about the drawbacks of science as well as the benefits, and the steps that can be taken to mitigate these drawbacks.

References

1. Alves, J. et al., (2020). A case report: insight into reducing plastic waste in a microbiology laboratory. In: Access Microbiology (3/3). London: Microbiology Society.
2. UK Government, (2022). Carrier bag charges: retailers’ responsibilities. [online]. Available at https://www.gov.uk/guidance/carrier-bag-charges-retailers-responsibilities [accessed 21/03/23].
3. Sustainability Exchange, (2023). LEAF – A New Approach to Achieving Laboratory Sustainability. [online]. Available at https://www.sustainabilityexchange.ac.uk/leaf_a_new_approach_to_achieving_laboratory_sus [accessed 23/03/23].

According to the NHS, 1 in 2 people develop cancer at some point in their life. Unfortunately, I was able to see the devastating effects that chemotherapy and radiotherapy can have on a patient through my grandmother. Studying biomedical sciences incited me to research new technologies that are being developed in order to aid cancer treatments and I came across the use of nanoparticles but more specifically liposomes.

What are liposomes?

Liposomes are organic nanoparticles that are being widely studied by scientists, consisting of a bilayer of phospholipids that come together to form vesicles that are non-toxic, non-immunogenic and biodegradable. They have the ability to deliver active pharmaceutical ingredients by either encapsulating hydrophilic molecules inside the vesicle or by entrapping hydrophobic molecules in the lipid bilayer.

Not only do they have the ability to carry drugs but also can improve the delivery of antigens and other molecules to our immune cells, helping them destroy the cancer cells!

What characteristics make liposomes a good drug delivery system?

1. Liposomes can deliver both hydrophilic and hydrophobic drugs, meaning that a large range of drugs can be delivered using them.
2. They provide a protective layer around the drug which prevents degradation of the drug by the body and reduces the toxicity as the drug is not infecting the healthy cells in our body.
3. The targeting of liposomes to cancer cells also increases the efficacy of the drug.
4. Liposomes are biocompatible and biodegradable because they are made up of the same material as the membrane of cells, which minimises the risk of further side effects in our body.

So… what is the downside?

Up to this point, the use of liposomes sound like an amazing tool to be used in cancer research. However, scaling up the production of these liposomes makes it much more expensive than simply delivering chemotherapy to patients which could mean that people with less resources will not be able to pay for the treatments. Liposomes have a short shelf-life which means that if the drug has not reached the cancerous cells before this, the drugs will be delivered to healthy cells instead. Furthermore, they are susceptible to aggregations that can change their size and shape and possibly leading to unwanted drug release. The use of liposomes can also lead to hypersensitive or inflammation reactions, putting patients at risk.

Are these disadvantages much worse than the side effects caused by months of hospital visits in order to get chemotherapy and radiation?

Personal opinion

I believe that the idea of liposomes to be used for cancer treatment is one of the many amazing ideas that scientists are coming up with in order to improve the life of many. The use of liposomes in the field on oncology could have the potential to efficiently deliver drugs that are able to kill cancer cells and there are ongoing clinical trials for using them in certain types of cancer such as prostate cancer. However, I think that further improvements have to be made in order for this to be a safe and efficient drug delivery method we can use on humans. Scientists need to keep investigating the use of liposomes and also other nanoparticles in order to come up with a better solution to cancer than chemotherapy and radiation.

For further scientific readings on liposomes:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8879473/#:~:text=Compared%20with%20traditional%20drug%20delivery,and%20lower%20toxic%20side%20effects.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6017847/

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As someone who is very interested in biological fiction, I am currently reading ‘The Body’ by Bill Bryson. I came to the chapter, ‘In the Dissecting Room: The Skeleton,’ and was intrigued to hear that medical cadavers have been the topic of various controversies throughout history. Soon after reading this, I also attended the ethics and law lecture, which led me to delve deeper into the issues and history of acquiring medical cadavers for teaching.

