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Open Access Debate

Taking tissue seriously means taking communities seriously

Ross EG Upshur1*, James V Lavery2 and Paulina O Tindana3

Author Affiliations

1 University of Toronto Joint Centre for Bioethics, 88 College Street, Toronto, Ontario, M5G 1L4, CANADA

2 Centre for Global Health Research, St. Michael's Hospital, #315, 70 Richmond Street East, Toronto, Ontario, M5C 1N8, CANADA

3 Navrongo Health Research Centre, Ghana Health Service, PO Box 114, Navrongo, GHANA

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BMC Medical Ethics 2007, 8:11  doi:10.1186/1472-6939-8-11

Published: 26 October 2007

Abstract

Background

Health research is increasingly being conducted on a global scale, particularly in the developing world to address leading causes of morbidity and mortality. While research interest has increased, building scientific capacity in the developing world has not kept pace. This often leads to the export of human tissue (defined broadly) from the developing to the developed world for analysis. These practices raise a number of important ethical issues that require attention.

Discussion

In the developed world, there is great heterogeneity of regulatory practices regarding human tissues. In this paper, we outline the salient ethical issues raised by tissue exportation, review the current ethical guidelines and norms, review the literature on what is known empirically about perceptions and practices with respect to tissue exportation from the developing to the developed world, set out what needs to be known in terms of a research agenda, and outline what needs to be done immediately in terms of setting best practices. We argue that the current status of tissue exportation is ambiguous and requires clarification lest problems that have plagued the developed world occur in the context of global heath research with attendant worsening of inequities. Central to solutions to current ethical concerns entail moving beyond concern with individual level consent and embracing a robust interaction with communities engaged in research.

Conclusion

Greater attention to community engagement is required to understand the diverse issues associated with tissue exportation.