Xenotransplantation - Nuffield Council on Bioethics

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Animal-to-Human Transplants : the ethics of xenotransplantation Table 1.1 One year and five year survival rates of transplant recipients 1 Organ Survival Rates 1 year 5 years Kidney 84% 70% Liver 62% 54% Heart 73% 62% 1.4 Organ transplantation offers several benefits. For some conditions, such as advanced heart failure, treatment with drugs or restorative surgery may not be possible and a transplant will provide the only way of replacing a failed vital organ. Heart or liver transplantation can offer many additional years of life for people who otherwise might not survive, as the one year and five year survival rates for liver and heart transplant recipients show (Table 1.1). Worldwide there are patients whose lives have been considerably extended following transplantation: by 23 years after liver transplants and 20 years after heart transplants. 1.5 Transplantation can not only increase the length of life, but also improve its quality. Even where there is an alternative form of treatment, such as dialysis for end-stage kidney failure, a transplant frequently offers a higher quality of life despite the drawbacks of the continuous immunosuppressive regime most transplant recipients require. Kidney transplant recipients are freed from the necessity of regular, uncomfortable and time-consuming treatment and are restored to a level of health not possible with dialysis. They are able to eat and drink freely, and to travel, in ways that people on long-term dialysis often cannot. Patient support groups describe heart transplant recipients who are able to climb hills, and undertake other activities, that they would not have been able to manage before the operation. Some transplant recipients participate in highly demanding sporting contests such as the Transplant Games. 1.6 It should be noted that, contrary to some misperception, transplantation is not particularly expensive. Estimates are very difficult to make, but it is possible to get a rough idea of the relative costs of different treatments. A kidney transplant operation costs in the region of £10,000. After that, the cost of immunosuppressive drugs and other follow-up treatment is about £3,000 a year. In contrast, dialysis costs about £18,000 a year if the patient is treated in hospital, and about £11,000 if the patient is treated at home. Thus, kidney transplantation is a more cost-effective 1 Source: United Kingdom Transplant Support Service Authority (UKTSSA) publications: Renal Transplant Audit 1984-1993; Liver Transplant Audit 1985-1992; Thoracic Organ Transplant Audit 1985-1992. 2
The promise and the problems treatment for patients with renal failure than long-term dialysis. The cost of other transplant operations varies according to how long the patient remains in hospital. Heart transplants cost about £10,000 - £18,000 and liver transplants about £15,000 - £18,000. Immunosuppressive drugs and other follow-up treatment after a liver transplant cost about £3,000 - £5,000 a year. 2 The demand for organs 1.7 The success of transplantation, however, brings with it the problem of obtaining an adequate supply of human organs for such treatments. In the UK, the majority of human organs for transplantation come from donors who are brain stem dead but whose lungs are being artificially ventilated in an intensive care unit and whose hearts are still beating. Most of these people have suffered severe brain damage, mainly caused by brain haemorrhages or road accidents. Some organs, such as kidneys, can be removed from donors whose hearts are no longer beating. And kidneys, sections of the liver, and some tissues such as bone marrow, can be donated by living people. Live donation, however, is a major procedure and it is not possible for hearts. Thus, the supply of organs for transplantation is very restricted and falls far short of demand. Even if all human cadaveric organs were somehow made available for transplant, the supply would still not meet the potential demand. 3 Meanwhile, as the benefits of transplantation have become more apparent, so the demand for this form of treatment has increased and the shortage of human organs has become more acute. This is illustrated by the figures for kidney transplantation, the most commonly performed transplant operation (Figure 1.1). In 1978, in the UK and the Republic of Ireland, 765 kidney transplant operations were performed, and 1,274 people remained on the waiting list. By 1994, the number of transplants performed that year had increased to 1,744, but the number of people remaining on the waiting list had increased to 4,970. 4 2 Another method of estimating treatment costs uses the QALY or Quality Adjusted Life Year, which tries to take account of the increase in life-expectancy and quality of life gained by treatment. This method has its difficulties, but it can give a rough idea of treatment costs. It indicates, for example, that a kidney transplant is about four times more expensive than a hip replacement, but confirms that it is a less expensive treatment for kidney failure than dialysis (Mason J et al. (1993) Some guidelines on the use of cost effectiveness league tables. British Medical Journal, 306:570-2). 3 Caplan A (1992) Is xenografting morally wrong? Transplantation Proceedings, 24:722-7, quoted in Tania Woods’ submission to the Working Party. 4 United Kingdom Transplant Support Service Authority (UKTSSA) (1995) Yearly transplant statistics for the United Kingdom and Republic of Ireland as notified to UKTSSA. UKTSSA information sheet. 3
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Xenotransplantation - Nuffield Council on Bioethics

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