Book Review

Fetal Tissue Transplants in Medicine

N Engl J Med 1993; 329:513August 12, 1993

Article

Fetal Tissue Transplants in Medicine
Edited by Robert G. Edwards. 352 pp., illustrated. New York, Cambridge University Press, 1992. $110. ISBN: 0-521-41075-4

Many medical applications using fetal tissue have been conceived, and in a number of instances they have been tested clinically. Unfortunately, the field of fetal-tissue transplantation has engendered more than its share of controversy. Some proponents have damaged their cause by overenthusiastic and unsubstantiated claims of success with fetal transplantation to treat various diseases; opponents have entangled the science of transplantation in the politics of abortion. Refreshingly, Fetal Tissue Transplants in Medicine, edited by the distinguished English scholar Robert G. Edwards, skillfully avoids both extremes and provides a balanced and serious overview of this emerging area of medicine. The book surveys the ethical, legal, practical, and scientific issues important to the use of fetal tissue. What impresses me most and fulfills a clear need in this field is the way each chapter delineates not only the benefits but also the limitations of fetal-tissue grafting.

In collections of review articles such as this one, I usually read only the chapters directly relevant to my research. However, in this instance I read the book from cover to cover. It was worth it. In the area I know the most about, transplantation for the treatment of Parkinson's disease, it was a pleasure to find an extensive and fair review of a complex literature. The other contributions are equally rewarding. Edwards' chapter on the transplantation of mammalian embryonic cells provides a fine introduction to that field. B.E. Tuch's review of the history of clinical fetal pancreatic grafts illustrates some of the problems inherent in demonstrating graft survival and function. It should be mandatory reading for anyone who believes successful fetal-tissue transplantation to be simply a matter of slicing, dicing, and grafting. Chapters on areas well outside my expertise, such as the grafting of blood-forming organs, are clearly written and interesting. J.C. Polkinghorne's essay on the law and ethics of transplanting fetal tissue is a thoughtful, reasoned discourse on a topic that usually invites emotionally charged rhetoric.

Without question, this is an excellent book. It will serve as an important reference for students, scientists, and physicians interested in fetal-tissue transplantation for years to come. As is true of all books in rapidly advancing fields, part of the work is already dated. For example, in the past year there have been several substantial advances in the use of fetal-tissue grafts to treat Parkinson's disease (e.g., Freed et al., Spencer et al., and Widner et al., New England Journal of Medicine 1992;327:1541-1563). However, the value of this book lies in its critical analysis of the state of fetal-tissue grafting in 1991-1992, when most of the chapters appear to have been written.

Don Marshall Gash, Ph.D.
University of Kentucky, Lexington, KY 40536