Where did medical cadavers previously come from?

Public opinion of dissection around the 18^th and 19^th century, even for the benefit of science, was seen as sickening and disrespectful. Fitting with the questionable ethos of the time, only hung criminals were seen to warrant this brutal fate. I was appalled to discover that this was justified by judges who believed murderers deserved further prosecution after their execution, so offered their bodies up for dissection without choice.

Why did this need to change?

Still, there never seemed to be enough cadavers to distribute between medical schools. Bryson mentions in his book that in 1831, London had 900 medical students with only 11 cadavers. This ultimately led doctors to turn to grave robbing. These hellish actions were not a punishable offence at the time, which only encouraged them to continue. I was shocked to hear this, but it made me realise that legal enforcement was the only way forward to put a stop to the clearly desperate thievery. My research led me to find that the Anatomy Act of 1832 was enforced because grave robbing had gotten too out of hand. This allowed medical institutions to also take ownership of the bodies of unclaimed poor persons.

While this seemed to fix the shortage and improve standards of anatomy textbooks, I found it shocking to believe that the financial status of a person upon their death should determine the fate of their body. Can the sacrifice of convicts and the poor be justified for the greater good of science? Rather than discarding abandoned bodies, should they be put to better use? I can see balance in this argument, but it is hard to believe doctors had free license to dissect unclaimed bodies. This opinion was shared by many.

“They tell us it was necessary for science. Science? Why, who is science for? Not for poor people. Then if it is necessary for science, let them have the bodies of the rich, for whose benefit science is cultivated.” – William Cobbett (1763-1835, advocate for English poor and working-class)

Where do medical cadavers come from now?

Under the Human Tissue Act 2004, written and witnessed consent for anatomical examination is required prior to death, it cannot be made by anyone else after a person has died. In the UK, It is illegal to buy and sell human remains, therefore modern medical schools rely entirely on donations of those willing to give their bodies for science. I was even pleasantly surprised to hear that some schools are positively overwhelmed by donations that they must turn away excess offerings.

A current perspective:

I was intrigued to see what current medical students thought about cadavers and the regulations implemented by Southampton University. I consequently conducted a short interview with a student which I found very insightful, as shown below.

A real-life nightmare:

Unfortunately, I was devastated to find that some countries still use unclaimed bodies for teaching. I found a truly awful news article where a student from the University of Calabar in Nigeria was traumatized by an anatomy class that used the dead body of his friend. I discovered that 90% of Nigerian medical cadavers are criminals killed in shootings. Whilst this story truly horrified me, it shows that there is still a global shortage of legitimate cadavers .

I believe there should be tighter universal regulations that limit the distribution of unclaimed bodies for science, but similarly increase international positive awareness to encourage more people to donate their bodies. This may be the only solution to permanently fix shortages without overstepping ethical practice.

Prisoners are those who owe a debt to society, they are made to pay for this by giving their time and freedom in proportion to the crime. Although an effective deterrent against breaking the law, it lacks any active use to society – no substantial payment is being collected. This could change with two democratic representatives offering reduced sentences of “not less than 60 and not more than 365-day reduction in the length of their committed sentence” for organ donations. This ethical section of the module is one which engaged me the most as if forced me to consider viewpoints and problems that I hadn’t been exposed to before in the entire course which was very stimulating and hence the motivation for writing about this specific topic. 

This proposal ultimately offers prisoners an alternate method of paying their societal debt, one that benefits those in most need of it. Of course, there are many denouncers who have this proposal in their crosshairs, shooting ethical and legal arguments at it. In this blog, I will present these arguments and question or dismantle their validity primarily through a utilitarian mode of thinking. One of the main gripes with this potential bill is that it gives prisoners an ‘easy way out’ of their punishment. Perpetuators of this line of reasoning will be displeased to learn of sentence credits and parole which can be granted on basis subjective as good behaviour. If reading books and attending vocational seminars can reduce a sentence, why should organ donation, an act with far greater positive effects be treated any differently? 

