Xenotransplantation: Is it Worth the Risk?

Girasole240v2Description: Of the 120,899 people on the transplant list, last year 6,500 of those people succumbed to the known fact that there just are not enough organs for everyone who needs one. What if there was another way to get an organ? Xenotransplantation presents another option for organ donation. Xenotransplantation is the procedure in which animals donate their organs, tissues or cells to prolong a patient’s life until a human organ can become available. It is an interim procedure that can save many lives; however it is not risk-free and raises many complex ethical issues. My paper focuses on the acceptability of using these animals as organ donors, the lack of a voice these animals have in the process and whether harming these animals is worth it if the transplant is unsuccessful. 

Introduction

There are currently 121,012 people on the national organ transplant list. Of those 121,012 people, only about 24,000 people received a life-saving transplant last year, while 6,500 succumbed to the reality that there is an insufficient supply of organs for everyone who needs one (UNOS).  Almost all of the remaining 100,000 people on the donor list will not receive a transplant in any given year.

There is hope for these people on the donor list. Xenotransplantation is a medical breakthrough that can potentially shorten the number of names on the transplant list. Xenotransplantation is the donation of nonhuman organs, tissues, or cells to a human recipient. It is an interim procedure that can prolong the lives of many patients who are on the transplant list until they are able to receive a human organ. It is an important development in the world of medicine today, despite the fact that many people are not aware that xenotransplantation is an option for an organ or tissue transplantation as a substitution for a human organ.

Though xenotransplantation is an important medical breakthrough and a valuable tool to help manage the transplant list, it is not without risk and raises many moral and ethical issues for further consideration.  For example, xenotransplanted organs usually reject fairly quickly, raising the ethical issues of safely and effectiveness. Animal organs are not designed survive in a human body, so we should question whether it is worth the risk to even try to implant an animal organ in the human body.

Issues of nonmaleficence, or “do no harm”, are also raised. Since animals cannot fend for themselves or communicate with humans, they cannot opt out of donating their organs. It is not just an organ that is taken from them; it is their life. The animals cannot live without their vital organs.  When an organ is taken from them, they die, sacrificing their life to help save a human life. In addition, only the organ that is taken from the animal is used for transplantation. The other body parts that are not used are discarded and cannot be used for any other useful purpose as a result of the medications that the animals are given for the transplant.

Xenotransplantation raises another important issue, namely animal representation. The animals are a vulnerable population since they cannot advocate for themselves, or opt out of the procedure. Their “voice” is lost in this process. They cannot communicate with humans. They cannot voice their objections and they do not have anyone to advocate for their rights.

The goal of my paper is to explore the ethical issues around xenotransplantation. As mentioned, the issues I will discuss include: nonmaleficence for the animal, fairness to both parties, effectiveness of the procedure since the organs can reject so quickly, and impact to the donor and the recipient. Some ethical questions that I will address include the following:

  • Is it fair to kill animals for their organs?
  • How far is too far with xenotransplantation given that these animals are voiceless in the process?
  • Is it worth the animal dying when the procedure is risky for the recipient?
  • Do animals have a right to life?
  • Do animals have to die for humans?

 

Factual background:

Because of the organ shortage in the United States, there are approximately 121,012 people currently on the national transplant list (UNOS). The need for organs grows about 15% each year and an average of 18 people die per day waiting for an organ. Pig valves are the longest lasting tissue that can be xenotransplanted and the average time a valve lasts is around 15 years.

Many people who have received a xenotransplant do not survive longer than a year because the organ rejects.  Rejection occurs when the body does not recognize the cells of the new transplant, either the organ, tissue or cells, and the body attacks the new organ in self defense. Rejection can occur in any transplant, not just xenotransplants.  However, rejection occurs much more often with xenotransplants since the animal organs are not compatible with the human body.  Humans and animals are two different species and the technology to successfully donate organs between species has not yet evolved.

