Preparation of Papers in Two-Column Format



ENGINEERING THE KIDNEY: CHALLENGES, ETHICS, AND EDUCATION

Hailee Kulich (hrk6@pitt.edu)

Ethical Engineering

One of the main goals of bioengineering is to provide improved or expanded treatment for commonly encountered medical disorders [1]. A condition such as renal failure is an example of a situation where the application of bioengineering may lead to an improvement in the treatment of a common medical condition where there is currently a limited number of available treatments. There are two means by which kidney function can be replaced in humans: dialysis and kidney transplantation [2]. While these processes can be lifesaving, they also are expensive, invasive, and rarely a permanent solution. The development of an artificial kidney would potentially solve many of the problems associated with these interventions and, if successful, lead to improvement in the quality of life for thousands of patients suffering from renal failure.

While engineers have a responsibility to improve the lives of those around them, they must do this in an ethical manner. According to the NSPE Code of Ethics for Engineers, engineering has a direct impact on the quality of life for many people; therefore, engineers must approach their jobs with honestly, integrity and fairness [3]. In tissue engineering, it is imperative that engineers treat all forms of life with respect, are mindful patient rights, and continuously work to better the lives of others [4].

As a freshman engineering student, it is important to be familiar with the expectations of an engineer. By researching topics of interest, young engineers will gain a better understanding of the area of engineering that interests them. Also, through studying ethics, engineering students are made aware of their responsibilities to society early on in their careers. Education is vital to the development and success of an engineering student, and exposure to the challenges and ethics of engineering should be introduced as early as possible.

Kidney Structure and Function

The kidney regulates internal electrolyte and water balance, secretes hormones, and eliminates toxins [5]. It serves as a filter and receives about 20% of cardiac output. The basic functional unit of the kidney is the nephron [6]. Each nephron is composed of a series of tubes that receives filtered blood and regulates electrolyte and water balance by active secretion and reabsorption important materials [5]. A deterioration of kidney function caused by the loss of nephron function, leading to a loss in the organs ability to perform its critical functions, is termed renal failure [7].

[pic]

Figure 1 [8]

BASIC TUBULAR SEGMENTS OF THE NEPHRON.

RENAL FAILURE

There are three stages involved in renal failure: reduced renal reserve, renal insufficiency, and end-stage renal disease. During the reduced renal reserve stage, nephrons begin to fail but patients are asymptomatic. If more than 75% of the nephrons fail, renal insufficiency is said to occur, resulting in clinical symptoms (excessive urination) and detectable laboratory abnormities (elevated nitrogenous waste in the blood). When more than 90% of the nephrons fail, end stage renal disease has occurred, leading to dilute urine, low urine output, severe fluid and electrolyte imbalances, and an inability to maintain homeostasis [9].

[pic]

Figure 2 [9]

EFFECTS OF RENAL FAILURE.

DIALYSIS AND KIDNEY TRANSPLANT

Currently, there are two main treatments available for renal failure: dialysis and kidney transplantation [7]. Dialysis is a process that involves removing the blood from the body, filtering it, and returning it back to the body. This process removes harmful toxins from the blood and regulates electrolyte balance. However, it is an invasive procedure that must be done on a regular basis [2].

[pic]

Figure 3 [10]

THE PROCESS OF DIALYSIS.

ANOTHER OPTION FOR THOSE SUFFERING FROM RENAL FAILURE IS TRANSPLANTATION. A FUNCTIONAL KIDNEY IS REMOVED FROM A DONOR OR CADAVER AND TRANSPLANTED INTO THE RECIPIENT. WHILE THIS PROCESS MAY SEEM LIKE A GREAT SOLUTION, KIDNEY TRANSPLANTS ARE WROUGHT WITH PROBLEMS, SUCH AS A SHORTAGE OF DONOR ORGANS AND REJECTION OF THE FOREIGN ORGAN BY THE RECIPIENT’S IMMUNE SYSTEM. THIS MAY REQUIRE THE RECIPIENT TO BE PLACED ON EXPENSIVE IMMUNOSUPPRESSIVE DRUGS, MAKING THEM MUCH MORE SUSCEPTIBLE TO OPPORTUNISTIC DISEASES [12]. EVEN WHEN SUCCESSFUL, THE TRANSPLANTED KIDNEY HAS A LIMITED LIFE SPAN, LASTING ON AVERAGE KIDNEY APPROXIMATELY SEVEN YEARS [13].

Thus, while dialysis and transplantation may provide relief to renal failure patients, both have their drawbacks. The development of a better therapy, specifically an artificial kidney, may greatly improve the lives of patients with renal failure. However, engineers must carefully approach tissue engineering of the kidney by researching and experimenting in an ethical manner [3].

