Debate Taking tissue seriously means taking communities seriously

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. Background Human tissues consist of a heterogeneous set of biological materials of interest from a scientific point of view for the development of diagnostic and therapeutic agents, and the study of genetic determinants of disease. Knowledge derived from human tissues research has led to fundamental advances in understanding a wide range of human diseases [1]. As clinical and basic research move to an increasingly global scope, particularly with the recent focus on tackling the major health issues in the developing world, it is important to understand the wide range of ethical issues involved in the exportation of tissue from the developing to the developed world. Tissue analysis is a lucrative field, and it is unclear how benefits are explained to research participants, thus rendering aspects of informed consent problematic. The fate of exported tissues is often unaccounted for, making oversight difficult. Guidelines are poorly adhered to, and communities often not informed of the exportation, and when Published: 26 October 2007 BMC Medical Ethics 2007, 8:11 doi:10.1186/1472-6939-8-11 Received: 27 June 2007 Accepted: 26 October 2007 This article is available from: http://www.biomedcentral.com/1472-6939/8/11 © 2007 Upshur et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.