During a recent practice encounter, a client commented to the clinical nurse specialist (CNS) that it would not be too long before people would be able to have a new organ created by a 3-dimensional (3D) printer rather than waiting until one becomes available via current organ transplantation processes. This was not the first time that the CNS had engaged in a brief chat with a patient or family member about the future prospects of 3D printing technologies. The potential possibilities associated with this up-and-coming manufacturing venture are increasingly discussed in the popular media and in professional literature. Health professionals should become familiar with the basics of 3D printing and its possibilities so that they can contribute to interesting conversations with the public and individual health care consumers that are evidence-based and accurate.

Additive manufacturing or 3D printing uses computer-aided designs (CAD) to construct a 3D structure from successive layers of materials until the solid object is completed.1 CAD is able to accomplish this task by slicing the digital model into very thin layers or cross sections. The computer program guides the printer in its building of the object via these sequentially added layers. The printer and its "ink" are 2 critical elements that are often the focus of science and engineering research.2 Designing and selecting the appropriate printer mechanisms and materials are key concerns and contribute to the barriers that need to be circumvented before 3D printing can reach its full potential.

Applications for 3D printing widely vary and as a result of this variability, 3D printers are used globally across many industries. The opportunities for design intricacies benefit the food industry, including chocolatiers interested in creating novel designs in chocolate,3 and architects attracted to unique housing opportunities.4 The industrial sector of the manufacturing market is pushing to explore strategies to maximize the benefits of 3D printing and to fill a variety of voids. It is interesting to note the potential utility of additive manufacturing creations in response to natural disasters. Disaster relief efforts benefit when 3D printers are used to create medical devices, tools, and even shelters.5

Additive manufacturing is able to create complex structures by using a wide range of materials including metal, wax, wood, rubber, cloth, plastic, food, and biological materials.1 Although manufacturing models can cost well over a million dollars, consumers can purchase desktop models for a few hundred dollars. Online shoppers can easily search for options through Web-based shopping platforms.

Health science researchers are similarly interested in the opportunities inherent in 3D printing applications; however, the challenges are unique when compared with the concerns of nonbiologic manufacturing enterprises. Biomedical engineers focus on using additive manufacturing to replace, repair, or regenerate tissue or organs that are defective, diseased, or missing.2 The end products of biologic printing processes are tissue-like structures that are a compilation of functional cells, natural and man-made biomaterials, and growth factors. Biofabrication requires a porous scaffold or framework upon which cells are seeded and grown so that a cell-integrated substitute is created that may serve as an alternate for the tissue or organ needing replacement.2 The bioprinting process consists of 3 stages: (1) preprocessing to prepare the cell suspension; (2) processing by depositing the bioink on the scaffold; and (3) postprocessing during which maturation occurs.6 The biologic and man-made components are very sophisticated, and research continues to examine the best way to create and use these materials. Compounding the challenges associated with the biologic materials, organs have complex architecture with highly specialized cells living in sophisticated arrangements. These challenges have not yet been overcome, so creating transplantable vital organs is not currently possible.2

There are useful 3D bioprinting applications that are currently available, accessible, and beneficial. Cosmetic testing may be conducted using 3D reconstructed human epidermis test models.7 Toxicity tests can evaluate products and chemical ingredients for skin irritation and corrosion potential. A significant advantage of this product testing opportunity is avoiding animal testing.7 Additive manufacturing is also useful for testing electronic nicotine delivery systems such as e-cigarettes and tobacco heating devices. Commercially available 3D reconstituted human airway tissue can be exposed to undiluted cigarette and e-cigarette aerosols using a smoking robot.8 Additive printing offers promise for replacing animals and cadavers in research as well as creating models that might improve communication about surgical procedures and enhance informed consent processes.1 Three-dimensional printing may also be a useful ancillary tool to assist students in developing operative skills by practicing with realistic models as alternatives to gradual participation in surgical interventions.1

A recent review of clinical trials that are using 3D printing technologies reveals interesting trends and provides descriptive information about the current state of additive printing in health research.9 Researchers surveyed 15 primary clinical trial registries across the world and identified 92 clinical trials with more than 6000 enrolled patients. Approximately 45% of these studies were located in China. Orthopedic surgery represented the largest number of studies, with credit for about a quarter of the registered trials. Some studies involved maxillofacial surgery, orthopedics, cardiology, dentistry, and maxillofacial surgery.9

Published literature reveals that bioprinting is a long way from printing organs for transplantation. Complex organs require living cells with varying functions, structures, and designs. Printing technologies need to develop the capacity to preserve cell functioning and dispense live cells onto scaffolds without damaging the cells.2 Once technologies have progressed to where these requirements are satisfied, other challenges will persist, including controlling cell maturation processes so that requisite tissue structures can grow.2

Three-dimensional printing offers exciting possibilities to public and individual health. While challenges remain, it is likely that the technology will increasingly contribute to the health care field, including, perhaps, eventual organ replication. Nurses should stay abreast of 3D printing possibilities and offer science-based information to health care consumers and colleagues so that expectations are reasonable. The future possibilities of 3D printing's contribution to holistic health are considerable and warrant optimism and enthusiasm.

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