The Asian perspective on xenotransplantation: bridging the organ gap through regional collaboration and tailored clinical protocols

Xenotransplantation using genetically engineered porcine organs has emerged as a transformative strategy to address the critical organ shortage crisis in Asia, where low deceased donation rates and high disease burden create a persistent supply-demand gap. This review examines the Asian perspective on xenotransplantation across five domains: sociocultural acceptance, technical advances in multigene-edited pig platforms, clinical protocol optimization for Asian recipients, regulatory harmonization through the Asian Xenotransplantation Association, and infrastructure development including hybrid clinical centers and capacity-building initiatives. Asian countries, particularly China, South Korea, and Japan, have demonstrated substantial progress in gene editing, designated pathogen-free breeding, and translational research. However, clinical success requires region-specific immunosuppressive protocols, pharmacogenomic adaptation, endemic infectious disease surveillance, and culturally sensitive public engagement. Regional collaboration through harmonized regulatory frameworks, multinational trial networks, and equitable access models will be essential to ensure that xenotransplantation benefits all Asian populations. This review proposes a distinct "Asian way" that integrates scientific excellence with cultural diversity and regional solidarity to shape the future of transplantation medicine.