An organ-on-a-chip is a microfluidic cell culture device created with microchip manufacturing methods that contains continuously perfused chambers inhabited by living cells arranged to simulate tissue- and organ-level physiology. By recapitulating the multicellular architectures, tissue-tissue interfaces, physicochemical microenvironments and vascular perfusion of the body, these devices produce levels of tissue and organ functionality not possible with conventional 2D or 3D culture systems. They also enable high-resolution, real-time imaging and in vitro analysis of biochemical, genetic and metabolic activities of living cells in a functional tissue and organ context. This technology has great potential to advance the study of tissue development, organ physiology and disease etiology. In the context of drug discovery and development, it should be especially valuable for the study of molecular mechanisms of action, prioritization of lead candidates, toxicity testing and biomarker identification.--Sangeeta N Bhatia & Donald E Ingber Nature Biotechnology, 32, pages, 760–772(2014).*
Organ-on-chip research has been promoted for a decade now (see this Scientific American article from 2011). And in recent years, it has become a staple of medical research, and now is entering clinical practice or, if not already, foreseeably so. There is, in fact, increasing public and philosophical interest in cerebral organoids because of their potential for consciousness. See for recent work by Koplin & Savulescu here, who claim that "brain organoid research raises ethical challenges not seen in other forms of stem cell research."+ Let me stipulate that Koplin & Savulescu are right about this. Even so I also think that when reflecting on the ethical and social challenges generated by organ-on-a-chip research, exclusive focus on such mini-brains, understandable and urgent though it may, may also lead to inattention to other interesting issues related to non-brain-organoid research. I would like to sketch some of these.
At present researchers are working to create 3D patient-specific micro-models facilitating individualized clinical disease prediction, prevention, and intervention. Simultaneously, a new kind of model-organism for basic research into the underlying disease(s) and efficacy of proposed therapeutics is, as Melinda Fagan pointed out in 2017, being created. (I warmly recommend Fagan's article.)** When I am focused on patient models, I use 'organoids;' when I am focused on model-organisms, I use 'organ-on-a-chip.' In what follows, I am interested in organoids/organ-on-a-chip for patients with defective or malfunctioning organs.*
Crucially, organoids resemble are generated from the patient’s own tissue; and so can blur the distinction where an individual begins and ends (this is, in fact, one of Fagan's main points). Since particular organoids may come to be linked to personalized treatment, it is reasonable to suggest that it will constitute their extended self. This is especially the case once the patient associates themselves, their identity, with their disease and/or when society treats their disease as a risk factor. This is, of course, not necessary.
But when a patient is in a hospital environment, a lot of attention is focused on their defective organs and the manner in which these defects constrain/inhibit/limit their lives. (Here i am influenced by, recall, Elizabeth Barnes' work on disability.) So, it is reasonable to expect that patients (and I now adopt Humean language) may project or spread themselves onto their organoids, which may represent or materialize their disease progress. It is, then, them in an artificial environment.
That organoids can be part of their extended self is not self-evident: they are often perceived as just a clinical tool on par with a blood sample or a X-ray. My suggestion is that in a clinical context such organoids will be more like prosthetics than X-rays (see here an interesting article by Hilhorst). I suspect this is especially natural to experience a 3D model as an extended self in the context of hereditary disease, where the ultimate therapeutic or clinical aim is not just to mitigate the effects from, but to modify or correct/repair the underlying genetic error.
So, I speculate that organoids can become more than just a representation of a part of the patient; they can also play a role in their social identity, e.g. in their interactions with their physicians, care-givers, insurers, family, etc. I am especially curious if their moral phenomenology and language will shift. One relevant question is the extent to which partial identification with an organoid can influence the patient’s decision-making or well-being, even clinical efficacy.++ Another more ethical question is to what degree such identification should influence the role a patient's wishes for the organoid should trump others.
Even so, organ-on-a-chips, as model-organisms, must facilitate standardization and share-ability of research and function as epistemic tools of inquiry. The ethics and politics of treating humans, or their parts in artificial environments, as model organisms is, it seems, itself underdeveloped. (I started thinking about this in light of Sabina Leonelli's 2012 paper.) In particular, since stem-cells can be self-organizing and have lineage generating capacity, it is worth asking to what extent the current oversight and consent regulations that cover organ-on-a-chip research do justice to the possible sense of self of donors and patients may experience with their organoids. There may be all kinds of conflicts brewing.
*Full disclosure: my interest in the topic has been prompted by a team at Leiden University Medical Center, which invited me to join in a research project pertaining to hereditary diseases involving organ-on-chip.
+I have benefitted from reading unpublished work by folk at UCSD, including Reuven Brandt, who has been very helpful.
**Anya Plutynski recommended it to me on Facebook in this thread.
++Everybody has complex relationship with one's embodiment, but I may falsely be presupposing that for those with genetic disease this is more poignant.
***I thank drs. Valeria Orlova and Saskia Lesnik Oberstein for comments on earlier drafts of some of this material.
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