In addition, all patients who have received any sort of transplant must take immunosuppressant medication for the rest of their lives to prevent rejection.  Despite this fact, rejections still occur. There are two main types of organ rejection: acute rejection and chronic rejection. Acute rejection occurs when the transplant is very new.  Very often, the patient can be treated and the new organ saved. Chronic rejection occurs over time because of the gradual loss of organ function and most times cannot be treated successfully.

Different species of animals can be used for donation. Pigs are the most common animal for donation because their organs are bigger and they are more readily available. Primates are a better candidate for donation since their DNA is a better match to human DNA.  In fact, primates share 98% of their DNA with humans. Primate organs, however, are smaller than human organs and this fact can raise issues for transplantation.  Another important factor limiting the availability of primates for donation is that primates are rare in the environment and are protected in nature by humans because of their similarity to us.

A well-known case involving xenotransplantation is the Baby Fae case. Fae was “born an accident” as noted by People magazine. Her parents did not want a child and they divorced before her birth. Fae was born on October 14, 1984 at 6:55 am, two months before her due date. She was born with hypoplastic left heart syndrome, a fatal condition that left her with weeks to live. Her heart was crippled and completely useless, as the left side of the heart was underdeveloped.  There was nothing the doctors could do, except send Fae home to die, until Dr. Lenord Bailey had an idea. Since no organs were small enough to fit inside the small baby’s chest, Dr. Bailey harvested a heart from a seven month old baboon and transplanted it into Fae. On October 26, 1984, the baboon heart was implanted in Fae’s chest at Loma Linda University Medical center in California.

This transplant was a historic advance in medicine because a procedure like this had never been done before. Fae did not only survive the surgery, but thrived with the new organ for over two weeks to everyone’s surprise. Then for reasons that still remain a mystery, her organs started to shut down one by one. Baby Fae died on November 16, 1984 (People Magazine). Her transplant was the first ever xenotransplant attempted in the world and it was more successful than all the doctors thought it would be. It was a ground-breaking procedure that has changed the world of organ donation today, proving that animal organs may be offered to a patient as an interim solution while waiting for a human organ.

In performing my research, I identified five main stakeholders of interest: 1) the donor animal; 2) the recipient of the donation; 3) the doctor who performs the procedure; 4) the family of the recipient: and 5) the owner of the animal.

The animal is greatly impacted by the procedure; they are not just donating an organ to save the life of a recipient, they are sacrificing their animal life to save the life of the human.  The recipient has a difficult decision to make, as well; they have to decide whether they want to wait for a human organ, or receive an animal organ in the interim while waiting for a human organ. This is not always an easy decision.  The doctors involved always want what is best for their patients and, as discussed above, xenotransplantation is not always the safest option for the patient and carries much risk. The family of the recipient has a difficult role to play, as well. Clearly, they want what is best for their family member, but they have the burden of deciding whether the risk of the procedure is worth the chance of saving, or at least prolonging, the life of their loved one.

All of these stakeholder interests are important.  However, the balance of the discussion will focus primarily on the animal and on the patient involved in this process. In addition, I will explore the following four main ethical issues in this paper: 1) safety; 2) effectiveness; 3) nonmaleficence; and 4) fairness.

The issues of safety and effectiveness are related and relevant to xenotransplantation.  As discussed previously, this procedure is relatively new and carries risk.  Xenotransplantation is neither the safest nor most effective option for the recipient because the organs can be rejected, thereby putting the patient at risk.

The principle of nonmaleficence (“do no harm”) is also relevant.  Harm is inflicted on the donor animal since the animal is sacrificed for its body part without regard to the basic value of the animal’s life.  The recipient is also harmed to the extent that the patient will need to undergo a risky procedure to receive an organ that will not withstand their lifespan. Finally, concepts of fairness apply to xenotransplantation on many levels.  We need to consider the issue of fairness in the context of killing an animal to harvest only one needed organ when the rest of the body is wasted. Also, when organs are taken from animals, they do not give their consent because they cannot communicate their wishes or objections to the procedure. Their lives are taken from them without their consent in the donation process.  Fundamentally, is it fair to kill animals for the sole purpose of saving humans in the short-term while they wait their turn on the donor list?  Is it fair to waste the rest of the animal in the process?  What about the fairness of providing an organ to a recipient that we know will not last the life of the recipient?  These are all important issues for further consideration and debate.

