Xenotransplantation - Nuffield Council on Bioethics

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Animal-to-Human Transplants : the ethics of xenotransplantation restrictions associated with immunosuppressive drug regimes and problems with compliance. 9.10 How might the stresses of xenotransplantation compare with those of human organ transplantation? For early recipients, at least, fear of transplant rejection is likely to be very real. Follow-up will also be very demanding, since it will involve procedures to monitor possible transmission of animal diseases (paragraphs 6.33 - 6.37). Compliance, or otherwise, with such monitoring will have implications not just for the health of the individual recipients, but possibly for the wider community. 9.11 It is difficult to predict how people’s views of their bodies and of their identities, might be affected by xenotransplantation. On the one hand, the use of animal organs might eliminate any disturbing implications associated with receiving a human organ. On the other hand, receiving an animal transplant might cause different stresses. The response is likely to reflect notions of what it is to be a person, to be human and to be an animal. These notions are not uniform for this or any other society, but vary according to social and cultural background. A small UK survey has shown that 40 per cent of potential recipients would have no objection to receiving a pig kidney. A US survey of transplant recipients found that they were more likely to say they would accept a xenograft if they needed another transplant and no human organ was available. 10 An Australian survey of acute care nurses found that two-thirds said they would not accept transplantation of an organ from a pig. 11 9.12 One cause of unease is the breaching of normally inviolate boundaries. 12, 13 This is seen in human organ transplantation. The recipient of a transplanted organ may feel that the boundary between self and non-self has been breached. As described above, receiving an organ from a dead person may also disturb the recipient. With xenotransplantation, an additional boundary, that between human and animal, may become blurred. Whether, or in what ways, this is perceived as a problem will depend on how the human being-animal boundary is defined and the significance that is attached to it. If the essence of humanity is seen as a capacity to transcend the level of organic existence, then a person’s sense of identity should not, in theory, be threatened by a transfer of organs across species boundaries. The idea of xenotransplantation may become troublesome if there is not thought to be a strict division between humanity and bodily existence. In this case, to receive an organ 10 The UK study was carried out at Guy’s and St Thomas’s Medical and Dental School, London and presented at the British Renal Symposium, Harrogate in 1994. The US study was carried out by the National Kidney Foundation (NKF Survey reveals positive feelings on animal-to-human transplants (1995) Dialysis and Transplantation, December 1995, p 677). These surveys were described in the submission from the UK National Kidney Federation. 11 Mohacsi P et al. (1995) Letter to Nature, 378:434. 12 This section draws on the submissions from Marilyn Strathern and Tania Woods. 13 Fox R (1995) Presentation at an Institute of Medicine conference on Xenograft transplantation: science, ethics and public policy,Washington DC. 104
Personal and social effects of xenotransplantation from another animal might be seen as a mixing of one’s human essence with that of the animal, and therefore as a dilution of one’s humanity. <strong>Xenotransplantation</strong> will be troublesome for a different reason if it is felt that some or all of those characteristics by which human beings are recognised as persons are also shared by animals (paragraph 4.13). To receive organs or tissue obtained by killing a healthy animal might then be seen as objectionable. 9.13 It is sometimes argued that if receiving an animal transplant was particularly disturbing to pig heart valve recipients this would have emerged as a problem by now. As mentioned above, however, the significance of a transplant varies, depending on the particular organ or tissue (paragraph 9.8). Pig heart valves are small pieces of tissue that have been treated to make them non-viable. The possibility that someone might react much more strongly to transplantation of a vital organ from an animal cannot be dismissed. 9.14 The submissions received by the Working Party contained a range of reactions to the idea of xenotransplantation. Sheila Silcock asked “Might there be such a thing as emotional rejection? Suppose a patient suddenly had a revulsion about having received an animal organ. Counselling prior to organ transplant is essential and would presumably be even more vital before a xenotransplant.” Audrey McLaughlan reported that “patients in the Renal Unit mentioned that they had qualms about having animal organs within their bodies.” Students from Dalriada School in Northern Ireland had a variety of opinions. Some said: “I would be prepared to accept an organ from a pig.” and “using a pig organ in your body is better than dying.” Others said: “we have been made superior to animals and it would be degrading to be made of part pig, part human” and “the concept of an organ being part of me seems quite distasteful”. How xenotransplantation might be regarded by people who view the pig as ritually unclean was discussed in Chapter 4 (paragraph 4.24). 9.15 Predicting how people might feel if xenotransplantation were performed on them or on someone close to them, is very difficult. Virtually nothing is known about the effects of xenotransplantation upon perceptions of identity, whether for xenograft recipients or amongst those who care for them or interact with them in other ways. This highlights the need for more research into these issues. The Working Party recommends that counselling of xenograft recipients should include discussion of the possible personal impact of xenotransplantation. The Working Party further recommends that research should be initiated to study the personal impact of xenotransplantation on potential and early recipients. 105
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Xenotransplantation - Nuffield Council on Bioethics

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