The 2026 International Society for Heart and Lung Transplantation Consensus Statement on Clinical Cardiac Xenotransplantation

In the year 2000, the International Society of Heart and Lung Transplantation (ISHLT) issued a report from the xenotransplant advisory committee on the role of xenotransplantation in the treatment of end-stage cardiac and pulmonary diseases.1 The consensus report acknowledged the urgent need for more thoracic organs and highlighted xenotransplantation as one potential solution. Significant hurdles were identified including challenging immunologic barriers, uncertainty regarding whether anti-HLA antibodies might cross-react with pig antigens, and risks of transmissible infections. After taking stock of the field of xenotransplantation and of preclinical and clinical thoracic organ transplant results to date, the committee highlighted the necessity for further research before initiation of clinical trials could be considered, including specific benchmarks for preclinical heart and lung xenotransplant models. Additionally, the document addressed ethical considerations surrounding the choice of source animal and the potential for porcine organs to provide life-sustaining function in the human recipient.<br/><br/><br/>After two decades, considerable strides have been made in the realm of xenotransplantation generally and of thoracic xenotransplantation more specifically, including the performance of two clinical heart xenotransplant cases. Yet, the landscape remains fraught with challenges reminiscent of those identified in the ISHLT's initial report. In this consensus blueprint for the future, we collectively redefine some previously articulated challenges, review the state of the field, and outline recommendations for moving the field forward.