Clinical trials in cardiac xenotransplantation: are we ready to handle ethical issues?

Abstract

Heart allotransplantation has become one of the methods of choice in the treatment of severe heart failure. In the face of its difficulties, such as the unmet balance between organ supply and demand, the use of xenotransplantation might be an attractive option in the near future, even more with the ongoing progress achieved regarding the avoidance of hyperacute rejection and primary organ disfunction, maintenance of xenograft function and control of xenograft growth. To make possible this translational challenge, some points must be taken into account indeed, and they are the equipoise of human benefit and animal suffering, the risk of unknown infections, a well prepared informed consent, ethical and religious beliefs, and the role of cardiac xenotransplantation in a ventricular assistance device era.

Don't pig(!) the wrong heart!

“…Now, are there patients who do not qualify for mechanical support and could be candidates for heart replacement from an animal? The authors of this study 2,9 join several others suggesting that patients who do not tolerate anticoagulation should be considered. They forget to mention that one of the major shortcomings of xenotransplantation is thromboembolic events and that some type of anticoagulation was applied in the Munich baboons as well 3 .…”

“…Triggered by this advancement, the question has been brought up again, are we ready for clinical trials of xenotransplantation? Garcia et al, 2 in this journal, seem to answer this question in the positive. They subsequently contemplate the ethical implications of such a therapy.…”

“…The authors mention the high cost of MCS and the fact that in many countries access to MCS is limited, mostly for financial reasons. 2 Xenotransplantation without question would as well be quite costly. 16 Upbringing and handling of donor animals in appropriate conditions requires extreme care and is resource-intensive.…”

“…The authors mention the high cost of MCS and the fact that in many countries access to MCS is limited, mostly for financial reasons 2 . Xenotransplantation without question would as well be quite costly 16 .…”