One could argue that xenotransplantation is not a safe option and should not be performed since the risk of transplanting an animal organ is much higher than the risk of transplanting a human organ.  Others may argue that if the patient is dying, the transplant is worth a try to save the life of the patient.  In my opinion, I believe that most people would argue that the recipient’s well-being is the most important concern; if there is a chance that the transplant could be beneficial to the recipient, then the doctors should perform the procedure. However, I also believe that xenotransplantation has not been tested enough to prove that it is a consistently safe and beneficial procedure. Since patients who receive xenotransplanted organs usually do not survive longer than a year with their new organ, I do not believe that it is safe or effective for the recipient. This statistic excludes pig heart valves that can last from 15 years to 20 years.  However, even with this longer lifespan of the pig valve, the patient who receives a pig valve will probably still need to undergo more surgeries at a future time (Heart Valve Surgery).

Nonetheless, in both arguments, the recipient is always the main concern. If one was to argue in favor of the transplant, they could argue that the transplant, if successful, could save the life of the patient so it is essential to give it a try and do whatever is possible to save the patient. If one were to argue against the transplant, they could argue that the long-term wellbeing and safety of the patient are always the main concern and that there is too much risk to the patient for such a limited outcome.  Also, the procedure undoubtedly harms an animal.

There are many considerations when contemplating the safety and effectiveness of this new procedure. The primary consideration is always the recipient’s safety, which should be the top priority of everyone involved in the transplant. The recipient should always be the key concern because it is their life that this transplant affects. The recipient has to live with the choice that they make and they must choose the organ that will last the longest and help them maintain their lifestyle. As discussed, another consideration is that the animals are always harmed in this procedure, and if the transplant is not guaranteed to work, why would one harm an animal without the guarantee of a positive result for the recipient?

Xenotransplantation can save a life, but it is not always the safest way to go about a donation or transplantation. In rare occasions, excluding pig valves which last much longer, the new organ will not last a very long time and therefore why would one add that risk to an already risky procedure?

While xenotransplantation may be an alternative and a temporary option for some patients waiting on the transplant list, it is not a mutual benefit for both parties involved. For the animals, it is not fair to take their organs without their permission.  This permission will never be forthcoming since animals and humans cannot communicate effectively. Also, animals have no say in whether they choose to donate or not; that decision is made for them. This lack of voice brings up the ethical issue of fairness to the animals. There is not a mutual benefit for both parties involved in xenotransplantation. An animal gives up its life to save a human’s life and the patient’s new organ will not last the span of their life.

As noted throughout this paper, fairness is a very important issue in xenotransplantation. It is unfair to the animals not to have a say in their fate. Since it is so hard to find a match for the recipient and the organs don’t last long, then why kill the animal if their organs are not always the best option for the patient’s long-term wellbeing? The transplant is also a waste of the rest of an animal’s body if only one small organ or heart valve is taken from them. If there were another way to use the animal’s body in addition to the donation, it would be less of a waste of their body and their life.

Not only is xenotransplantation un fair to the animals involved, it is not fair to the recipient. A patient who has waited a long time for a new, healthy organ should have faith in their new organ and know that it will last a long time, instead of worrying about the organ failing at any time. The day that a patient receives that life-saving operation is probably one of the happiest days of their life because they can return to their live as normal. If a patient receives a xenotransplant, they cannot have that same faith in their new organ because the animal’s organs are not meant to survive inside a human’s body.

