Perspectives of Comfort: Donors in the Xenotransplantation Process

Hwang230Description: Xenotransplantation, the donation of non-human transplants to human recipients, is just one procedure that can help alleviate the stark gap between the number of recipients on the national organ donation waitlist and donors, both living and deceased.  With it come questions of the moral worth and treatment of donors.  Although this paper will not discuss the ethics of whether or not xenotransplantation itself is a morally sound procedure, it will explore the ideas within the protocol itself and the importance of comfort and painlessness during a medical procedure, aspects that are often neglected or forgotten in order to balance a certain hierarchy that is shaped by the restriction of resources.

Introduction

Is there a difference between a pig organ donor and a human organ donor?  In general, all beings are treated uniquely and differently, but what exactly fosters this variety of conduct, and how does this idea connect to the medical world?  According to humanxenotransplant.org, “Xenotransplantation refers to procedures in which live cells, tissues, or organs derived [from] a non-human animal are transplanted, implanted, or infused into [a] human patient.”  Although not much research has been put into xenotransplantation in the past, an interest has reappeared because of the increasing number of patients on the national organ transplant waitlist.  If a larger supply of organs and tissues can be generated, then more people can receive life-saving treatments.  This also raises questions about comfort as a neglected and forgotten priority of medical operations.  Furthermore, when we are forced to rank the necessities of overall life, comfort usually ends up near the bottom.  In this paper, I aim to discuss the importance of comfort and painlessness for all donors, human and non-human, by examining wellbeing, respect, and safety.

Xenotransplantation

Currently, over 120,000 people are on the national transplant waitlist, but only 24,000 operations from 11,800 total donors, deceased and living, were performed from January to October in 2013 (“Data” Organ Procurement and Transplantation Network).  With this stark gap between donors and recipients, researchers worldwide have been searching for a solution to one of two problems: the high need for operations or the lack of donors.  Xenotransplantation, the donation of body parts from non-human species, is one way that can help ease the gap and give people lifesaving operations by increasing the supply of organs, tissues, and other needed transplants.

Xenotransplantation offers immense promises as well as obstacles.  While it would help supply more transplants, a long-term successful xenotransplantation has not occurred yet, due to scientific complications.  The longest a solid organ xenotransplant has ever lasted is 98 days (biotechlearn.org.nz).  There are four “types” of xenotransplantation: an operation in which an entire solid organ, such as the heart or kidney, is removed from the animal and transferred to the human; an operation in which cells or tissues with no connection to animal vessels are removed from the animal and transferred to the human; extracorporeal perfusion, the circulation of blood out of the human body, through animal products, and back to the body; and operations in which parts of the human body come into contact with parts of the animal and are then replaced (humanxenotransplant.org).

In the past, xenotransplantation has offered operations for patients in dire need of transplants but unable to obtain one.  This situation can occur due to the lack of transplants available or because the patient is ineligible to be placed on the waitlist.  In June of 1929, a man, left anonymous in this news article, received a baboon’s liver because his own was destroyed by hepatitis B, leaving him ineligible to accept a donation (“Terminally Ill Man”).  Although he only lived for seventy more days, if the longevity of xenotransplantation could be increased, then it could be a vital solution to saving many lives; in fact, longer lasting pig heart valves have already seen success (“A History of Xeno Experiments”).  In theory, xenotransplantation could also offer a short-term solution to organ transplantation while the patient is still waiting for a viable long-term donation.

The first successful attempt at a xenotransplantation surgery occurred in 1963 when Dr. Thomas Starzl completed six xenotransplants.  However, this success is relative because the patients only survived for up to 98 days.  In 1997, there was a worldwide ban on xenotransplantation because of an outbreak of porcine endogenous retrovirus, a virus that affects pigs that could have endangered human xenotransplant recipients.  Since then, research and xenotransplantation operations have slowed (biotechlearn.org.nz).

