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BMJ 1999; 319 doi: (Published 13 November 1999) Cite this as: BMJ 1999;319:1312

Rapid Response:

Ethics of using infant foreskins for bioengineering


Minerva (13 November 1999) is uncertain if the human foreskin is
useful to its owner. Gairdner, who published the first scientific study of
the foreskin in the BMJ just 50 years ago1, pointed out that the foreskin
was useful to the infants he studied as protection for the glans. Since
then, further studies have shown that the foreskin, with its unique
innervation, functions as an erogenous tissue in adults.2,3

reports that an American bioengineering firm uses infant foreskins removed
at routine neonatal circumcision to manufacture tissue-engineered skin

The product referred to in this article is ‘Apligraft’
produced by Organogenesis Inc, Canton, Mass. The amputation of healthy
tissue from an infant is in itself unnecessary and unethical, violating
the child’s human rights and exposing him to pain, risk of surgical
complications and loss of this erogenous tissue. Then to use the foreskin
as a tissue donation for the benefit of third parties contravenes the
ethics of tissue donation, as the donor has not consented to the donation.

Benefit accrues to the doctor, who is paid both to perform the operation
to provide the tissue to the bioengineering firm. The bioengineering
firm operates a multimillion dollar business. It has been estimated that
the potential retail value of one baby's foreskin is $190 million5. The
recipient benefits from a satisfactory skin graft. This money-making
business, however, operates in an ethical vacuum, in which the
unconsenting donor is irreparably harmed, and receives no compensation.

Members of an ethical profession should refuse to use bioengineered
tissue derived from foreskins of living babies. Alternative techniques
should be developed to grow the patient’s own skin cells in tissue culture
and then
graft them back onto his lesion, or, alternatively, tissue derived from
cadavers or consenting adult donors would be acceptable.



PO BOX 71,
ST15 0SF


1 Gairdner D. The Fate of the foreskin. A study of circumcision. BMJ
1949; ii: 1433-7.

2 Cold CJ and Taylor JR. The prepuce. Brit J Urol 1999; 83, Suppl 1,

3 Cold CJ and McGrath KA. Anatomy and histology of the penile and
clitoral prepuce in primates. An evolutionary perspective of the
specialised sensory tissue of the external genitalia. In male and female
circumcision. Edited by Denniston GC et al. Kluwer Academic/Plenum
Publishers, NY, 1999. Pages 19-29.

4 Falabella AF et al. The use of tissue-engineered skin (Apligraf) to
treat a newborn with epidermolysis bullosa. Arch Dermatol 1999;

5 Milos MF. Personal communication.

Competing interests: No competing interests

18 November 1999
John P Warren