Ethical Issues Involved in Solid Organ Xenotransplantation

Xenotransplantation (specifically, genetically modified pig-to-human transplant of organs, tissues, or cells) clinical trials are set to begin in the United States after decades of pre-clinical studies and recent decedent and compassionate use investigations. This article provides a primer on the key ethical issues attendant with this emerging therapy. We explore four central areas of concern: (i) the use of animals to meet human transplant needs, as well as their welfare since they are housed in non-natural conditions, (ii) the risk of infectious disease transfer from the porcine graft to the human recipient, known as xenozoonosis, (iii) patient selection criteria for initial clinical trials when an unknown risk/benefit ratio exists, and (iv) the necessity of public engagement in order to increase acceptance and trust of this novel potential therapy. The article argues that the long-term success and social acceptance of xenotransplantation are contingent not only on overcoming immunological hurdles but also on thoughtfully considering the ethical issues.