Currently, xenotransplantation in the United States of America is not in common practice because of the lack of prior research.  However, it can be approved by the Food and Drug Administration on a case-by-case basis for carefully monitored clinical trials or unconventional therapy, and experimenting is being devoted into finding potential uses for xenotransplantation.  A document released by the FDA called the Guide for Industry: Source Animal, Product, Preclinical, and Clinical Issues Concerning the Use of Xenotransplantation Products in Humans highlight essential details in setting up a xenotransplantation project and reflects the views of the FDA without being legally binding.  Furthermore, major discoveries undergoing further development include using xenotransplantation to treat type-one diabetes and Parkinson’s disease and genetically modifying animals to make transplantations more successful (“Xenotransplantation from Genetically Engineered Pigs”).  A considerable amount of interest has been shown in the use of pigs as organ donors because of their litter size, maturity rate, anatomical size, and similarity to humans (“Xenotransplantation” Medscape.com).

In a human-to-human transplantation, the recipient’s body normally attacks the new transplant because it recognizes it as foreign and tries to expel it from the body.  For this reason, recipients (other than those who receive from twin siblings) have to take harsh medication called immunosuppressant medicine to reduce the body’s ability to attack the foreign transplant.  As can be guessed from the name, this medicine restrains the entire immune system, the system responsible for guarding the body from diseases, and can leave the patient more susceptible to other illnesses (“Organ Transplant: After the Transplant”).  Since xenotransplantation is cross-species and not as well known, these risks could be even greater for recipients.  The major risks for failure of the xenotransplantation can be caused mainly by the transfer of pathogens (a disease-causing agent): the pathogen could be harmful to humans but invisible in animals, benign to humans overall but harmful to the individual, or combine with other pathogens to create new pathogens (humanxenotransplant.org).

Xenotransplantation projects require complicated facilities to maintain the animals and research that occurs inside.  The FDA recommends that the animals be forbidden from going outside to reduce the spread of pathogens.  The facility needs to be properly equipped to maintain proper conditions and specially designed to increase sanitation and decrease the risk of accidental injury to animals (Guide for Industry).  Since xenotransplantation is not very well known currently, it is unlikely that there are facilities dedicated to just xenotransplantation, but that could change with any success in research and experimentation.

Comfort and Ethical Pinpoints

Relevance of Comfort to Society

Comfort and painlessness are two of many factors that can impact people’s health.  While they might not seem as significant as vaccinations, they are apparent in everyday life and are just as influential as a proper amount of sleep, balanced nutrition, and regular exercise.  Prolonged pain can lengthen recovery time, induce stress, decrease appetite, and lead to anxiety and depression.  On top of that, overwhelming stress can lead to headaches, muscle tension, upset stomach, sleep disorders, and restlessness (“The Importance of Pain Control”).  In fact, an emerging conscious about comfort and painlessness just in everyday life has led to self-care and wellbeing becoming new priorities along for a comprehensive healthcare program.

The idea that conventional medicine and medical care should be equivalent in priority to self-care and even unconventional therapy such as acupuncture, constituting a sense of holistic wellbeing, has erupted in the new integrative medicine movement.  This new ideal has challenged medical institutions to find ways to combine modern medicine with aspects of self-driven responsibility to maintain a plan personal to each patient that heals and enhances every part of each patient’s life, not just a broken bone.  Mark Hyman, MD describes the movement as “treating the system, not the symptoms” (DukeIntegrativeMedicine.org).  In another source, Dr. Hyman says “diseases don’t actually exist” and continues to explain that diseases appear because of an imbalance in the body.  “Is depression really a Prozac deficiency?” he asked the audience.  Rather, he argued that diseases occur as a result of a break in important body patterns, and integrative medicine can encourage universal health and better treat these “diseases” (TEDMED).

The emergence of a holistic perception of medicine further supports the idea that comfort is important to medical operations and even ordinary life, confirming that comfort is indeed as priority to enhance during transplantation procedures.

Restricted Resources as a Characteristic of Decision Making

Difficult decisions often have to be made in the light of restrictions; this will be a repeated theme throughout this paper.  As long as society has any limits, choices regarding ranking based on moral value will impact a wide scope of stakeholders, and not always for everyone’s best interest.  If we had an unlimited supply of organs, researching and developing a program for xenotransplantation would be completely unnecessary; a limited amount of monetary resources requires that we rank aspects of medical procedures in order to allocate appropriately those funds.