Bioengineering of the Kidney

The main purpose of tissue engineering is to mimic the function of damaged organs through replacement, repair, or enhancement [2]. However, the kidney is a complex organ consisting of many different cell types making the task of creating a bioengineered alternative treatment difficult, but not impossible. Three approaches to solve this problem include engineering nephrons to integrate into the kidney, stem cell engineering and development of the artificial kidney. If successful, this new medicine will lead to a better quality of life for thousands of people. However, while researching, engineers often run into many ethical issues involving animal testing, responsibility towards patients, and public welfare. The invention of such a device would make society better off, fulfilling an ethical obligation engineers have to the world.

Nephron Integration

In theory, kidney function could be improved using tissue engineering to generate new nephrons to replace the patient’s diseased nephrons. In this process, developing nephrons are implanted into a host kidney, where they grow and differentiate. When the nephrons are fully mature, they are implanted into a diseased kidney with the hope that they will become a functioning part of the kidney, increasing renal function [2].

This experiment has been successfully performed in mice, proving that it is possible to incorporate new nephrons into a healthy kidney. However, nephrons must be able to integrate into a diseased kidney to be an effective treatment for those with renal failure [2]. Because those with end stage renal disease have small, fibrotic kidneys, it may be difficult for nephrons to function in this microenvironment, as evidenced by the fact that nephron integration has never been successfully reported in the context of an end-stage kidney [2], [8]. Elucidation of the mechanisms that would allow for successful nephron integration in an end-stage kidney has the potential to revolutionize treatment for those with renal failure since, unlike kidney transplantation, nephrons can be engineered specifically for the individual, eliminating the need for immunosuppressive drugs and their deleterious side effects [2].

Additional testing is necessary before this process could be successfully integrated into the human kidney. However, much of the testing that would be required would be performed on animals, which is a sensitive subject in the bioengineering community. Engineers are to treat every life with respect, whether it is human or nonhuman [4]. Several measures must be taken to ensure that animals involved in research are treated properly.

If nephron integration was to be successfully performed in a human kidney with renal failure, treatment options would become much more manageable for patients suffering from this disease. It would eliminate most of the painful side effects associated with dialysis and transplantation, leading to a better quality of life for many people [2]. As an engineer, one strives to better public health and welfare [3]. By successfully completing this project, engineers could treat renal disease in a more ethical manner.

The Artificial Kidney

The goal of an artificial kidney is to replace all the functions of the human kidney. While several attempts at this have been made, the most popular device is a renal tubule cell-assist device (RAD). The RAD contains 1) a series of tubes lined by cells from the potential RAD recipient designed to replace the failing kidney’s endocrine and metabolic functions and 2) a hemofiltration cartridge, designed to replace the failing kidney’s filtration [2]. As in nephron integration, the cells in the device belong to the recipient, eliminating the complications caused by rejection and immunosuppressive medication.

[pic]

Figure 4 [14]

MODEL OF A RENAL TUBULE CELL-ASSSIT DEVICE (RAD)

A SUCCESSFUL ARTIFICIAL KIDNEY WOULD BE MUCH MORE EFFICIENT THAN BOTH DIALYSIS AND TRANSPLANTATION. IT WOULD DRASTICALLY REDUCE HARMFUL SIDE EFFECTS CAUSED BY THESE PROCEDURES AND WOULD BE LONGER LASTING [2]. BECAUSE THIS WOULD LEAD TO A BETTER QUALITY OF LIFE FOR OTHERS, AN ARTIFICIAL KIDNEY WOULD BE A MUCH MORE ETHICAL TREATMENT THAN DIALYSIS OR TRANSPLANTATION.

Tissue Engineering: Ethical?

Because of the research necessary for tissue engineering, one may argue that the alternatives to dialysis and transplantation are not ethical. However, so long as the engineer respects all forms of life and patient rights, these procedures provide safer, more effective options for those suffering from renal disease. This would improve overall public health and, therefore, be a more ethical option than both dialysis and transplantation.

Tissue engineering deals with many sensitive subjects, such as animal testing, patient rights, and public health. As a bioengineer, it is vital that these areas are approached very carefully. Research involving experiments on animals can be difficult to manage. It is an engineer’s responsibility to treat all life forms with respect and in the most humane way possible. A bioengineer must also take care to be constantly aware of patient rights. This includes obeying all patient privacy laws, keeping all research regarding a patient confidential, and respecting patient decisions [4].

Perhaps the most important goal for bioengineers is to improve public health and welfare [3]. The development of a better alternative to renal failure treatment would benefit thousands of patients around the world. While there are some downsides to the research that is required to develop better medicine, the potential benefits outweigh the negatives. Because the health and welfare of the world would greatly improve through the research to provide better alternatives to renal failure treatment, it is both ethical and necessary to continue research in this field.

