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An Evaluation of the Advantages and Disadvantages of Extrusion-Based Bioprinting

Candidate: Cecilia Fawden,

Centre: Taunton School, 63255

Introduction
Bioprinting is the act of using technology, relatively similar to that of 3D printing, to print
live tissues. This use of cells to print tissues has potential to have a revolutionary effect on
modern day medicine, with the potential to eliminate or at least reduce the demand for
organ donors. Although bioprinting in itself remains a relatively new and emerging
technology, its future looks prosperous – particularly for the world of medicine. As a result
of this its development has continued to progress, with many of the scientists involved
focusing on the aim of bioprinting human organs for transplantation. The reason for this
being that, globally, there was a 17.6% decrease in the number of organ transplantations
from 2019 to 2020, with only 169,902 people receiving transplants in 2021 (Global
Observatory on Donation and Transplantation, 2022). Although the level of technology
required for bioprinting entire organs is yet to be reached, it has continued to develop with
the overall complexity of the printed materials continuing to evolve.

Extrusion-based bioprinting is one of the most commonly used techniques of 3D bioprinting

in regenerative medicine, where the focus is to restore the human tissues (Mason & Dunnil,
2007). Other techniques include those such as Droplet-Based bioprinting and laser-assisted
bioprinting, but extrusion-based bioprinting is where the bioink is printed by extrusion
pressure through a nozzle and into its new form or onto the substrate. Extrusion-based
bioprinting contains two separate methods, pneumatic printing and mechanical printing.
Pneumatic printing extrudes the use of compressed air while mechanical printing extrudes
through either pistons or screws.

This essay is an evaluation of the advantages and disadvantages of some of the individual
parameters within extrusion-based bioprinting, including their effects on the process. This
will establish an overview of its direction of improvement. There are multiple parameters
which can affect the success of a procedure. One of the foremost of these is the alteration
of the extrusion pressure, the pressure which is used to force the bioink out of the nozzle
and onto the substrate, and its effect on the bioink. The print speed is the speed of which
the bioink exits the nozzle and therefore can be affected by the extrusion pressure. There
are also the economic parameters of bioprinting, with the focus on the price of a typical
extrusion-based bioprinter, including running, maintenance and bioink costs. Arguably, the
most important parameter within the bioprinting is the level of cell viability. This is because
a low cell viability can result in the failure of the process, which is not ideal when
synthesising larger materials, especially those which are to be used as a medical treatment.

Advantages of Extrusion Pressure

The method of printing the cells can be viewed as an advantage due to the constant
application of pressure which provides a smoother bioink flow. This results in more regular
and accurate structures which are stronger and more durable. Therefore, these have an
increased chance of surviving a transplantation as will be more likely to endure the stress
of the surgical procedure. Typically, the compressed gas in the pneumatic method has not
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been as successful as mechanically dispensing the bioink because it has been delaying the
ink flow. In general, the pressure and ink flow rate are positively correlated and so the
higher the pressure the more constant the printed stream of cells. However, pneumatic
printing is technically better suited to printing at lower pressures due to its compressed
gas. This is because in mechanical bioprinters, particularly the screw variant, bioink can
become trapped around the driving parts and interrupt the ink flow. As a result of this,
pneumatic printing has a higher rate of cell viability (able to reach as high as 97% when all
other factors are optimised) when compared to its mechanical counterpart (Cooke &
Rosenzweig, 2021). This is despite the lower mass flow rate, often associated with the
pneumatic style, which is vital for the integral builds of larger printed materials
(Leberfinger, et al., 2019).

The use of different pressures is dependent on the printability of the bioink which in turn
is determined by its chemical contents. Experimental studies have shown that the number
of carboxylic acid groups contained within the hydrogel impacts the overall stiffness. This
can be adjusted to assist the bioink to withstand higher pressures and as a result enables a
considerably higher rate of cell viability (Kuzucu, et al., 2021). The high cell viability
increases the tissue’s chance of surviving the printing procedure and the resulting tissues
will be more structurally stable for effective function once transplanted. Despite this,
studies using coloured hydrogels to compare stiffer and softer types revealed that softer
hydrogels typically have a better flow rate and can form more technically sound structures
in comparison to the stiffer hydrogels. One can have faith in the results of this experiment
because they were published in 2021 and are reliable due to their recent discovery and
publication. The authors themselves are qualified in relevant fields of a MSc. in Materials
Science Chemistry and are also included under the label of Macromolecular Chemistry at
the university of Freiburg, Germany.