This idea does not just apply to the medical world.  For example, students have to take into account a limited amount of time and practice good time management skills in order to complete all of their work.  They would have to prioritize the different kinds of work they have to do, and sometimes the least important things would have to be completely cut.  In more detail, this might mean that someone would choose to study for a history test scheduled two days later rather than the English test occurring the next day because she might have received a disappointing history score last week.

To exemplify more specifically why the idea of restricted resources applies to xenotransplantation, there is the notion of whether comfort is significant enough to prioritize in the first place, who deserves it, and how much thought has to be put in to it. Analogous to a student allocating limited amounts of time, we have to choose which aspects of organ transplantation to prioritize.

On the Moral Status of Animals

The basis of measuring the moral status of animals is the ability to suffer.  When you touch a hot stove, you automatically jerk back to avoid pain and injury to your skin.  Each being that has the ability to suffer has the intention to avoid suffering.  By this minimal standard, people should avoid causing others to suffer, remembering that they would want others to do unto them what they would do to themselves.  According to this viewpoint, there is very little separating humans and animals: each can suffer and each has the desire to survive.

Some, like Carl Cohen, make the argument that humans are different from- and superior to- animals because of the ability to make decisions based on moral reasoning.  He makes a valid point in saying that animals and humans simply cannot be held in the same moral standing because they do not have equal capacities to make those decisions.  However, Peter Singer makes the case that when studying the relationship between animals and humans, humans often work in a “speciesist” way.  If an infant and a rabbit have the same abilities to make moral decisions, then why are only rabbits used for testing products?  He analogizes speciesism to racism by saying “If a being suffers, the fact that it is not a member of our own species cannot be a moral reason for failing to take its suffering to account […] the existence of suffering, rather than the sufferer, is what is really morally significant” (The Place of Nonhumans in Environmental Issues 57).

In the stand point of moral worth, since humans have the intrinsic capacity and ultimately do make decisions based morals and reasoning, then it is only fair that we hold humans in higher regard than non-humans and do what we must to protect them, although this does not give us the absolute right to do absolutely anything.  As long as someone suffers- human or not- the suffering limits our actions.  Following Peter Singer’s arguments, the comfort of animals should not be neglected simply because they are animals.  Along with having medical support for alleviating pain, those who take from others should have the responsibility to do so while causing the least damage.  Even if arguments were employed to explain why xenotransplantation and other actions largely negatively affecting animals are considered justifiable (a topic I will not delve into), it is the responsibility of those with power to use it responsibly and with integrity.

However, this is not to say that humans and animals necessarily deserve equal treatment, for they firstly have different needs and secondly have different interests.  In the words of Peter Singer, “… a normal human has hopes and plans for the future: to take the life of a normal human is therefore to cut off these plans and prevent them from ever being fulfilled.  Fish, I expect, do not have as clear a conception of themselves as beings with a past and future” (“Ethics and the Animal Liberation Movement”).  So while a significant portion of moral value is involved with the ability to suffer, it can be implied that future activity is important as well.  Following Singer’s model, killing a fish, while certainly not trivial, is not as morally dreadful as killing a human.

Another aspect to take into account is the concern for consent. In the donation process, the informed consent of human donors is paramount while animals have no chance to say no.  Animals could certainly be considered oppressed and unfairly taken from, especially because they die by the time the xenotransplantation process is over.  Ultimately, they have no knowledge of what is going on, they can make no decisions to affect their futures significantly, and they possess no control over their lives.  However, this idea also brings up the question of if animals would even be able to comprehend the decisions that affect their lives, the answer to which would be a presumed no.  If it has been decided that killing animals for their organs and tissues is extremely important for saving lives and can be morally justified, then it should be agreed that providing animals with basic comforts would be the least we can do for animals that save human lives.

Perhaps it can be argued that we are morally obliged to help only those we harm.  If beings are born in a neutral state of life, being in the middle of happy and unhappy, our only necessary task is to let those beings stay in the neutral zone.  We should refrain from pushing them to unhappiness, but we are not required to help them achieve happiness (whether the state the beings are born in to is sufficient enough not to require help is a different problem).  In this respect, when we harm someone, we should help her/him/it regain the former status of neutrality or even a higher level of happiness.  In relation to xenotransplantation and human organ donation, it is morally justifiable that we give comforts to those we harm for the sake of good.

