Xenotransplantation - Nuffield Council on Bioethics
Xenotransplantation - Nuffield Council on Bioethics
Xenotransplantation - Nuffield Council on Bioethics
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Animal-to-Human Transplants : the ethics of xenotransplantati<strong>on</strong><br />
6.18 Some<strong>on</strong>e who required a life-saving operati<strong>on</strong> would probably be prepared to accept<br />
a risk of infecti<strong>on</strong> which is greater than that thought to be acceptable for the whole<br />
populati<strong>on</strong>. The ethical questi<strong>on</strong> is how to balance the needs of individual transplant<br />
recipients, and the potential benefits to them of xenotransplantati<strong>on</strong>, against the<br />
uncertainties associated with the possible transmissi<strong>on</strong> of a new infectious disease to<br />
the general populati<strong>on</strong>. Even allowing that xenografts might bring benefits to<br />
patients in terms of increased quality and length of life, the potential public health<br />
risks nevertheless counsel cauti<strong>on</strong>. The c<strong>on</strong>sent of individuals to take these risks does<br />
not justify their impositi<strong>on</strong> up<strong>on</strong> the public.<br />
6.19 In other areas of medical and scientific developments, it has been found appropriate<br />
to limit the associated risks by establishing regulatory mechanisms. Examples are the<br />
regulati<strong>on</strong>s c<strong>on</strong>trolling the development of new medicines, and of gene therapy<br />
techniques. Where there is a perceived risk to public health, or the envir<strong>on</strong>ment,<br />
there is further increased rigour, as seen in the area of genetically modified organisms<br />
(paragraphs 4.50 - 4.52). This suggests the urgent need in the field of xenografting to<br />
establish agreement <strong>on</strong> best practice and the appropriate regulati<strong>on</strong> of xenografting<br />
procedures.<br />
The principle of precauti<strong>on</strong><br />
6.20 As set out above, the development of xenotransplantati<strong>on</strong> is associated with the<br />
potential risk of transmissi<strong>on</strong> of new diseases to the human populati<strong>on</strong>. It is not<br />
possible to predict or quantify this risk but, in the worst case, the c<strong>on</strong>sequences could<br />
be far-reaching and difficult to c<strong>on</strong>trol. In this type of situati<strong>on</strong>, a cost/benefit<br />
approach to dealing with risk analysis has limitati<strong>on</strong>s because the costs (and, indeed,<br />
the benefits) are not known and cannot be predicted. Since the possible c<strong>on</strong>sequences<br />
of developing xenotransplantati<strong>on</strong> are potentially very serious, it is hardly wise to use<br />
a method of risk analysis that cannot address such c<strong>on</strong>sequences until they start to<br />
be seen.<br />
6.21 The principle of precauti<strong>on</strong> offers an alternative method of risk analysis and<br />
assessment. 21 This has been developed within the field of envir<strong>on</strong>mental policy and<br />
applied to the c<strong>on</strong>trol of polluti<strong>on</strong> and the release of genetically modified organisms.<br />
The principle of precauti<strong>on</strong> requires that acti<strong>on</strong> should be taken to avoid risks in<br />
advance of certainty about their nature. This challenges the view that, until there<br />
is evidence that a new technology is harmful, it is acceptable to proceed with its<br />
development. It suggests that the burden of proof should lie with those developing<br />
the technology to dem<strong>on</strong>strate that it will not cause serious harm.<br />
21<br />
O’Riordan T and Jordan A (1995) The Precauti<strong>on</strong>ary Principle in C<strong>on</strong>temporary Envir<strong>on</strong>mental Politics.<br />
Envir<strong>on</strong>mental Values, 4:191-212.<br />
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