 Another point of contention that was brought up during the lecture is the intentions of the prisoners, that unlike positive programs prison programs done for their improvement, organ donation is simply a shortcut. This argument has the potential of being very true but is simultaneously irrelevant. To illustrate my point here is a statistic to do so: According to the World Health Organization (WHO), approximately 17 people die each day in the United States alone while waiting for a transplant, which amounts to over 6,000 deaths per year. Similarly, in the European Union, over 10,000 people die each year while waiting for a transplant. I believe any meaningful reduction in this number is an overall benefit that outweighs any nefarious intentions prisoners may have to ‘circumvent’ punishment. 

When discussing this topic, it was hard not to imagine a loved one in a position where they needed an organ from a prisoner that would receive a reduced sentence, to me it seemed an obvious choice. Personalising the proposal probably skewed my objectivity and made the personal benefits outshine any real societal negatives that became too hard to see in comparison, but when dealing with ethics there is no objectivity and anecdotes replace averages, ironic considering my utilitarian thinking cap.  

Although there are advantages to this proposal highlighted in this blog, there are real concerns that arise like whether it is unfair to take advantage of the situation prisoners are in for donations or for prisoners’ health post-operation. It is these types of questions that engage me so much with this aspect of the course and allow me to appreciate the complexity, grey-ness and probably the futileness of trying to marry science to ethics whilst still making it a worthwhile venture. 

“I think, I am.“

These famous words were written by Rene Descartes in his book Meditations in 1641. It deals with the philosophical theory of knowledge or as known as epistemology. The reason I am writing the blog on this topic is derived from the lecture in week 6. During this, the lecturer mentioned sensation and haptics in prostheses that bring another level of sensory input for the disabled. This topic echoed my previous reading on Descartes. In the book Meditations, Descartes advocates the separation between the mind and the senses. Where senses are gathered from experiences, the mind holds some fundamental knowledge. For example, Descartes gave the example of a dream argument, that the senses in a dream can deceive a person, such as the smell and the touch. But fundamental knowledge such as colour, and the three-dimensional environment are the same as reality. While the senses can be wrong, and the mind is fundamental, as a result, the separation enables one to seek the fundamental truths, as Descartes argues. However, Descartes is also a mathematician. And the fundamental truths in Descartes’ view are factors that form our reality, such as physics, and 1+1=2. But what about the senses? Our own way of perceiving reality?

For matters such as a person predicting when the bus will arrive, or the action of a person if one says certain phrases to them, the prediction can usually be correct, only if they have gathered enough knowledge through senses in the past. This type of knowledge can be fitted into Bourdieu’s theory of practice, where some of the predictions are formed by habitus, in another word, a societal structure that determines how we think and act.

But what about instincts? A newborn baby will instinctively seek nutrients, we breathe with our lungs without learning it from schools, and we retract our hand muscles when we touch something hot. These actions are not determined by habitus but by stimuli. Lorenz’s research on animal instincts (ethology) with ducklings points toward that the hatchlings are born with learning programmes, which only need to be activated by stimuli. The ducklings were born to be attracted to certain stimuli that resemble the features of a mother hen, which is similar to human infants learning to recognize faces. Humans have fight-or-flight instincts that trigger certain parts of the brain when faced with dangerous situations. We also eat, drink, and rest based on body chemistry.

Reflection

Based on scientific evidence, the habitus of society, as mentioned, guides one’s behaviour. Yet the habitus itself is created through a social pattern. And it could be argued that social patterns are based on biological responses. One could, as I did as well, fall into the trap of a nihilistic view on this matter, that society is nothing but a complex exchange of chemistry responses that guides what we perceive as the “reality”. However, “I think, I am”, I refuse to be defined by a set of chemistry responses, but through my senses, and what I experienced throughout time.