Together, consent and the ability to suffer lay the foundations for animal rights.  By the above reasoning, the animals who donate- can it be called donation when the transplants are taken, not given?- do deserve a certain form of treatment, which can be collectively named as animal rights.  Even if animals cannot claim or argue for these rights, they should be treated as though they are entitled to them.  Maybe they do not deserve the same rights humans have, but they do deserve and are warranted something; what more is a right?

Principles of Analysis

This paper will use the above mentioned information to focus on respect and safety in emphasizing the importance of comfort and painlessness to medical procedure involving different kinds of donors by exploring the conducts in pre- and post-surgical procedures and the facilities in organ transplantation.  Respect examines the viewpoints held by society and how those viewpoints can affect people’s decisions and the outcomes of situations.  Safety will explore the objective side of comfort and painlessness: why it is necessary in a physical manner related to health.  Each analysis will feature humans and animals separately with a brief conclusion section in which the conditions for both donors are compared, contrasted, and reviewed.

Analyses

Respect

Introduction

Humanity has a long history of animal cruelty and using animals for personal gain but, at the same time, has shown great compassion towards them as well.  I aim to analyze respect because I believe a difference in perspective is the basis of different treatment towards different beings.  First and foremost is a difference in moral value, as mentioned previously, which can also be affected by limited resources.  People only have so much time, energy, and ability to carry out their lives, and they have to decide which aspects are most important to them.  This leads to a gradient of treatment.  For example, traditionally, if three children were trapped in a burning building and a mother could only save one, she would choose to save her child.  To create a hypothetical hierarchy of these three children, her child would be most important, her child’s friend in the middle, and the child she does not know last.

In this scenario, the mother is required to make a judgment call that will affect her actions concerning the problem, and maybe even have long-term consequences.  This happens in ordinary life, every single day.  The crux of the matter is whether these judgments are founded fairly and soundly.  The most prominent opposition to the topic of this paper was, “Well… Animals are just animals, so why is this important?”  This viewpoint shows a lack of processing the position of the animal donor in xenotransplantation.  While humans and animals are not equal and do not necessarily have to be treated the same, respect for those who are different prevails because of the need to prevent extensive pain.

Human

Candidates for donation are selected through a process that compares compatibility first and foremost.  Please note that I will only discuss living human donors as candidates because all animal donors are living at the time of donation as well; this would keep analogies consistent.  Donors must be in optimum health and have certain aspects of their blood and tissues in common with the recipients so that the transplantation will work with the maximum benefit.  This will come up again when discussing safety.  While a successful transplantation with a healthy transplant is important for the recipient’s health, the initial health of the donor is also significant since the donor must recover from invasive surgery.

The second part of choosing donation candidates, after it is clear that the donor and recipient physically match, is mental preparation. Throughout their stay at the hospital, donors are given a team of doctors, nurses, and social workers to make sure that they are fully aware of everything that is happening and the risks they face (livingdonorsonline.org).  In fact, LivingDonorsOnline.org suggests that each donor should be “intellectually,” “emotionally,” “physically,” “financially,” and “spiritually” prepared to donate.  These steps are taken to make sure that each donor fully understands the donation process and is not coerced or forced into donating.

Living human donors are typically treated with the utmost care and gratitude for giving the gift of life.  The story is different for everyone, but some donors become friends with the recipients, and some donors already knew the recipient before being asked to donate.

Animal

With so few xenotransplantation operations, it is hard to determine what the typical thoughts towards source animals are.  Since the donations of these animals are so crucial to the recipient in an already very risky operation, the health and wellbeing of the donor animal is just as important as the human donor’s.  However, good treatment of animals is different from safe treatment of animals.  It could be that since the goal of xenotransplantation is to enhance another human’s life, the treatment of animals throughout the process is less important than the overall success of the operation, the improved health of the recipient.  Furthermore, it is possible that the comfort of the animal is only important because it affects its health which would affect the health of the recipient.

In other cases, the comfort of the animal might be completely neglected because it has no efficient way of complaining or affecting change.  Especially with a limited amount of monetary resources, conserving as much money as possible is very important, and the comfort of these defenseless animals is easy to overlook.  As long as someone’s mistreatment of the animal does not affect the goal of the xenotransplantation, the mistreatment might go unnoticed.

