This thesis is part of the biomedical project ‘Augmented Lung’, supported by the CEA, which aims to improvelung transplants through the use of ex vivo modified grafts to better resist post-transplant infections. Today, lungtransplant patients face high rates of rejection and infectious complications, with significant mortality in theyear following transplantation. The ‘Augmented Lung’ project is developing innovative technological solutionssuch as extending the duration of ex vivo perfusion, administering genes to grafts, and strengthening naturalimmunity against pathogens. The proposed thesis aims to support this project from an ethical perspective,incorporating reflection on the human, societal, regulatory and philosophical implications of such an innovationfrom the initial stages. Unlike a traditional approach, where ethical considerations often come too late, thisdoctoral work aims to anticipate the potential consequences of the project even before its clinical completion, inorder to ensure responsible innovation. Two axes structure the scientific issue. The first is prospective: startingfrom the hypothesis that the technique will become effective and transferable in clinical practice, the aim is to
anticipate the challenges, particularly in terms of patient consent, social acceptability of genetic modification ofa transplanted organ, and regulation of clinical trials. This aspect also involves an epistemological analysis ofthe term ‘augmentation’ itself: is it gene therapy or another form of intervention? This clarification is essential,as it determines the regulatory framework, patient information, and societal assessment. The second axis isiterative: it involves supporting, throughout the technological development process, major decisions relating tothe choice of methods, tools or strategies, taking into account not only their scientific effectiveness, but alsotheir ethical, economic, social and organisational implications. At each stage, questions will arise: whichtechnologies should be prioritised for monitoring transplants? What types of vectors should be used to transfergenes? What consequences will these choices have for patients, healthcare institutions and the environment?The methodology is based on an interdisciplinary approach combining philosophy, bioethics, health law andscience and technology studies. It will involve interviews with researchers, clinicians, engineers, userrepresentatives and patient associations, as well as ethnographic observations. Particular attention will be paid tocitizen participation. The expected results are both theoretical and practical. On the one hand, they will help tobetter define the concepts of ‘augmented’ organs and genetic intervention in transplantation. On the other hand,they will provide a decision-making framework for scientific and medical teams, integrating ethicalconsiderations from the design stage of innovations. This research therefore aims to enrich upstream thinking inbiomedicine and propose a model for integrating the humanities into technological projects. The thesis is fullyintegrated into the activities of the CESP's ‘Research in Ethics and Epistemology’ team, which has recognisedexpertise in the cross-analysis of technical and philosophical issues. It also meets the strategic objectives of theCEA, particularly in terms of the social acceptability of innovations in healthcare. The partnership with patientassociations, such as HTaPFrance, reinforces this dynamic of responsible and socially conscious innovation.