What price would you pay to heal your brother of third-degree burns?
What price would you pay to gift your sister back a leg lost to amputation?
What price would you pay to provide a loved one with an organ needed to replace a failing one?
These are questions that I considered as I transferred off active duty after six years of service in the United States Army. Spending a moment myself at the Warrior Transition Unit out of Schofield Barracks, Hawaii, I was privileged to witness the bravery of fellow soldiers as they pushed through grievous injuries to return to their families and lives. I have wondered if there was not more we could be doing for them.
The Department of Defense (DoD) has posited that we can, in fact, do more. In 2016, the DoD organized $284 million in funding to establish the Advanced Tissue Biofabrication (ATB) Manufacturing USA Institute in Manchester, New Hampshire. One of the primary purposes of this investment is to develop 3D ‘bio-printing’ technology to improve patient outcomes at military hospitals. 
The DoD is no stranger to Additive Manufacturing (AM). In recent years, the Army and Navy have used 3D printing to reduce inventory costs, optimize supply chain operations, and speed combat preparedness by creating functioning weapons systems in contested regions and spare parts for ships at sea.  However, its recent founding of the ATB signals the DoD’s belief in the potential for Additive Bio-Manufacturing (Bio-AM) to advance processes currently used to treat critically-wounded soldiers.
The need for process improvement in treating soldiers with debilitating injuries, and therefore the importance of Bio-AM in facilitating that improvement, is clear: since its inception in 2007, the Warrior Care and Transition Program (WCTP) has supported over 72,000 seriously-injured soldiers and is currently rehabilitating approximately 2,100 soldiers across 14 Warrior Transition Units. Of these soldiers, only 43% were able to return to the force.  For those soldiers who incurred injuries serious enough to prompt an early termination of service, a staggering 52% rated both their continuing medical care as inadequate. 
In an effort to treat the growing number of soldiers in these categories, the DoD is allocating more resources towards the expansion of the WCTP program in the short-term, and pursuing promising technological advancements that can address gaps in soldier care plans in the mid-term. The founding of the ATB is emblematic of the mid-term strategy. By awarding this new public-private Manufacturing USA Institute to the Advanced Regenerative Manufacturing Institute, the DoD has carefully curated a conglomerate of 47 industrial and 26 academic partners, and provided them the resources, and the vehicle to employ those resources, towards innovating medical solutions within the Bio-AM space. 
Because the DoD’s Bio-AM initiative is still young, we have yet to see a true integration of 3D bio-printing technology into government treatment facilities. That is not to say that Bio-AM field at large is not producing substantial innovations. Promising companies such as Organovo and 3D Bioprinting Solutions have been able to “use extruder needles or inkjet-like printer heads to lay down successive rows of living cells” to fabricate liver, kidney, and thyroid gland tissue for use in drug discovery and laboratory testing.    Other companies, such as Rokit, are developing in-situ 3D Bioprinters to produce human skin for patients afflicted with dermatological diseases and severe burns, while others still, like Cyfuse Biomedical, are using fine needle arrays to print cellular structures that can be arranged to form biological components such as tubular tissues, cartilage, digestive and urinary organs, and blood vessels.   
To amplify the progress and results of its organic Bio-AM consortium, I would recommend expanding industry partnerships. While the ATB is formed of some of the largest companies (Abbott, Becton Dickinson, United Therapeutics) and most prestigious academic institutions (Harvard, MIT, Cedars-Sinai Medical Center), much of the recent cutting-edge research is coming from the more agile players in the Bio-AM space, as previously illustrated. For the DoD to bring meaningful and timely process improvement to the care of soldiers with injuries addressable by 3D Bioprinting technology, it must be ever vigilante for brilliant new innovators and do whatever it can to foster their research and bring them into the fold of the ATB.
The first question I have for you is reminiscent of those I would ask myself during my time at the WTU in Hawaii: what price would you, and by extension should the DoD, pay to provide care to those who have served our country? The second question I have has implications for the DoD and beyond: given that this technology could foreseeably produce entire living organs and perhaps more in the future, should the DoD, or anyone else, pay any price to acquire it?
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