Early Education

Because of the many ethical issues engineers face on a daily basis, early education is essential for young engineers. By introducing the problems professionals face, engineering students gain a better understanding as to what issues they will face in the future. Also, by allowing students to delve into a topic of interest, it allows them to reaffirm their interest and will most likely give the students an easier time choosing the engineering field that suits them best.

Early education is necessary for the development of a young engineer. When exposed to the experimental and ethical concerns, it allows engineers to strengthen their critical thinking skills as well as fully understand their responsibilities to society. The process of understanding the achievements of engineering and the ethical concerns with those achievements is vital for a successful engineering student and should be introduced as soon as possible.

Engineering, Ethics, and Education

Currently, 300,000 individuals suffer from renal failure in the United States [2]. The mainstays of therapy are dialysis and kidney transplantation, both of which are costly and have undesirable side effects. As illustrated above, many of the problems associated with the current therapies could be solved through bioengineering, leading to the development of better way to treat renal failure, potentially improving the quality of life of thousands Americans.

While this process could benefit many people, engineers must take care to approach this problem in an ethical manner. This includes respecting all forms of life, obeying patient rights, and working to better public health and welfare. The development of better medicine to treat renal failure would greatly improve public health, making it an ethical procedure worth pursuing.

Because the world of engineering requires knowledge of achievements and ethics, early exposure to these ideas is vital. If given the opportunity to research challenges and ethics, the engineers of tomorrow will develop into more successful engineers.

References

[1] (2011) “Introduction to the Grand Challenges for Engineering.” National Academy of Engineering Grand Challenges for Engineering. [Online: Web site]. Available:

{2] Hammerman, Marc. (2003) “Tissue Engineering the Kidney.” Kidney International, Vol. 63. [Online Article]. p1195-1204. Available:

[3]”NSPE Code of Ethics for Engineers.” National Society for Professional Engineers. [Online Article]. Available:

[4]”Biomedical Engineering Society Code of Ethics” Biomedical Engineering Society. [Online Article]. Available:

[5] Gattone, Vincent. (2009) “Kidney Structure and Function.” Microscopy Society of America. [Online Article]. Available:

[6] Chmielewski, Christine. (2003, April) “Renal Anatomy and Overvie of Nephron Function.” Nephrology Nursing Journal. [Online Article]. Available:

[7] Costa, Jonathan, Crausman, Robert, Weinberg, Marc. (2004). “Acute and Chronic Renal Failure” Journal of the American Podiatric Medical Association. [Online Article]. Available:

[8] (2011) “What is Renal Function?” Kidney Care Center. [Online Picture]. Available:

[9] Kelly, Maryann. (1996) “Chronic Renal Failure” American Journal of Nursing. [Online article]. p 36-37. Available:

[10] (2011) “Dialysis” Health and Fitness. [Online Picture]. Available:

[11] Torpy, Janet. (2011) “Kidney Transplantation” The Journal of the American Medical Association. [Online article]. Available: jama.ama-

[12] (2008) “Kidney Transplant Overview” The New York Times. [Online article]. Available: \

[13] Fillmore, Cathleen. (1987) “The Problems of Pioneering Patients” The Toronto Star. [Online article]. Available:

[14] (2008) “New Kidney on the Block” University of Michigan Health System. [Online Picture]. Available:

Additional Sources

Amadei, Bernard. (2011) “Engineering for the Developing World” National Academy of Sciences on behalf of the National Academy of Engineering. [Online article]. Available:

Revkin, Andrew. (2008) “How Many Grand Engineering Challenges are Really Policy Changes?” The New York Times. [Online article]. Available: challenges/

Richardson, Jim. (2002) “Effects of a Freshman Engineering Program on Retention and Academic Performance”.[Online Article}. Available: citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.20...rep...

FMpgqBQFpc8w42dygMau2lI0lRjJs2txpo5fdYNENd_S8BB&sig=AHIEtbQ2Rgzed2J_lqO4_OPkzHUPc1pW1g

Unger, Stephen. (2010) “Responsibility in Engineering: Victor Paschkis vs Wernher von Braun. IT Professional, University of Pittsburgh Swanson School of Engineering Volume 12 Issue 3, 2010, p. 6-7, DOI10.1109/MITP.2010.94

(2011) “The Grand Challenges” National Academy of Engineering Grand Challenges for Engineering. [Online video]. Available:

Acknowledgements

I would like to thank Beth Bateman Newborg and Deborah Galle for their helpful insight into the requirements of this assignment. I would also like to thank the staff at the Benedum Library for their assistance in finding the reliable information used to write this paper. Finally, I would like to thank Dr. Scott Kulich for his expertise on kidney function and his proof-reading abilities.

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