Xenotransplantation - Nuffield Council on Bioethics

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Table of contents Table of contents Members of the Working Party and terms of reference Summary of recommendations vi - vii viii - x Chapter 1 The promise and the problems 1 Transplantation in medicine 1 The demand for organs 3 Reducing the shortage of human organs 5 The promise of xenotransplantation 6 Ethical concerns 8 The importance of moral convictions 9 Chapter 2 Alternatives to xenotransplantation 13 Preventive health measures 13 Increasing the supply of human organs 14 Artificial organs and tissue 17 Bioengineered organ and tissue replacements 20 Conclusion 23 Chapter 3 <strong>Xenotransplantation</strong> : progress and prospects 25 Definition and scope of xenotransplantation 28 The immune response 28 Preventing organ rejection 29 <strong>Xenotransplantation</strong> of primate organs and tissue 30 Baboon bone marrow transplants for treating AIDS patients 31 Will primate organs function properly in human beings? 31 <strong>Xenotransplantation</strong> of pig organs and tissue 32 Hyperacute rejection 32 Other obstacles to xenotransplantation using pig organs 35 Conclusion 36 Chapter 4 Animal concerns : principles 37 The use of animals for medical purposes 37 The balance of animal suffering and human benefit 38 Animal rights 39 Self-awareness and personhood 39 Speciesism and the moral community 41 Relationships 42 Attitudes to nature 43 Conscientious objections to the use of animals for medical purposes 44 The use of animals for medical purposes: conclusions 45 Concerns about the use of primates for xenotransplantation 46 The use of pigs for xenotransplantation 52 The use of transgenic animals for xenotransplantation 52 Chapter 5 Animal concerns : practice 57 Animals (Scientific Procedures) Act 1986 57 The care of primates 59 The production and care of transgenic pigs 60 The production of transgenic pigs free from infectious organisms 63 The removal of organs and tissue from animals 64 Conclusion 66 iv
Table of contents Chapter 6 Transmission of infectious diseases 67 The risk that infectious organisms will be transmitted from animals to human beings 68 Infectious organisms 69 Comparison of the risks to human beings from infections organisms of primates and pigs 70 Assessing the risks of infection 72 The risk of animal diseases spreading from xenograft recipients into the general population 73 The principle of precaution 74 Assembling information about the risks of disease transmission 76 Producing animals free from known infectious organisms 77 Follow-up of xenograft recipients 78 Conclusion 80 Chapter 7 Early patients 83 When will xenotransplantation trials involving human beings be justified? 83 Consent considerations 87 Children 89 Adults who cannot consent on their own behalf 90 Conscientious objections 91 Conclusion 93 Chapter 8 Effects on the health care system 95 Implications for the National Health Service 95 The cost of xenotransplantation compared with human organ transplantation 96 The scope of xenotransplantation 97 Arrangements for introducing xenotransplantation into the NHS 98 Chapter 9 Personal and social effects of xenotransplantation 101 Attitudes towards xenotransplantation 101 Effects of xenotransplantation for individual recipients 102 The implications of xenotransplantation for attitudes to human organ donation 106 Chapter 10 Conclusions and recommendations 109 Ethical concerns 110 Animal concerns: principles 111 The use of primates for xenotransplantation 112 The use of pigs for xenotransplantation 113 Animal concerns: practice 114 Transmission of infectious diseases 116 Early patients 118 Effects on the health care system 120 Personal and social effects of xenotransplantation 121 Implementation of recommendations 122 Annex A Public consultation 123 Annex B Consultation letters and information pack 125 Annex C Individuals and organisations contacted 130 Annex D Submissions 133 Annex E Glossary 135 Acknowledgements 143 Index 144 Order form 147 v
Page 1 and 2: NUFFIELD COUNCIL ON BIOETHICS Anima
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Conclusions and recommendations
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Xenotransplantation - Nuffield Council on Bioethics

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