As higher pressures are often coordinated with higher print speeds in order to equalise
the ink flow rate, it is possible to print using materials with a poorer structural integrity
that could not be used without the risk of a low cell viability. This is because increasing the
pressure also increases the flow rate of the bioink and enables the nozzle to move faster
across the construct and so the overall print speed increases. This can allow the cross-
linking and other stabilising processes to occur sooner. This is more beneficial when using
bioinks that contain cells which cannot leave their set conditions for too long without
deteriorating. As a result of this, an increased range of cells can be used without limiting
the cell viability of the material. Therefore, more complex tissues and organs are able to
be printed. Additionally, the combination of the nozzle’s faster translation rate and the
increased pressure allows a smoother printing style with more consistent filaments due to
the improved ink flow. Overall, the use of higher pressures allows the use of faster print
speeds and the more suitable filament consistency required for the printing of larger
materials (such as organs for transplantation), and those containing cells requiring specific
conditions (Schwab, et al., 2020).

Disadvantages of Extrusion Pressure

The extrusion mechanism is in itself a disadvantage due to the high levels of stress that
the cells receive during the printing process. The level of stress is specific to the individual
cell and its response to the set level of pressure. There is also the additional challenge of
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developing a bioink suitable to withstand these conditions. Due to the nature of the
process, the bioink must be soft enough to extrude but able to become hard enough to
retain printed shape and functions (Hölzl, et al., 2016). This has been demonstrated
through Collagen hydrogels having a relatively poor strength during the printing process
but being able to retain their shape using frames and bioink-specific crosslinking. This was
experimented on in an investigation into suitable cells and their corresponding hydrogels
for tissue fabrication, analysing the use of specialised and unspecialised cells but
specifically stem cells (Leberfinger, et al., 2019). These post-printing procedures could be
viewed as too extensive and time consuming which would have a negative effect on the
cost and scale required for it to become a standard treatment.

Other hydrogels may be more suitable for housing the cells, but this is dependent on the
individual procedure. Typically, the hydrogels with a lower viscosity have a lower
resolution after their printing, particularly at higher pressures due to their negative effect
on surface tension. This surface tension can impact the printability through diminishing
both the printing accuracy and the resolution (Chen & Malekpour, 2022). This results in
printed materials which are not suitable for transplantation due to the intricate nature of
the surgery, for instance the precision required to connect veins and arteries, which will
be unachievable is the material is inaccurate.

The sheer stress experienced by the cells during the extrusion printing procedure is
determined by the pressure. Therefore, the greater the pressure the greater the stress
that the cells are exposed to, and the larger the reduction in the cell viability. The amount
of stress the cells receive can be influenced by the pressure used, the diameter of the
nozzle, and the bioink viscosity. For example, bioinks with a high viscosity require a higher
average printing pressure. Both of these factors contribute towards increased cell stress
and a low cell viability; therefore the resulting printed material would not survive the
printing process or a transplantation rendering it unsuitable. An experiment reported that
human liver cells being printed by mechanical printing first became damaged at pressures
of 14.5psi (Billiet, et al., 2014). This is equivalent to 1.0 bar and the average extrusion-
based bioprinter runs between 3 to 7 bar. This is a considerable disadvantage as at the
pressure of 1.0 bar, the cell viability is already below 50%. More evidence has been used
to demonstrate that the use of pressures above 0.05 bar have caused damage to human
mesenchymal stem cells in both the viability of the printing and the long-term growth of
the surviving cells (Truc Huynh, et al., 2016). This reveals that despite printing at even the
considerably lower pressures, the cell membranes are still rupturing and therefore
negatively impacting the cell viability of the overall printing mechanism. This leaves only a
few cells intact to print, let alone form an organ. Additionally, these low pressures can
have a negative impact on other parameters and reduce the cell viability in multiple ways.

