Research using human tissues--a crisis of supply?

It is a paradox that the pursuit of ethical practice can sometimes produce distinctly unethical results. Pathologists seek to study diseased human tissues for the benefit of mankind, but in the UK there has been a sudden restriction in the availability of this basic resource, supposedly on ethical grounds. This was triggered by adverse publicity about the inappropriate retention of whole organs at paediatric post-mortem, but the reaction has spread to influence the use of 'surgical waste' left over after routine analysis of therapeutic resections, diagnostic biopsies, and even blood samples. The use of such material for research is being restricted, and its use in teaching and laboratory quality control is being questioned. This has occurred despite the facts that public opinion favours using such 'waste' material for research; that the tissues would otherwise be incinerated; and that until very recently, such tissues were regarded as having been 'abandoned' by the patient. This review attempts to chart how this dramatic change has occurred. It then considers some of the ethical problems in using such 'surplus' tissues and proposes mechanisms by which this valuable resource can remain available for most biomedical research, while maintaining or enhancing the autonomy of individual patients. This crisis has shown a tendency for regulatory authorities to apply very restrictive, oversimplified rules, without due consideration of the character of each project. The motivation is to avoid the possibility of media criticism, even though such rules block ethically sound work which is of value to all, including the individuals whose protection is supposedly being sought. The moral need for logical ethical arguments instead of such 'one size fits all' regulations is emphasized. Copyright 2001 John Wiley & Sons, Ltd.