May 26, 2024

Hope, hype and xenotransplantation

On January 7, 2022 David Bennett, a 57-year-old with terminal heart disease, made history as the first person to receive a genetically modified pig’s heart. He lived on for another two months, dying on March 8. The feat was hailed as a great achievement in the media. However, in The Hastings Center forum, bioethicist Franklin G. Miller expresses exasperation with the hype. He complains that not enough attention was paid to the ethical issues surrounding the xenotransplant.

As is typical of news stories concerning xenotransplantation, this article draws attention to the more than 100,000 Americans on the transplant waiting list, most of whom are seeking a new kidney. However, only 25,000 kidneys are transplanted in the United States each year. No effort is made to place this set of facts about organ donation and transplantation into a population health perspective. Of course, it is lamentable that approximately 6,200 Americans die each year while awaiting an organ transplant. But this represents only 0.2% of the approximately 3.2 million Americans who died in 2022.

Moreover, no mention is made of the prospect of preventing end-stage chronic disease, which in the case of kidney disease gives rise to the need for expensive and burdensome dialysis and organ transplants. Preventive efforts include enhanced educational and policy interventions to promote healthy diets and lifestyles and greater uptake of drug treatments to control hypertension and diabetes. Although lacking in scientific prestige, the fascination with technological innovation, and the prospect of substantial profit, promoting prevention holds promise for reducing the incidence, or ameliorating the progression, of chronic diseases.

The New York Times article reports that the Food and Drug Administration gave “compassionate use” emergency approval for this xenotransplantation intervention. But there is no mention of the compassionate alternative of palliative care and whether this was explored with the patient and his family.

Also noteworthy is the absence of any mention in the article of the ethical issues associated with the exploitation of pigs, who are intelligent animals, for the sake of this cutting- edge research and innovative treatment. Prior and ongoing pre-clinical xenotransplantation research has also involved transplanting pig hearts into baboons. And the FDA has stipulated that investigators must keep a large number of primates alive for at least six months after transplanting pig organs as a prerequisite to permitting clinical trials in humans .