According to Aristotle, “nature is a hierarchy in which those with less reasoning ability exist for the sake of those with more reasoning ability” (Ethics and the New Animal Liberation Movement). In contrast, Jewish and Christian religions believed that “humans are responsible to their Lord for the proper care and use of what has been placed in their custody” (Ethics and the New Animal Liberation). These opinions directly contradict one another. Aristotle believed that we, as humans, can do whatever we want with animals because nature is a hierarchy and animals happened to be placed below us and exist to serve our need. Jewish and Christian readings note that we are responsible for taking care of animals because they were entrusted to us and we need to care for anything below us.

Some might argue that it is perfectly fine to sacrifice an animal’s life to save a human’s life because humans are worth more and we are not required to secure the permission of the animal, particularly since they are not able to communicate with us.

In my opinion, I believe that we should care for and protect animals because they do not just exist to satisfy our needs; their life has intrinsic value. Xenotransplantation is not fair to the animals involved; it is not fair to kill the animals just for one organ if their body cannot be used to benefit anything or anyone else. Also, this procedure ignores the intrinsic value of the animal’s life.  Having an animal die for a human does not seem right to me, especially if the transplant is not the safest option for the recipient.

The utilitarian perspective says “the greatest good for the greatest number of people” or “go through with something if the joy is greater than the pain” (Santa Clara University). An important consideration is that animals are getting killed for their organs and the recipients are not benefitting that much from the transplants in most cases. I think that xenotransplantation is not the greatest good for the greatest number of people. Ideally, the recipients would have the greatest benefit as a result of the procedure; however, since the transplants do not last that long, they are not really benefitting that much in the short-term and they still need to keep their names on the transplant list for the long-term.

The animals involved in this procedure do not have any say in what is going to happen to them. They are almost like young children who do not have parents to advocate for them. Doctors are required by law to obtain the patient’s consent or the family of the patient’s consent before doing anything to the patient themselves. Why would a doctor not need an animal’s consent before they kill them for their organs? Just because an animal cannot provide consent, does it mean that that animal has fewer rights than someone who is able to give consent? If this situation was analogized in the broader context, in society there are measures in place to protect individuals who are not able to represent themselves. Take, for example, a child who has lost both parents at a young age and has been placed in foster care. Who represents the interests of those children and how do we keep them safe? The government has regulations to protect their interests because they are not able to advocate for themselves. Shouldn’t this same protection apply to animals that similarly are not able to express their preference or otherwise to advocate for themselves?  These animals have their organs taken by force because they cannot give consent. They also cannot opt out of the organ donation process as humans can.

To humans, animal’s lives have different values and animal’s lives are not on the same scale as human lives. We value primates very highly because of their intelligence and because they are so much like us. Primates and humans share 98% of our DNA, which is why as a society we value them so highly and it is very difficult to harm them. We value dogs very highly because we keep them as pets. They are known as “a man’s best friend” and they can be used to help disabled people, but as a society we don’t value some animals as highly, for example, mice. Mice are animals that most people view as pests and animals that are used for research.  Then, why do we, as a society, see pigs as animals that we can exploit for food or organs? Also, why do we only eat animals like cows and pigs and not dogs or cats? Should we, as a society, place relative values on different animals?

The ethical principal of nonmaleficence, also known as “do no harm”, is a term that is usually only applied to human patients and not to animals. However, if animals are serving as organ donors, which is something that humans do as well, shouldn’t these donor animals receive the same rights and privileges as human donors? Animals respond to pain just as humans do, so shouldn’t we help to ease their pain as well, because no living being should be subjected to pain.  Nonmaleficence applies to xenotransplantation in terms of the donor and the recipient. The donor, the animal in this case, gets killed for their organs. The recipient can also potentially have harm done to them, for example, if the transplant is unsuccessful, then the patient will need to endure additional medical treatment.

If the transplant fails and the patient’s new organ rejects within a short period of time, is it even worth it for the patient to undergo a procedure that will eventually lead to additional medical treatment in the future? The longest a patient survived with a xenotransplanted organ was about nine months (Heart Valve Surgery), and he died because his recently transplanted organ was rejected, even with heavy medication.