From this mode of thinking, strong moral support for medical advancement can be derived. Imagine the reality perceived by someone who suffers from nerve damage that affects any of the five senses since birth. The reality perceived by them will be totally different. Without medical advancement for prostheses and other surgical treatments, living in a reality without realising the reality is false due to uncontrollable factors is a really cruel thing to think about. Like Descartes’ theoretical example of a deceptive god that intentionally created reality to always be false. It is a great evil if this was to be true. As such, some medical advancements can really be something to be awe of.

As a biomedical sciences student, what initially drew me to this module was my interest in stem cells and genetic engineering. I am currently reading The Genetic Age: Our Perilous Quest to Edit Life by Matthew Cobb, which chronicles the history of gene editing, from its advent in the 1960’s to our current day. In it, he recounts the 1975 Asilomar Conference on Recombinant DNA, and its lasting impact on how scientists maintain their ethical responsibility of public safety.

SV40 and Asilomar

In 1974, Paul Berg was attempting to use tumour-causing simian virus 40 (SV40) to introduce the E. coli lac gene into mammalian cells. He also successfully introduced SV40 into E. coli, which became one of the first successful recombinant DNA experiments. However, this led to concerns from other scientists that the bacteria containing SV40 could escape his lab and cause cancer in infected people. Berg agreed to place a temporary moratorium on all recombinant DNA experiments, leading to a lot of panic in the public, as people rightfully wanted to know just how dangerous these experiments were.

In 1975, Berg and around 100 other scientists in his field gathered at Asilomar Conference Centre, California to draw up safety guidelines for recombinant DNA experiments, with reporters present. Over several days, they discussed bio-safety precautions and which experiments should and shouldn’t be taken. Some took a very utilitarian approach, arguing that a few people hypothetically getting infected by an escaping virus was outweighed by the potential benefits of recombinant DNA technology, and that any guidelines were impinging on their academic freedom as scientists. Others argued that even one person hypothetically getting cancer was too much of a risk. Eventually, the participants were able to agree on safety protocol and containment strategies for recombinant DNA experiments and even prohibited some that were considered too dangerous.

The Lessons of Asilomar

In 2008, Berg published an opinion piece in Nature Magazine reflecting on Asilomar and posing the rhetorical question of whether another similar conference would resolve the current controversies in science at the time: “foetal tissue, embryonic stem-cell research, somatic and germ-line gene therapy and the genetic modification of food crops”.

While Asilomar’s participants didn’t discuss the ethical nor social aspects of genetic engineering and only focused on the health risks of the specific recombinant DNA experiments, it was the first example of wide-scale self-regulation within the scientific community. It created an expectation for the same standard of social responsibility to be applied to all future forms of genetic engineering and its associated technologies.

A re-evaluation of self-regulation

In his Asilomar opinion piece, Berg brings up an important and worrying point: most scientists in recombinant DNA research at the time worked in public institutions whereas scientists today often work for private biotechnology companies. They are at the behest of their employers, forced to place the financial interests of the companies before the health and safety of the public.

In his book, Cobb points out that public decision-making in genetic engineering has been limited so far. At Asilomar, policy was only made between scientists with some input from lawyers. There were reporters present but only for transparency’s sake; public trust was gained, but they weren’t involved in the process itself. He argues that the potential impact of today’s gene editing technologies means that “public involvement in decision-making, on the basis of open experimental data rather than secrecy and suspicion, needs to become widespread and routine” and “it is only because of public disquiet that has prompted the introduction of regulatory control that genetic engineering thus far has been safely deployed”.

My thoughts

I agree with Cobb that there must be an open and stronger line of communication between scientists and the public. Genetic engineering is a constantly evolving frontier of biomedical science, with new frontiers being discovered constantly. It is far too easy to be swept up in the excitement of it all and tumble down the rabbit hole, performing unnecessary experiments in the name of progress and notoriety, like in the case of He Jiankui’s embryo-edited twins. There are numerous ethical implications surrounding genetic engineering; it toes the line between life-saving somatic therapies and flirtations with – if taken too far – eugenics.

