Xenotransplantation is the transplantation of organs, tissues, and cells from one species to another. Since the mid 1980s, research on transplanting organs from animal to animal and animals to humans has been gaining momentum. In the beginning, research focused on primates. However, problems arose and pigs became the preferred species for xenotransplantation. Only in the past few years has research on animal to human transplants become more accepted due to the risks and ethical issues involved. The major issues include tissue rejection, the value of animals over humans, risk of creating and spreading new diseases, financial issues, psychological issues, and religious issues. All of the issues bring ethical debates among scholars, researchers, and activists. The purpose of this paper is to examine the major ethical issues of xenotransplantation being debated.

In the beginning of xenotransplantation, primates were used for research and transplants due to their genetic closeness to humans. However, primates have a very social nature and are very intelligent (Mani 57). Due to the lack of interaction primates would receive in isolation, Vasudevan Mani and Ryan Mathew feel the conditions would be too severe for the primates to survive and be mentally sound (57). Also, many primates are on the endangered species list, and "conservationalist concerns suggest that their use for xenotransplantation should be forbidden:" according to Mani and Mathew (58). Robin Weiss also feels there are too many ethical concerns when it comes to using primates for transplants and suggests pigs as a good candidate, because they grow quickly and to the correct size, conceive large litters, and can be raised in isolated conditions without many problems (931). As a result of these issues, pigs have become the most commonly used test subjects in xenotransplantation today.

Now that pigs are being used in a majority of xenotransplantation trials, work is being done by researchers to overcome or at least suppress immune rejection of the pig organs. Currently, researchers are focused on genetically mutating pigs to make their organs resemble human organs to minimize the risk of rejection. If the procedures become successful, there will be a large scale of breeding and killing of animals to provide organs for transplantations. Julia L. Greenstein and Henk-Jan Schuurman feel genetically modifying pigs into transgenic pigs is considered a major break through and brings high expectations for later development in xenotransplantation (19). Sara Derenge and Marilyn Rossman Bartucci agree that the transgenic pigs greatly reduce the chance of rejection (2). However, Harold Y. Vanderpool believe pig to human transplants will not be allowed to occur until the organ survival times in research trials has greatly improved due to the strong recommendations made by the FDA (154). On the other hand, Derenge and Bartucci claim animal rights activists disagree and have a problem with the transgenic changes in the pigs, because "it is morally wrong to produce animals for their organs and that genetically manipulating them for any reason could ultimately harm the animal" (2). Genetically modifying the animals will benefit xenotransplantation, but will ultimately harm the animal being used by either harvesting the organs from the animals or complications resulting from genetic modifications.

Inevitably, the value of human life over the life of an animal is going to come into question. Since the animals have not given their consent, people must decide whether the lives of animals should give way to the lives of humans. A few arguments for xenotransplantation include the fact that humans sacrifice animals for food and pig heart valves have already been successfully transplanted into humans. The writers for the book Engineering Genesis The Ethics of Genetic Engineering in Non-Human Species explain how a majority of arguments to proceed with the use of animal for xenotransplantation are not valid, because the heart valves are not living tissues, which means they are not able to induce rejection, and not everyone eats meat (136-37). In addition, they feel other alternatives should be examined (136-38). Jonathan Hughes has similar views and feels none of the arguments given are valid justifications to sacrifice animal lives for human benefit, and until there is a valid argument given, animals should not be sacrificed for xenotransplantation (23).On the other hand, Mani and Matthew disagree and strongly believe saving human lives justifies a minimal amount of suffering in animals, but feels boundaries should be set as to what a minimal amount of suffering is (56).

Another major issue of debate is the risk of the spread of a new disease. Since the genes of pigs are being put into human bodies through organ transplants, concern about genetic mutation involving animal diseases and human cells has arisen. The first steps that are being taken begin by isolating animal transplant candidates. First, the pigs are born through caesarian section so the fetuses do not have a chance to be contaminated during the natural birthing process. Then, the piglets are immediately isolated in sanitary conditions. From the birth until the organs are harvested for transplant, the pigs are kept and handled only in sanitary conditions. However, being sanitary does not stop the pigs from carrying genes susceptible to disease. Recently, researchers have discovered that porcine endogenous retrovirus can infect human cells when combined in vetro (Clark 139). Margaret Clark fears the porcine endogenous retrovirus may combine with retroviruses in humans to form the next AIDS epidemic (139). However, Vanderpool disagrees and states that the "FDA decided in April 1999 that protocols involving nonhuman primate xerographs in humans should not be submitted until their risks are known, controlled, and publicly discussed" (154). So, human trials will not proceed until the risks are known and the FDA decides whether or not it is safe to proceed. Derenge and Bartucci bring up another important concern. Allograph recipients are already at risk, because their suppressed immune system leaves them vulnerable to infection (3). With xerographs, the risk is enlarged by the transplantation of animal organs in to human bodies because of the viruses the animals already have (3).

