The Ethics of 3D-Printed Organs: Who Gets Access When Supply Isn’t the Problem?

Emily Wolf
11 minutes ago
4 min read

As of 2025, over 103,223 men, women, and children are on the national transplant waiting list, and 13 people die each day waiting for an organ transplant, according to Organdonor.gov. Now imagine a transplant list that isn’t just fueled by donors. One where fewer people have to wait months or even years because printers can create organs. This is what hopeful researchers around the world are working toward every single day. While numerous researchers are studying solutions to this problem, few are considering the ethical challenge of equitable distribution. Thus, the central question to answer is as follows: if organs can be printed, who decides who gets them first and on what basis?

Before making future decisions, let's first understand how the current organ list operates and how allocation works. Allocation is primarily driven by one thing: scarcity. In the U.S. specifically, patients are ranked by medical urgency, waiting time, tissue compatibility, and geography, because there simply aren’t enough organs for everyone in today’s day and age. For instance, the Model for End-Stage Liver Disease Score, also known as the MELD score, determines who gets a liver transplant by prioritizing patients with the most severe disease. Similarly, the Lung Allocation Score, also known as the LAS, ranks by severity for lung transplants. In theory, if bioprinting advances enough, hospitals could print kidneys, livers, or hearts based on patient demand, which would reduce the bottleneck of the overall list. Instead of over 6,000 deaths in the U.S. because of long wait times, the supply might be increased to meet that demand. Although the increased supply isn’t quite infinite due to the cost of technology, materials, expertise gap, etc. Current bioprinters cost upwards of hundreds of thousands of dollars, and materials like special biolinks with living cells in them remain difficult to produce on the scale that would be needed to remove the demand.

When looking at ethical dilemmas of access, we can refer to historical situations to get a glimpse of what might happen in the future. For example, insulin was sold for $1 per patient in 1921 to ensure access, yet now, insulin prices are a major barrier preventing those who need care from receiving it. This presents the possibility of socioeconomic barriers such that wealthier patients may access printed organs first, especially if they’re sold at a premium. In the 1960s, a committee in Seattle rationed earlier dialysis machines based on determined social worth, and the media thus dubbed it the “God Committee.” This warns that lifesaving technology being scarce or expensive often means that better-connected patients can get in first; learn more about this history from the American Medical Association Journal of Ethics. Next, geographic inequity is a factor because powerful technology is usually first found in urban hospitals and high-income countries before it spreads to other locations. The WHO/ONT Global Observatory tracks how often different parts of the world have transplants, which is useful in determining which locations would likely get access to these 3D printing capabilities first. Finally, there's some ambiguity in regulation, which causes some gray zones in organ printing. In the U.S., the FDA currently regulates 3D-printing devices, and the European Union treats bioengineered tissue as advanced therapy medicinal products, or ATMPs. Classification affects not only what evidence is required for approval, but also how quickly and easily approval can actually be attained.

As 3D-printed organs today are intended to use specific patient cells in creation, it’s likely safe to assume that future 3D-printed organs will do the same. The landmark Moore v. Regents case (1990) held that patients generally don’t keep property rights when they discard tissues, although certain consent and disclosure duties still apply. Another case, Greenberg v. Miami Children’s Hospital (2003), found that families who donated samples to identify a Canavan-disease gene couldn’t claim property in the samples. Originally, the families had wanted Miami researcher Dr. Matalon to find the gene and make a widely available test; however, the hospital obtained a patent once the test and gene were found. Generally, the precedent for U.S. courts in bioethics is that tissue given as a donation doesn’t necessarily retain property rights. Despite these past rulings, there aren’t as many specific cases relating to 3D printing, as it's still in preliminary stages and could have an entirely different outcome in the legal field.

After discussing the potential ethical issues above as well as previous precedents, we must define and take into account various decision-making frameworks. One example is utilitarianism, which, simply put, means maximizing the total good. In this framework, patients are prioritized based on which ones are expected to gain the most life years or health benefits. Another system is egalitarianism, where everyone is treated as equals and lotteries are used to select candidates, especially when many may have similar outcomes. Furthermore, a justice-oriented framework prioritizes historically underserved communities, who frequently lack access to quality care or receive it last. You may even decide to use a hybrid framework of the above options when considering the bioethics behind the distribution of 3D-printed organs.

3D-printed organs could end tragic waiting lists, but removing scarcity doesn’t necessarily eliminate hard choices; it simply moves them. Oftentimes, there is an emphasis on acquiring fully functioning and applicable 3D-printed organs, yet there’s little discussion of the specific ethics behind distribution. That’s why we must set the rules now and ensure they are clear, fair, and grounded in evidence as well as empathy. It isn’t possible to fully answer the question presented at the start of this blog in such a short time, so take a deep dive into bioethics on your own time, because the application and distribution of medical interventions is just as critical as their invention.