Science should be for the benefit of many, not few. All people deserve to have access to important and life-saving technologies and furthermore, should have knowledge of and a say in how those technologies are regulated and applied. In his own opinion piece about Asilomar, pioneering microbiologist and conference participant Stanley Falkow wrote in 2012: “The (very privileged) social contract by which science is sustained depends on the public continuing to understand why this work is beneficial and worthwhile.” And more than a decade later, his words ring truer than ever.

References

Berg, P., 2008. Asilomar 1975: DNA modification secured. Nature, 455(7211), pp.290-291.

Cobb, M. (2022) The Genetic Age: Our Perilous Quest to Edit Life. London: Profile Books.

Falkow, S., 2012. The lessons of Asilomar and the H5N1 “affair”. MBio, 3(5), pp.e00354-12.

Amidst an ethical debate regarding organ donation in an ethics and law workshop, the complexity of the discussion inspired me to delve further into the moral and legal implications of organ donation. While it is true that organ donation is a lifesaving procedure, it is interesting that when it comes to infants with life-threatening illnesses, it’s not so easy.

Case study

For example, Mrs Z, a young, overdue, pregnant woman underwent an ultrasound examination and was told that her baby was anencephalic – A condition where no brain is present except for portions of the brain stem and there is a high likelihood the baby will be born underdeveloped and stillborn. Heart and kidney transplants could be possible.

In light of this, the mother decided to volunteer her baby as an organ donor. Despite her wishes, the moral debate began as physicians became uncertain on what steps to take. If they accepted the mother’s wish to donate organs, is it their duty to try and resuscitate the baby if it was still born? Should they accept her wishes at all? When should or could the baby’s death be pronounced?

Moral Panic

Mrs Z’s case is a controversial debate, predominantly due to the moral and legal obstacles to taking organs from a pre-diagnosed anencephalic new-born.

To start, following the mother’s requests would be a way to alleviate the growing shortage of vital organs for organ recipients in need. Organ size restrictions mean that strategies to increase donation rates may not be of much use. However, there have been cases where ‘miracle babies’ have lived long after expected. How do we determine who takes priority?

In addition, under current law, organs can be taken from patients who are ‘brain-stem dead’. Despite brain absence, an anencephalic infant does not meet this criterion as they retain a functional brain stem that can maintain vital functions. So, by law, the mother’s desire to donate may not be permitted. The baby should be treated as they would ordinarily be treated, regardless of determined death. Would we normally resuscitate a still-born infant? Prolong suffering? Yet, if these organs have the ability to save the lives of dying infants, I believe that the organs should be donated, provided the baby does not suffer.

Finally, in actuality, there is no reason why the parents shouldn’t be able to donate the organs of their baby to suitable recipients, provided it follows the death of their child. But… the glorification following the words ‘organ donation’ makes me wonder if the parents were informed on alternative approaches for recipients, such as stem cells or Norwood staged surgery. Were they aware that the absence of a major part of the brain doesn’t imply instant brain death? Is this pure utilitarianism? I believe it should be standard that families who request organ donation from their anencephalic baby should be given concise information and educational material provided on the practice and its implications.

Final thoughts

In my opinion, if there is a way to donate Mrs Z’s baby’s organs without drastically intervening standard treatment, organ donation should proceed. However, the answer differs if a significant alteration occurs. Going above and beyond to prolong gestation on a distressed infant in order to ‘mature’ organs for donation requires moral reservation.

Nevertheless, recent research has diminished the idea of anencephalic new borns as organ donors, with the exception of theoretical debate and case studies. The American Academy of Paediatrics (1992) concluded that organ donation from anencephalic infants should not be undertaken due to the serious difficulties surrounding the establishment of brain death and limited success rates.