What I am trying to ask is this: What is our moral perception of animals as a whole, and how does that change depending on what the animal does?  Pets are often considered and treated like family, an endless stream of cows visits the slaughterhouse every day, and we turn a blind eye towards rats subject to scientific experiments.  Why is it that the animals that arguably have the greatest beneficial impact on society are regarded the least by the very society they support?  It is because the objectification makes the burden causing suffering to another conscious, sentient being easy to bear.  It is easier to let a being endure suffering if we emotionally care less about it, including humans.  Recall the burning building from the introduction.  Since the mother cares so deeply for her child, she is emotionally unable to let her child burn and suffocate in that building.  The same applies to xenotransplantation: since the most important stakeholder is the recipient, the donor animal is therefore less important.  Out of sheer and utter respect for fellow suffering beings, a basic level of comfort should be provided to the donor animals.

Conclusion

Whether animals are thought of as donors or means to an end is debatable.  Human donors would never be thought of as a means to an end- every gift is appreciated because of the motivation for giving.  However, animals are controlled and taken from.  While people do not have power over other people and cannot force them into donating, this situation is the opposite for animals.  Since both animals and humans give the same gifts and have the same end results, animals and humans should be treated and viewed similarly, as equals.  Alternatively, it could also be argued that animals are not truly donors because they do not have the same knowledge, insight, or motivation as human donors even though they ultimately give their lives, not just an organ that allows the recipient to live.

Another relevant point is the treatment of humans and animals after surgery.  The recipient and family are always deeply grateful for the human donor’s gift of life.  If the donor does not choose to remain anonymous, the donor and recipient may exchange letters or build a personal relationship (if the donor had not been an acquaintance at first).  At the end of a xenotransplantation procedure, the donor animal is ultimately killed for its donation.  If the mindset is to rear the animal and cover its needs for the sake of the recipient’s health, it could be considered an objectified means to an end.  By this view, the needs of the animal are immaterial compared to the human.  However, even if this donor is just a tool to improve another person’s health, the very fact that it can suffer is enough to make it a valid stakeholder throughout the xenotransplantation process.

The animal donor, like a human donor, has emotions and desires and no choice but to feel the same pain and suffering as a human donor.  Perhaps animals’ emotions and desires are not equivalent to humans’ emotions and desires, but on a fundamental level, if they are able to feel the same pain as others, then they should be given the same level of comfort as them too.

Safety

Introduction

We are often forced to evaluate and rank the importance of several different values when we are in tough situations, as specified under the characterization of restricted resources.  In the scope of life-saving medical procedures, safety would rank very high, if not number one.  In a situation where an individual needs a xenotransplant to live, safety, quick recovery, and affordability would be more important than comfort, leading to comfort often being an underappreciated value in medical procedures.  Ensuring safety can involve blood and tissue tests and more complicated examinations as a match is found.  For example in human-to-human procedures, after a match between the recipient and the donor is found, a computed tomography angiogram, better known as CT scan, can be conducted to map out the internal structure of the body.  However, this does come with a risk: dye must be inserted into veins near the site that needs to be imaged, and that dye can cause an allergic reaction to the donor (LivingDonorsOnline.org).

Prolonged pain and discomfort can have adverse side effects to all animals, human and non-human, and yet they are often neglected and forgotten in favor of other more significant aspects of the medical procedure.  For instance, if a patient has fifty dollars to spend, those fifty dollars are more likely to be spent on immunosuppressant medicine than pain relievers since the immunosuppressant medicine has a more direct impact on the status of the patient’s health and life.  However, long periods of pain can still cause severe health problems, such as a longer recovery time, headaches, increased stress, eating disorders, and other problems previously mentioned in the general introduction of this paper (“The Importance of Pain Control”).  While the effects of pain might be easy to dismiss and do not seem significant at first, the long-term impacts can be detrimental, so it is important to consider comfort when planning medical procedures.