Advantages of Print Speed

The main advantage of bioprinting at the relatively higher speed associated with extrusion-
based bioprinting, is the increased efficiency of the machinery. The higher print speed
increases the cell viability due to the shorter time that the hydrogel is left before requiring
any post-processing procedures, like crosslinking. This is supported by studies showing that
excessive or disproportionate crosslinking can negatively impact the cell viability and
decrease the printability. Therefore, the faster the print speed the lower the amount of
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crosslinking required in printing sessions and so the cell viability can increase (Ahn, et al.,
2012). This is beneficial as it not only reduces the overall print time, but the higher cell
viability increases the chances that the printed material will be viable for transplantation.
Within these experiments, the cell viability (using a scaffold) increased to 84% due to the
reduced cross-linking, despite a lower ending print speed. Therefore, reduced crosslinking
(because of the faster print speed) is beneficial to the construction of the biomaterial. As a
partial result of this, larger tissue constructs can be printed with a higher rate of cell
viability, increasing over the standard 80% threshold, and increases its chances of survival
for transplantation (Cui, et al., 2017).

In most instances, extrusion-based bioprinting has an optimum print speed of 100μms-1 with
cell viability reaching a maximum level of 80% of cells (Sundaramurthi, et al., 2016).
Experimental studies into the effects of print speed and extrusion pressure on cell viability
have shown that to achieve a higher cell viability initially, either a higher print speed and
higher pressure or a lower print speed and a lower pressure achieved the best results
(Fakhruddin, et al., 2018). These equalised parameters provide a more even ink flow rate
which results in a smoother print as a result, which ultimately forms a more structurally
stable printed material (Gillispie, et al., 2020). Print speed as an advantage is influenced by
the reduced rate of cell survival at higher speeds and higher pressures. This is a result of
the cell membranes becoming damaged by the nozzle extrusion and not the high print
speed itself.

One of the strong advantages of extrusion-based bioprinting is its ability to print with high
cell densities. This can be further improved by the use of multiple print heads which, while
not directly improving the print speed itself, increase the efficiency of the machine and
will reduce the total time taken to print the material. This is because less time will be
wasted switching between nozzle types and different bioinks, it will also reduce the
number of crosslinking procedures required (Khalil, et al., 2005). This increases the cell
viability of the printed material which in turn increases its success as a transplant. The
technique allows an easier rotation between different hydrogels for co-printing where
different cell types may be used to create gradients across the printed structure (Gleadall,
et al., 2018). This allows an easier synthesis of the more complex and larger printed
materials, such as organs, which will be able to benefit regenerative medicine through the
ability to replace certain human tissues.

Disadvantages of Print Speed

It is difficult to improve the speed without sacrificing either the high cell viability or the
high resolution. Currently, the print speed of 100μms-1, cell viability has a low of 40% of
cells surviving with the optimum resolution of 100μm2 (Sundaramurthi, et al., 2016).
Within pneumatic printing, a greater speed of the printing results in a reduction of printing
precision. This is in contrast to mechanically driven printers where a higher level of
accuracy has a lower print speed. The print speed itself is difficult to alter because of its
prominent effect on resolution. This is a strong disadvantage because adjustability is key
when printing larger and more complex organs with more specific structures (CELLINK,
2019). This is due to the intricate structures associated with human tissues which would
be unachievable with this set up.
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Arguably, cell viability is the most important aspect of the printing, particularly as
improving science’s ability to print larger constructs requires a much-improved viability to
be worthwhile. However, the viscosity of the hydrogel also determines the cell viability in
relation to print speed and therefore is not the print speed as an advantage. At slower
speeds the cell viability is still negatively impacted as, due to the longer amount of time
taken to print, the cells are at a greater risk of dehydration and nutrient deficiencies.
Larger constructs then become more challenging, eliminating the chance to print whole
organs (Ozbolat & Hospodiuk, 2016). In this experiment into the effects of the pressure
and print speed used on the printed structure. At lower print speeds (around 3mms -1) and
higher pressures (around 100psi) there was an excessive volume of bioink outpour, in
contrast to the higher print speeds (around 10mms -1) and lower pressures (around 60psi)
where the resulting printed product was patchy. The experiment concluded that the print
speed and extrusion pressure are directly correlated, and therefore it is difficult to alter
either for areas of the materials without compromising the bioink flow or the cell viability
limiting the structures possible to print.