Another issue suppressing the progress of xenotransplantation is financial considerations. The cost of a kidney transplant from one human to another is close to $116,100, which includes the surgery and retrieval of the organ, plus $15,900 per year in follow-up costs (Derenge 4). However, Derenge and Bartucci believe that the cost of the transplant from an animal to a human will be much more expensive, because the organs will be sold as a health care project (4). Also, they explain: "The buying and selling of organs that has been rejected in this country as being exploitive, and there is inherent danger that the market could be manipulated so that only those with appropriate financial resources could receive transplants" (4). Although xenotransplantation would make organs accessible for everyone, not everyone will be able to afford them due to their extremely high cost. Since xenotransplantation is being researched to make organs more accessible to those with organ failure, the organs should be able to be accessed by those patients. If the cost is high, the people who need the transplants the most may not be able to receive them.

When humans receive organ transplants from another human, they may become subject to psychological problems. Derenge and Bartucci claim that patients who receive transplants commonly experience "depression, anger, isolation, guilt, changes in body image, sexual dysfunction, and low self esteem" (2). It is only natural that in many cases problems will escalate when transplanting animal organs into humans. In addition, Derenge and Bartucci think "some patients may see their body as being invalid by these animal parts and thus consider themselves inferior," because now they are part animal (2). Clark agrees and states that even though the patients feel stress from "acute illnesses, radical treatments, and social issues, transplantation may tap deep emotions that no one really understands" (140). However, some patients may see the animal organ transplants they received as a blessing and a second chance at life. In addition, Stellan Welin believes psychological reactions also depend on the quality of care given to the patients before they receive the transplant (234). With xenotransplantation, patients may need to be given a psychological evaluation before and after transplants to be sure the patients can handle animal organs being placed in his or her body. In order to get a better understanding on how human to human transplant recipients feel about xenotransplantation as a viable option to save their lives, researchers surveyed 100 transplant recipients. 80% believed xenotransplantation would be an option. 10% said they would not agree to xenotransplantation under any circumstances (Derenge 3). Since a large amount of transplant recipients would choose xenotransplantation as a means for survival, they should be given the chance to receive the animal organs once the preclinical trials become successful and accepted.

Religious issues are another powerful topic debated when it comes to xenotransplantation. Derenge and Bartucci point out the fact that Jews and Muslims may have problems accepting any tissue from a pig, because they view the pig as an unclean animal (3). However, Mani and Mathew state that Christians believe humans were made in the image of God and therefore have a unique significance (57). So, "animals would not have the same moral status as humans, and animal interests would weigh less heavily than human interests" (Mani 57). Depending on what religious beliefs each individual has, xenotransplantation could be acceptable or morally wrong. Although some religious beliefs prohibit the use of pig organs, the patient needs to make the ultimate decision as to whether his or her life is worth risking because of those beliefs. Some may feel it is worth the betrayal and some may feel it is not worth sacrificing his or her beliefs.

Although there are many ethical issues and opinions concerning xenotransplantation, the decision to receive a transplant is ultimately up to the recipient. Many factors need to be taken into consideration when deciding to receive an animal organ transplant. The purpose of the article was to review the major issues and concerns about xenotransplantation. First, the patient must decide whether he or she feels the transplant is morally acceptable by consulting religious beliefs and his or her belief about animal rights. Then, the patient must review the risk of organ rejection and viral mutation, and decide if the transplant is worth the numerous follow-ups for the rest of his or her life. Finally, the patient has to be financially secure enough to pay for the transplant. Once the patient makes the decision to receive a transplant, he or she will be subject to several rules they must follow in everyday life and lifelong doctor visits. Xenotransplantation can be a good way to give organ transplants to everyone who needs them, but researchers have a long way to go before the patients can receive an animal organ safely.

Bruce, Donald and Ann Bruce, ed. Engineering Genesis the Ethics of Genetic Engineering in Non-Human Species. London: Earthscan Publications, 1998.

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Derenge, Sara and Marilyn Rossman Bartucci. "Issues Surrounding Xenotransplantation." Association of Operating Nurses Journal 70.3 (1999): Proquest Direct. Oklahoma State University Library. Article 44626921. 23 Sept. 2003 http://80-proquest.umi.com.argo.library.okstate.edu/.

Greenstein, Julia L. and Henk-Jan Schuurman. "Solid Organ Xenotransplantation: Progress, Promise and Regulatory Issues." Journal of Commercial Biotechnology 8.1 (2001): 15-29.

Hughes, Jonathan. "Xenografting: Ethical Issues." Journal of Medical Ethics 24.1 (1998): 18-24.

Mani, Vasudevan and Ryan Mathew. "Xenotransplantation: Animal Rights and Human Wrongs." Ethics and Medicine 19.1 (2003): 55-62.

Vanderpool, Harold Y. "Commentary: A Critique of Clark's Frightening Xenotransplantation Scenario." The Journal of Law, Medicine, and Ethics 27.2 (1999): 153-57.

Weiss, Robin A. "Science, Medicine, and the Future: Xenotransplantation." British Medical Journal 317.7163 (1998): 931-934.

Welin, Stellan. "Starting Clinical Trials of Xenotransplantation-Reflections on the Ethics of the Early Phase." Journal of Medical Ethics 26.4 (2000): 231-36.

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