Human

Studies have been conducted that support the benefit of comfort for human patients.  For instance, comfortable hospital rooms often led to quicker recovery times, and patients with windows with a view of nature and natural light used and needed less pain medication, and special ceiling tiles that absorbed sounds aided their sleep habits (“Room for Recovery”).  Considering these auspicious outcomes, comfort should be considered a significant factor to the success of medical conducts.

Additionally, donors go through thorough testing, both mental and physical, to make sure a good match is made, they are already in excellent health, are aware of the risks they face, and feel safe throughout the process.  Donors need to be in excellent health because they need to be able to recover well from the invasive surgery.  Donors can leave the hospital once their gastrointestinal tracts are functioning properly, can move around independently, and can manage pain.  They need to have regular check-ups to make sure that their bodies are healing well (LivingDonorsOnline.org).

So far, it seems as though the medical society has excellent ways to improve the likelihood of a successful operation, and the next step would be to improve the operation itself.

Animal

The animal facility in particular is set up in a way that safety is the number one priority.  It must be clean, have no risk for injury, and prevent the spread of pathogens.  Aspects like temperature and humidity, light, noise, space, and food are regulated (“Guide for the Care and Use of Laboratory Animals”).  Animals, like humans, go through extensive testing for the same goals as humans since they need to be healthy in order for their donations to heal another person.  However, there is no aspect of mental health throughout this process; there seems to be no way to find out if the animal is ready for surgery because of the lack of ability to communicate with it.  After the surgery and its death, the animal is most likely cremated to prevent the spread of any germs.

Conclusion

In medical operations, safety is key.  The medical society is based on four pillars: autonomy, non-maleficence, beneficence, and justice.  Each of these ethical values is based on keeping people safe: protecting patient autonomy, making sure nothing bad and only good happens, and ensuring fairness for everyone.  To put it bluntly, the patient will live if the doctors are mean.  The patient might not live if the safety is compromised.  Does this mean that everything should be done to ensure the safety of the xenotransplantation so that it succeeds?  To a point, it does.  However, there is also a point when such protocols can become over exaggerated.  All tests and procedures should be directly relevant and justifiable.  Animals- and humans- should not have to undergo additional, excessive, or unnecessary processes- even when related to safety and especially when causing increased pain and discomfort.

With today’s advanced technology, it is possible to perform complicated tests to ensure safety and check for problems with an individual’s help.  However, these tests can also be simply irrelevant and avoidable with other more simple treatments.  For example, it is not uncommon for people with lower back pain to request an MRI, CT scan, or X-ray to diagnose the problem, but the pain often ameliorates within a month, according to ConsumerReports.org.  In fact, “back-pain sufferers in a 2010 study who had an MRI within the first month didn’t recover any faster than those who didn’t have the test—but were eight times as likely to have surgery, and had a five-fold increase in medical costs;” furthermore, some “doctors often comply to provide reassurance and to avoid lawsuits” (“Many Common Medical Tests”).  Although this specific example is not related to xenotransplantation, it shows that extra tests are not always helpful and can actually be harmful.

A couple comparisons to this example include echocardiograms, images taken of the heart using radioactivity and renal arteriograms, the process of mapping the structure of kidneys, arteries, and veins by circulating dye throughout the blood (LivingDonorsOnline.com).  Each case is meant to ensure safety to the recipient, and might become necessary depending on the situation, but can also cause harm to the donor and so should not be over used, like the previously used example of the CT scan.

Comfort affects safety.  As mentioned beforehand, pain has many adverse health effects.  When the lack of comfort leads to the lack of health, ensuring comfort becomes a moral obligation as much as an important medical concern.  Since the medical society operates under the pillar of non-maleficence, and the donor animals are inducted into the medical society because of their role in health procedures, the animals must also be covered in the need to ensure comfort and painlessness.  Additionally, this medical principle can also be applied to everyday life: not causing harm without justifiable cause.  Xenotransplantation (once it is consistent and reliable) can be considered necessary because of the severe need to save lives by providing critical medical procedures to those who need them, but it also causes harm to the animal donors.  This inevitable harm to the animal donors must not be increased by a lack of care to their safety, health, or comfort, simply for the reasons of not compromising safety and adhering to the viewpoint that since these animals can suffer as humans can, they are just as deserving of a certain level of comfort.

