title: Taking tissue seriously means taking communities seriously.
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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  Greater attention to community engagement is required to understand the diverse issues associated with tissue exportation.
authors.affiliation: University of Toronto Joint Centre for Bioethics, 88 College Street, Toronto, Ontario, M5G 1L4, CANADA. ross.upshur@sunnybrook.ca
authors.forename: Ross E G
authors.initials: RE
authors.lastname: Upshur
authors.forename: James V
authors.initials: JV
authors.lastname: Lavery
authors.forename: Paulina O
authors.initials: PO
authors.lastname: Tindana
mesh_terms: D035843:Biomedical Research / Q000941:ethics*; D032821:Commodification; D019049:Developed Countries / Q000191:economics; D003906:Developing Countries / Q000191:economics; D028744:Ethics Committees, Research; D032984:Ethics, Research; D014943:Global Health; D006801:Humans; D007194:India; D007391:International Cooperation; D010067:Ownership / Q000941:ethics*; D010330:Patents as Topic; D012108:Research Personnel; D035842:Research Subjects; D012935:Social Justice; D020858:Tissue and Organ Harvesting / Q000941:ethics*; D014058:Tonga; D014454:Uganda; D035862:Vulnerable Populations