Some could argue that animal’s lives are not worth as much as a human life, so if you sacrifice one animal’s life to save a human’s, it is worth the sacrifice. Some could also say that even if the transplant doesn’t work, it was worth the try to save the human’s life and to use the knowledge that is gained from that failure to continue to improve the treatment. On the other hand, even though it is always worth it to try to save a human life, what price is society willing to pay to the degree that it inflicts harm on an animal for this outcome?

In my opinion, nonmaleficence is an important issue because animals cannot fend for themselves and they are being harmed when it is not always necessary. If the transplant is unsuccessful, was the animal harmed for nothing? Also, is it worth it to kill an animal and not get stellar results from the transplant? Why harm an animal when the transplant will eventually harm the recipient, as well?

In xenotransplantation, there is harm being done because animals are dying and there is not a huge benefit for the recipient. If someone wants to do no harm, then they should not kill an animal for their organs.

Conclusion

There are many ethical issues in the topic of xenotransplantation. Four main issues considered in this paper are: 1) safety; 2) effectiveness; 3) fairness; and 4) nonmaleficence. Each of these ethical issues are at the core of whether xenotransplantation is a good option for organ, tissue and cell donation. Safety and effectiveness are important ethical issues because the transplant is not always the safest option for the recipient or the long-term solution for the patient since the transplanted animal organs usually do not last very long.  Fairness comes into play with xenotransplantation; it is not fair to kill an animal for its organs without any other information of their wants or needs. The animals also cannot give consent, so their organs are being taken by force. Nonmaleficence is an important issue because, not only is there harm being done to the animal, but also potentially to the recipient if their new organs fails.

In any event, the main concern in any donation case is the well-being of the recipient. Having an animal organ transplanted into a human body is not always safe or effective for the recipient because the organ can reject very quickly and the donor is usually not a perfect match for the recipient. It is not fair to kill an animal for its organs when they have no say in the process and cannot opt out if they of the donation. Humans can choose whether they want to donate, so why shouldn’t animals have the same privilege? The animals are being harmed in this case and it not always necessary.

Humans view the life of animals differently. Some people value a human life as worth more than an animal life because “we have more reasoning ability” (Aristotle). Animals are considered a vulnerable population because they cannot advocate for themselves and are susceptible to exploitation.

If I had had more time to research this project, some other ideas I would have explored include whether we should treat animals as donors, or just strictly as animals. Human donors are well cared for and animals are killed for their organs. Should we treat donor animals better because they are helping to save a human life?

Another question I would have explored is whether animals who die for organ transplants are any different than animals who are slaughtered for reasons that are deemed acceptable in society, for example, for food.

Another interesting issue I came across in my research involves genetically modified animals for donation. In this procedure, the cells of the recipient are injected into the animal, the organ, with the cells of the recipient, are then grown inside the animal, and the organ is harvested and transplanted into the recipient. This procedure, although slightly different, involves many interesting issues similar to the issues discussed above, including fairness and safety.

One final question I had about xenotransplantation while researching my topic was whether human exploitation of animals will, at some point in the future, just become the normal way of conducting our lives simply because we have the ability to do so, without the need to justify the exploitation as we do in xenotransplantation.

More research needs to be done before xenotransplantation is offered as a solid option for patients to pursue. Since this topic is such a new contribution to society, it needs to be tested more before doctors can truly believe in it, put their faith in it and put their patient’s lives in its hands. With more research, doctors may find a way to have less of the animal’s body wasted.

Xenotransplantation could save someone’s life, but the animals involved pay the price for saving the patient’s life. Animals are not only valued by many people, but are loved and cherished members of many families and it would be hard to imagine a world without them.

By Alexa Girasole

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One Response to Xenotransplantation: Is it Worth the Risk?

  1. Alexa Girasole says:

    Do you think xenotransplantation is a viable option for organ donation given all the possible complications?

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