To overcome organ shortage, designers develop engineered livers: devices/methods aiming to temporally assist or permanently replace it. As a complex organ with more than 500 functions, the design of engineered livers is one of the greatest challenges of the field. Since the mid-20th century, multiple pathways have been taken using diverse materials such as charcoal or cells. We argue that establishing a design strategy to engineer a liver is not entirely a technical issue. Our research aims to highlight all the factors and thus should give new design directions to engineered organ designers.
We undertook a philosophical analysis guided by the literature and starting from the field. We conducted participant observation in the lab experiments and 24 semi-structured interviews with 19 international actors of this engineered organ field. A thematic method was employed to analyze the data by distributing the interview’s material into groups such as design strategy or regulation.
We identified two major designers’ sources of inspiration. First, their vision of the liver, which could be defined by its functions and/or structure. Secondly, the technologies/methods that the designer mastered. In addition, several constraints such as budget or regulation had an impact. Based on those influences, designers developed design strategies leading to different engineered livers such as artificial, bioartificial, or hybrid. Each designer had the same mantra “keep it simple” meaning “find the shortest path to the patient”. Hence, if liver detoxification functions and artificial kidney were designers’ inspirations, the simplest strategy was to avoid living components that complicated and lengthened the research and the industrialization process. Such a path led to an artificial device, which couldn’t improve patients’ survival. Also inspired by cellular culture, some designers changed their strategy: turn the dialysis filter into a bioreactor by adding cells, betting that the hepatocytes will perform their functions as in vivo. Such a path led to a bioartificial device, which was so far not more successful. Organ decellularization/recellularization mobilized the same betting strategy but designers' vision of the liver was more structural, speculating that if the structure was right, the function should follow. Recellularization remained however complex for large scale organs.
Highlighting the influences behind the technical choices and the resulting strategies can open up designers to innovative engineered livers. Grasping a device’s nature is the first step towards understanding its ethical impacts, thus helping the legislators adapt the regulatory categories with requirements suited. Even if this research focuses on the liver, its conclusions could be valid for other organs.
 Daston L. The Moral Economy of Science. Osiris 10, 2, 1995
 Blanchet A., Gotman A. L’entretien. Broché. 2015