Xenotransplantation - Nuffield Council on Bioethics

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Animal-to-Human Transplants : the ethics of xenotransplantation present only younger people are considered as having a high priority for human organs. While the health benefits of this could be considerable, the cost of transplantation programmes overall would be likely to increase. It is difficult to predict how far xenotransplantation might become the preferred mode of treatment for people who are not currently considered for human organ transplantation: potentially, this could lead to a large increase in transplantation activity. 8.11 Finally, transplantation procedures might be extended to a larger number of organs and tissues in the body, since the ready supply of organs and tissue will make it easier to develop and implement new procedures. There is much interest, for example, in the use of pig fetal neural tissue transplants for treating neurodegenerative diseases (paragraph 3.35). Such an expansion in transplantation activity would also increase the costs of the service. 8.12 The effects of xenotransplantation outside the transplantation service also need to be considered. For example, an increase in kidney transplantation would reduce the numbers of people on long-term dialysis, which is an expensive treatment (paragraph 1.6). The costs of drugs for the treatment of disease and the cost of hospital stays for those with failing organs might also be expected to decrease if organ and tissue replacement by xenotransplantation were to increase. Arrangements for introducing xenotransplantation into the NHS 8.13 Based on the discussion above, it is likely that the major cost implications of xenotransplantation would arise from the larger number of transplants that will be possible if the shortage of organs and tissue is overcome. These costs are difficult to estimate but they could be considerable. The main constraint on transplant programmes at the moment is not cost but the shortage of human organs and tissue. Should xenotransplantation develop into successful procedure and reduce this shortage, decisions about its provision will have to be made within the context of the wider debate about how resources are allocated within the NHS. As with other treatments, such as assisted reproduction and beta-interferon, there will be difficult choices to be made about priorities and rationing. 7, 8 The Methodist Church wrote in their submission: “The cost effectiveness of major work on transplants using genetically engineered animal sources must be judged against the health gain which could be achieved by a similar investment in preventive medicine, public health programmes and amelioration of poor social conditions.” 7 Multiple sclerosis drug prompts rationing fears (1995) British Medical Journal, 311:969. 8 Survey shows widespread rationing in NHS (1995) British Medical Journal, 311:1453-4. 98
Effects on the health care system 8.14 The development of xenotransplantation into a successful clinical procedure, however, is some way in the future. This will allow the NHS to control its introduction and to assess it carefully. Research teams currently developing xenotransplantation should keep accurate and accountable records of the costs of the procedures. In this way, policy makers will be in a better position to assess the cost implications. Should xenotransplantation cease to be experimental and become feasible as a clinical treatment, it should be restricted to designated centres for the foreseeable future. This would ensure adequate control of costs and monitoring of cost-effectiveness. 8.15 One model for the provision of specialist services in the NHS is the Supra Regional Services Advisory Group. This Advisory Group is responsible for 10 designated specialist services including the Heart, Heart-Lung and Lung Transplant Service and the Liver Transplant Service. The Advisory Group was established as a result of the 1991 NHS reforms with the following terms of reference: “To advise the Secretary of State, through Regional Chairmen of Health Authorities, on the identification of services to be funded supra regionally and on the appropriate level of provision.” 9 Any such service is expected to meet the following criteria. It must: “already be an established clinical (not diagnostic) service and offer the treatment of choice; cover a condition which is sufficiently rare that the service should only be provided by any single unit for a population significantly larger than 5 million; relate to a clearly defined group of patients with a condition whose rarity is such that the national caseload would not exceed 1,000 and would normally be about 400 a year; be capable of being provided in a small number of centres which between them can meet the national caseload and that the profession would accept that the service should only be provided in a restricted number of centres; be able to justify its costs when set against alternative uses for NHS funds; and cost such an amount that it would constitute a significant burden for providers and purchasers.” 10 9 Supra Regional Services Advisory Group annual report (1994-5) p 6. 10 Supra Regional Services Advisory Group annual report (1994-5) p 7. 99
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NUFFIELD COUNCIL ON BIOETHICS Anima
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Preface Preface Since the N
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Working Party on Xenografts Working
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Summary of recommendations Summary
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Summary of recommendations Effects
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Alternatives to xenotransplantation
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Xenotransplantation</strong
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Animal concerns : principles Chapte
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Xenotransplantation - Nuffield Council on Bioethics

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