Finally, it is difficult to compare the print speed without taking account of the effects of
the other parameters. Printing at a high speed requires a high pressure in order to
maintain the regular bioink flow rate, causing a low percentage of cell viability. To print
with a high enough cell viability to be worthwhile, a lower pressure has to be used with a
lower print speed. Otherwise, the bioink flow rate would become compromised and
reduce the cell viability which would make the alterations to the pressure pointless
(Fakhruddin, et al., 2018). Interestingly, printing with a low pressure and a low speed is
contradictory to the typical style of extrusion-based bioprinting which tends to favour the
combination of higher pressures and faster print speeds which creates doubt in the
science as the majority seem to use the machine at a disadvantage (Chen & Malekpour,
2022).

Advantages Of Cost
One of the key economic advantages of extrusion-based bioprinting is its relatively low
cost, in comparison to the other printers that are currently on the market. Multiple
bioprinting manufacturing companies with a more recent start-up have begun to
introduce printers with a considerably lower cost (Tong, et al., 2021). The affordably priced
extrusion-based bioprinters typically range from around £1300 to £8500, the majority of
these use single nozzle systems. Some brands have adapted to the current market and
reduced the price through the incorporation of the average syringe, instead of the normal
cartridge. Due to modifications such as these, bioprinting companies are able to
incorporate more for their price, like the Tissue Scribe (marketing at £1381) which
includes more advanced heating systems to help boost the cell viability, and Hyrel 3D’s
Engine SR which is multipurpose in that it can use multiple printing materials and not just
bioinks. Currently, these prices seem acceptable for society to pay, given their ability to
remove the rising costs associated with organ donation. When purchasing these printers
there is also the opportunity to purchase extras, including additional print heads to alter
the printer into a multi-nozzle system, these typically start from around £400 (Culture 3Ds,
n.d.) (HYREL 3D, 2021). This can be more cost efficient for the use of printing long term and
is also a better sales approach for smaller companies or individuals with a smaller budget
where multi-nozzle systems are not worthwhile due to the added cost when purchasing,
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this also creates the opportunity for the purchase of more nozzles further down the line
and creates more sales within the market.

Overall, pneumatic extrusion-based bioprinters have a lower cost than mechanical

extrusion-based bioprinters. This is because the pneumatic printer head in itself is more
compact than the mechanical printer heads because of the physical extras involved in
mechanical printing (pistons or screws as opposed to syringes). Pneumatic pumps are also
easier to sterilise and as a result they tend to have a higher cell viability, and therefore
having a higher success rate of printed materials (Tong, et al., 2021). The price of the
printer is dependent on the individual factors included. For instance, the number of
variants of each part can also be reduced by the use of a single compatible part. The use of
compatible syringe mounts which are able to extrude different bioinks through multiple
nozzle or needle attachments is an example of this because the total cost of the syringe
mount(s) will reduce. Additionally, syringe mounts often contain extra screw attachments
to ensure that the printing angle for the specific bioink can be correct, however these may
have an additional price (Engberg, et al., 2021).

In comparison to other bioprinting types, extrusion-based bioprinting is more affordable.

For instance, most of the commercial bioprinters that are currently on the market are
priced between £8,000 and £122,000 (Ioannidis, et al., 2020). The Poietis NGB-R, which is
mainly a laser-based bioprinter, sells for around £163,000 and is expensive, even for the
‘high-end’ bioprinters (Aniwaa, 2022). This is because it can incorporate micro-valve
bioprinting and extrusion-based bioprinting but most other bioprinters of that calibre are
not available for purchase, only by request (Scintixa, 2022). This in itself does reduce the
availability of the entire field and creates a lack of available information. The cheaper
variant, the Regemat Bio V1, markets at around £20,000 but incorporates three styles.
However, it is only intended for university researchers (Aniwaa, 2022). This is another
example of extrusion-based bioprinting becoming more commercially available and
overcoming the niche and slightly prestigious nature of the bioprinting field as the printer
is available for educational purposes and is accessible to the wider community through the
student population.

