Existing Ethical Tensions in Xenotransplantation

Abstract

The genetic modification of pigs as a source of transplantable organs is one of several possible solutions to the chronic organ shortage. This paper describes existing ethical tensions in xenotransplantation (XTx) that argue against pursuing it. Recommendations for lifelong infectious disease surveillance and notification of close contacts of recipients are in tension with the rights of human research subjects. Parental/guardian consent for pediatric xenograft recipients is in tension with a child’s right to an open future. Individual consent to transplant is in tension with public health threats that include zoonotic diseases. XTx amplifies concerns about justice in organ transplantation and could exacerbate existing inequities. The prevention of infectious disease in source animals is in tension with the best practices of animal care and animal welfare, requiring isolation, ethologically inappropriate housing, and invasive reproductive procedures that would severely impact the well-being of intelligent social creatures like pigs.

What Do Chimeras Think About?

“…54 In these cases, routine and experimental xenotransplantation raises issues of animal research, gene editing, and cross-species susceptibilities to pathogens. 55 There are welfare issues with respect to how engineered animals are kept in controlled, sterile, and unnatural conditions. 56 Animals could benefit from inter-and extra-species transplantation, such as a donation system to treat companion animals under veterinary care.…”

Current Status of Cardiac Xenotransplantation: Report of a Workshop of the German Heart Transplant Centers, Martinsried, March 3, 2023

“…As a novel treatment strategy, xenotransplantation (XT) raises several ethical issues [82][83][84][85] which require thorough scrutiny before entering a first clinical trial. The ethical assessment should proceed in a transparent and structured manner 86 .…”

In defense of xenotransplantation research: Because of, not in spite of, animal welfare concerns

“…Second, zoonotic transference can spread from the xenograft recipient to others, creating an epidemic or even pandemic disease. As Johnson explains, “everyone in the world is at risk from an XTx‐related [xenotransplantation‐related] infection, not merely the individual xenograft recipient”(p. 360); she goes on to say the “unknown and unquantifiable risks of [xenotransplantation] include the possible unleashing of zoonotic diseases that could potentially affect the entire world”(p. 364) 6 …”

“…Research involving animals will continue to be needed to address other ethical concerns involving clinical safety, patient autonomy, and public health, among others. Given how unique xenotransplantation is compared to our other use of and research on pigs (i.e., indefinitely breeding a species of pigs to serve as a supply of organs for human transplantation), this line of research, as L. Syd Johnson observes, “requires its own ethical justification” (p. 362) 6 . The unique challenges and risks posed to humans that arise from transplanting across the species barrier in addition to the costs borne by non‐human animals leads her to conclude that it is “the wrong solution to an urgent problem” (p. 363), which calls into question the value of the research.…”