Conclusion

Connecting humans and animals at the barest foundation is the common ability to suffer.  Differing, however, are their needs and desires.  Comfort to humans might require anesthesia, large feather beds, and fascinating novels while animals only need- or want- pain medication and a spacious living area.  By this perspective, animals deserve fair and adequate, but not necessarily equal, levels of comfort.  While the desire for comfort can differ according to the parameters of each situation, animals should not subject to additional suffering for any speciesist or unsound reason, the same way that a poor person is no less deserving of medical care simply because she cannot afford it.  At the intrinsic, non-political, non-monetary-based level, she is just as entitled to competent medical care as a rich person.  We might consider a universal standard for all species, just as we do for humans.  Furthermore, comfort and painlessness also play key roles in safety and wellbeing.  New thinking has evolved to include the management of pain with conventional medicine in order to maintain good health, and this idea should apply to all donors, human and animal.  Even without considering the moral worth of the animal, it is still more advantageous to observe comfort carefully to ensure a positive outcome for the xenotransplantation.

The idea of comfort as a medical priority is not only important to organ transplantation and xenotransplantation, but to palliative care, a topic slightly relevant to this paper.  According to GetPalliativeCare.org, palliative care is “specialized medical care for people with serious diseases” that is meant to help alleviate painful symptoms rather than treat the underlying problem.  The same site also states that it “focuses on symptoms such as pain, shortness of breath, fatigue, nausea, loss of appetite, difficulty in sleeping and depression.”  The entire focus of this medical movement is providing comfort for patients in the end stages of diseases or tolerate treatment more easily and emphasizes the importance of comfort not just for the safety and wellbeing of the patient, but also in a sense of improving the quality of life.  Although this notion of improving the quality of life is not discussed much throughout this paper, it also supplies another example of why comfort and painlessness are important to life overall.  If the first goal of living beings would be to avoid pain, the next would be to increase happiness, an objective that palliative care works to manage.

Nonetheless, there are frequent times when the patient is unable to confirm for him or herself what he or she would like to happen throughout the medical operation.  This is a conflict with consent, which is also seen repeatedly during this paper.  In particular, the animal donors are unable to give their consent and this notion would be a prime example against the implementation of xenotransplantation, as recognized by Alexa Girasole’s paper titled “Xenotransplantation: Is it Worth the Risk?”  In general operations, consent should be given by well-informed individuals who are impacted directly by the consent.  However, in the paper, the animals are assumed to give consent through a proxy: someone else decides that the animals would agree to be xenotransplantation donors.  This can occur in other situations, such as the responsibility for another family member, friend, or representative to assume the authority of making decisions on the behalf of someone in a coma, at the end stages of a disease, or even less seriously, cannot come to the phone.  The importance of receiving legitimate consent is hallmarked by the need to respect another individual’s autonomy, needs, and desires.

The final, most ominous question to ponder would be the treatment of the xenotransplantation animal immediately before the donation operation.  Should the animal donor be killed before it donates its transplant, as is the current norm?  The pain medication could adversely affect the animal’s health and make the next operation(s) less successful.  Death could be preferable to the severe pain it would have to go through multiple times to undergo multiple operations, and having the animal undergo several operations would only further objectify it as a means to an end.  On the other hand, using the animal for only one operation would be a waste of its total life and suffering while more people could benefit from the donations of one animal.  Finally, the animal should not be punished by death for giving life.

At the basis of the concerns for the treatment of all living things is the evaluation of moral worth, which plays into the idea of a hierarchy of priorities that was discussed in this paper.  Using our morals and values, we decide who and what is most vital to our lives and act on those choices.  Restricted resources can certainly play a role in building the ranking, along with the specific situation, cultural norms, social stigmas, and personal values.  Choices are made based on solid personal hierarchies; these hierarchies are a driving force in today’s society, not just xenotransplantation, organ transplantation, or medical procedures, just as comfort does not just apply to enhancing medical operations.

By Alyssa Hwang

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One Response to Perspectives of Comfort: Donors in the Xenotransplantation Process

  1. Alyssa Hwang says:

    During my paper, I spoke a lot of comfort as a neglected priority of life. Do you think there are others? Why are they important?

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