Disadvantages of Cost
Due to the increased demand in bioprinting of late, the Global Market Share of bioprinting
is set to reach over £1.2 billion by the mid-2020s and so their market value will increase to
its highest so far. As a result of this, bioprinters in general will struggle to remain
commercially available and will become difficult to source. However, it is not just the value
of the bioprinters that will increase, but the cost of their parameters. The general market
value of bioinks has increased by around 70% in the last 10 years (market share recorded
from 2012 to 2022) (Tong, et al., 2021) (BCC Research, 2016). This is mirroring the general
increase in running costs of bioprinting. Unfortunately, manufacturing companies that sell
printers for a lower cost have yet to be discovered by a select field and therefore their
economic potential is yet to be truly discovered. This has only added to the niche nature
of the field which has led to a lack of awareness over upcoming projects and
developments, as well as a significant lack of commercial awareness. This has greatly
impacted the funding of private and commercial organisations, as well as reducing
opportunities for trials due to a lack of public knowledge. Despite a great potential in
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bioprinting, particularly within the medical field, the lack of awareness and knowledge has
restricted the availability of grants and charity funding which has had a negative impact on
its development. There are very few articles that explore the economic side of extrusion-
based bioprinting, increasing the problem further and isolating the scientific area (Ozbolat
& Hospodiuk, 2016).

Comparing the cost efficiency of pneumatic and mechanical extrusion-based bioprinters,

mechanical extrusion typically replaces the use of pneumatic because of its higher cell
viability. These costs include the purchase of additional bioink or sturdier bioink, which is
often more expensive, to counteract a reduced cell viability. Pneumatic bioprinters also
require an external pump, as they are not piston or screw driven, creating an additional
expense when purchasing (Tong, et al., 2021). Compressed gas can be expensive to supply
long term, but this is more dependent on the individual and cannot be directly linked to
the bioprinting. Extrusion-based bioprinters typically have cheaper assembly and running
costs compared to other techniques. However, this is undermined by a significantly lower
cell viability and resolution when compared to these other methods (Choudhury, et al.,
2018). In consideration of this article, which was written in 2018, despite the technological
developments that have occurred since then, the fundamental disadvantages of selecting
the ‘cheaper’ option of extrusion-based bioprinting remain the same. This leads to
suspicion that, due to the lack of development since 2018, little may improve in the future
and that any funding would be better placed in the support of another technique of
bioprinting.

Parameters Positively Affecting Printability

Extrusion-based bioprinting is an improvement on its predecessor droplet-based
bioprinting because of its seemingly simple ability to print the cells in a continuous stream.
This is an advantage when paired with ‘the ability to incorporate cells with biomaterials’,
as it can structurally alter the bioink to suit the style of printing (Chen & Malekpour, 2022).
Many bioprinters also have temperature and nozzle control, which when combined can
increase the cell viability from 55.52% to 90%. This is particularly impressive as it succeeds
the typical 80% cell viability mark of extrusion-based bioprinting, allowing a greater
chance of the success of the printing procedure. According to this data, the monitoring
and maintenance of the temperature creates a reduction in the thermal damage that the
cells receive but it can also have an effect on the viscosity of some hydrogels, causing the
cell viability to increase in that way (Ouyang, et al., 2015). However, this experiment was
completed using Embryonic Stem Cells from mice and so it cannot be viewed as accurate
when printing with either human cells or with cells that have already specialised, but it is a
good development to progress forwards from.

There are two commonly used nozzle types within extrusion-based bioprinting, cylindrical
and tapered. Cylindrical nozzle types tend to have a lower flow rate in comparison to the
tapered nozzles which require a lower printing pressure but as a result claim a higher level
of cell viability (Li, et al., 2011). Another parameter of printability is the impact of the
printed angles of the substrate on the resulting material’s resolution. For instance,
printing the tighter and more acute angles lowers the resolution considerably more than
when printing with the wider and obtuse angles. This is caused as a result of the overlap of
the substrate required to print an acute angle which is not required in the more obtuse
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angles. As a result, this overlap also causes a ‘nonuniform layer height’ which can cause
imbalance and structural defects when printed onto. It also reduces the resolution (Chen
& Malekpour, 2022). This can be avoided simply by not printing the more acute angles or
by decreasing the bioink flow rate so that a smaller quantity is dispensed over the corner,
and therefore there is not enough extra bioink to overlap and damage the quality of the
resolution (He, et al., 2016).

Printability can be affected by both the composition of the bioink and the printing process
itself, as well as the design of the scaffold that is being printed onto (Naghieh & Chen,
2021). This scaffold can also determine the thickness of the printed layers but there is yet
to be any experimentation around its effect on the printability. However, the porosity of
the scaffold has been experimented on to show its effect on the printability and it is vital
that, during the printing process, the scaffold does have pores so that the printed
substrate can continue to obtain oxygen until the process has been completed. Therefore,
the use of more porose scaffolds has a positive effect on the cell viability, increasing the
likeliness that the material will survive the process and will be used in a treatment
(Gleadall, et al., 2018). The more porose scaffolds are a relatively simple way to increase
the cell viability of larger printed materials whilst preventing the collapse of the structure
during printing.

Parameters Negatively Affecting Printability

Following on from the printing overlap, it is unrealistic to avoid causing an uneven height
and bioink distribution by not printing the acute angles. This is because, as a relatively new
area of research, bioprinting in itself is constantly developing and by simply neglecting
printing acute angles will not be beneficial in the long term. When printing the more
complex structures, such as organs, it is imperative that within their structure they have
these acute angles. In the long term, neglecting the current issues could hinder the future
developments and prospect. In the short term, the resulting destabilisation could
compromise the structure and lead to a greatly reduced cell viability of the overall
structure. The alternative option is to either decrease the bioink flow rate or to decrease
the print speed over the corner. This is also unrealistic because of the time-consuming
work that will be required by the operator to regularly pause the machinery and alter the
settings. As a result of the additional time spent on these alterations, the cell viability is
likely to decrease anyway due to the extra time that the bioink spends in the machine or
on the substrate without receiving any cross-linking procedures (Ouyang, et al., 2016). This
can also relate back to the overall print speed and its impact on the cell viability due to the
time taken for the cross-linking procedures to occur (Ahn, et al., 2012). A cell-rich bioink is
much more efficient as it can deposit a higher total of cells. However, this can have a
detrimental effect on the cell viability. This experiment has shown that when printing with
a greater concentration of cells, there is also a greater percentage of dead cells in
comparison to printing with a lower concentration of cells in the bioink, resulting in the
printing of dead cells which is pointless (Grover, et al., 2011).

Pneumatic extrusion-based bioprinters tend to achieve a better overall printability than

their mechanically driven counterparts, with both the piston and the screw styles.
However, due to the use of air pressure, pneumatic printers are affected more by the
relationship between the feed rate and the width of the printed line. Higher feed rates
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cause a wider printed line, but it will often expand further post-printing due to the stress
received from the extrusion pressure. In contrast, lower feed rates result in a narrower
and broken line and therefore it is important to maintain a balanced feed rate. This
experiment showed that the optimum feed rate was between 5 mms -1 and 8mms-1, this
experiment was also repeatable and has a low standard deviation so can be deemed as
reliable (Yong, et al., 2016).

Conclusion
Ultimately, in extrusion-based bioprinting the advantages and disadvantages of each
parameter typically balance out, or are dependent on, the set levels of other effecting
parameters. This makes it challenging to identify the individual effects of each. However,
the extrusion pressure is certainly the most important parameter as its advantages and
disadvantages do not balance out. This is mainly due to the diminishing effect of pressure
on cell viability at all levels and arguably cell viability is the most important measure of the
success of the printing process. Therefore, the disadvantages of the extrusion element of
extrusion-based bioprinting must outweigh the advantages of all the other parameters
due to the nature of the technology. Despite the evident imbalances, extrusion-based
bioprinting is still viewed by most as ‘one of the leading manufacturing techniques for
tissue engineering and regenerative medicine’ (Gillispie, et al., 2020). This is because of its
relatively low private and commercial costs in the bioprinting market. This includes both
the original bioprinter purchase and the bioink purchases as well as other mechanical
additions that may be required. The relatively low-price range allows for a much easier
and widely spread accessibility in comparison to the other bioprinting methods, so there is
currently no viable alternative. The future of bioprinting is vast and particularly the
medical assistance that it could provide will be beneficial for all.

Extrusion-based bioprinting can certainly fulfil a role in regenerative medicine through

reducing the organ transplantation waiting list. This could happen in the near future due
to the current understanding of the technology, including its weaknesses. That which sets
it apart from the other techniques is its ability to accommodate a large range of bioinks as
well as the adjustability of its individual parameters (Wang, et al., 2022). At the time of
writing, extrusion-based bioprinting is still a developing science and therefore this essay
has been unable to explore many of its applications simply because they have yet to be
discovered, for instance only one bioprinted organ has been successfully transplanted.
Despite this, the extrusion-based bioprinting holds great potential for the future of
regenerative medicine, particularly organ transplantation, as well as possibilities to be
incorporated into other medical procedures.

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