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Preparing to Save Lives
Kristen Sievert
Academic affiliation: Oklahoma State University
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Xenotransplantation is the transplantation of cells, tissues, and organs from one species to another. Since there has always been a shortage of organs for human-to-human transplants, research on xenotransplantation began in the mid 1980s and has continued to gain momentum ever since. In the beginning of xenotransplantation research, primates were used. However, problems with genetics arose and focus turned to pigs. Xenotransplantation and xenografting is expected to help people who are undergoing organ failure and have already helped people with diabetes, Parkinson's disease, and Huntingdon's disease (Greenstein 16). To accelerate the process of organ transplantation, researchers are genetically modifying pig cells to resemble human cells so rejection will be less likely and easier to overcome. All of these procedures have brought about ethical concerns and debates. Some concerns involve personal preference, and other concerns have an impact on the research and projects as a whole. In addition, the viable arguments against xenotransplantation are not as strong as the arguments for xenotransplantation. However, none of the debates, as of now, have brought an acceptable argument to stop the continuation of xenotransplantation. Xenotransplantation is ethical, because the potential benefits outweigh the consequences.

There will always be people who need organs transplants. For as long as doctors have been performing transplant surgeries, there has been a shortage of organs for people with organ failure. Margaret Clark demonstrates the need for organs by explaining:

Despite the improvements in allograft transplants, human organ supplies are considerably below demand, and many patients die while awaiting a suitable organ. Estimates are that 45,000 Americans under 65 could benefit from a heart transplant, but only 2,000 get them annually. (137)

Due to the lack of organs for transplant, scientists began researching xenotransplantation in attempts to solve the organ shortage. Although human trials have not yet begun, xenotransplantation seems to be showing great promise for patients who desperately need organ transplants. The researchers began trials with primates as test subjects since they are so similar to humans.

Although primates were used in the beginning stages of xenotransplantation, pigs are a better candidate to use for xenotransplantation. To begin with, primates are very intelligent and need social interaction (Mani 57). Due to the lack of interaction in isolation, primates would suffer severe emotional damage and have little chance of survival (Mani 57). In addition, many primates are on the endangered species list and conservationalists believe primate use should not be allowed (Main 58). Primates also have genes very similar to humans. However, the few differences in the genes may greatly reduce the compatibility of animal organs with human bodies. Instead, pigs should be used, because they have a relatively short gestation period which would allow for quick genetic mutations. Furthermore, pigs grow quickly and to the correct size, conceive large litters, and can be raised in isolated conditions without many problems (Weiss 931). Since their organs are also similar in size to human organs, transplants from animal to humans would not be difficult, and work is being done to make pig genes compatible with human genes. All of the facts point to pigs as a good candidate to donate organs for xenotransplantation.

Although animal rights is an issue, the value of human life is more important. Animal rights activist "argue that it is morally wrong to produce animals for their organs and that genetically manipulating them for any reason could ultimately harm the animal" (Derenge 2). However, the sacrifice of these animals will in turn save the lives of many humans, which is infinitely more important. When xenotransplantation is perfected, the hundreds and thousands of people who die each year waiting for a transplant will have a chance to live due to the procedure. In addition, genetically mutating the animals is a stage in the process to perfect xenotransplantation. By mutating pig cells into cells that resemble human cells, researchers are decreasing the chance of tissue rejection and increasing the survival rate of the patients receiving transplants (Vanderpool 153). Also, activists argue that pigs are not able to make the decision to sacrifice their lives for humans so they should not be killed to donate their organs, but they do not make the decision to donate their lives to become bacon or ham either. There will always be a need for animals to give their lives for humans, but the animals will never have a voice in the decisions that humans make to sacrifice their lives. Even in the case that animals did have a voice, humans will always need animals, and the rate of sacrifice would change very little. Pigs are going to sacrifice their lives along the road to make xenotransplantation a common practice, but the benefits are so great that the sacrifice of the animals is justified.

Some people also believe religious issues should be taken into consideration when deciding to proceed with research on xenotransplantation. However, there are many different religions with very different ideals. For example, Jews and Muslims view pigs as unclean and believe they should not be used in transplants (Derenge 3). On the other hand, Christians believe humans have unique significance, because they were made in God's image (Mani 57). Therefore, they have no problem with xenotransplantation. Although people should stay true to their religious ideals, they should not force them upon people who do not have the same feelings and could potentially be saved by the procedure. Religious issues should be used when making the decision to receive a transplant and should be kept away from discussions deciding to proceed with research.

Another issue debated in xenotransplantation is the risk of new diseases being created and spread. Since xenotransplantation involves placing pig organs and tissues into human cells, there is risk of a pig virus or disease mutation with human genes to create a new virus or disease. Today, the disease that is of most concern is porcine endogenous retrovirus, which is present in pigs as part of their genome (Greenstein 24). Recently, researchers have found that porcine endogenous retrovirus can infect human cells when combined in vetro (Clark 139). Because concerns are so great, a moratorium has been discussed. Of course the worst case scenario would be the mutation of pig cells with human cells to result in the next epidemic similar to HIV. Unfortunately, the likelihood of spread is unknown and will remain that way until human transplants are tested (Welin 232). However, efforts are being made to overcome porcine endogenous retrovirus and the risk of transmition of any other pig virus. To overcome porcine endogenous retrovirus, researchers have done numerous studies, and one in particular is shown by Julia L. Greenstein and Henk-Jan Schuurman who explain:

A large retrospective study has been carried out approximately 160 patients that had previously been directly exposed to various living porcine tissue up to 12 years earlier, eg by tissue transplantation or by extracorporeal blood perfusion through porcine organs. Using the most sensitive molecular biology assays that are presently available, none of these patients showed any evidence of PERV infection. (24)

The results of this research show the minute chance of porcine endogenous retrovirus infecting human cells much less recombining with human DNA to create a new virus. With the efforts being made to protect the future xenotransplantation patients, a moratorium would only hinder the progress being made by researchers. In conclusion, precautions should be taken, but research should continue due to the benefits xenotransplantation can bring to patients. As far as keeping other diseases from infecting humans, precautions are also being taken. Although the risk of disease is not completely eliminated, pigs are born caesarean section so no germs will infect the pigs during birth (Mani 58). Immediately after birth, pigs are kept and handled only in sanitary conditions (Weiss 931). Finally, the "FDA decided in April 1999 that protocols involving non-human primate xenographs in humans should not be submitted until their risks are known, controlled, and publicly discussed" (Vanderpool 154). With the FDA watching closely, tests being run, and precautions being taken, xenotransplantation should proceed safely with success.

Overcoming organ rejection of specie to specie transplant has been a challenge for xenotransplantation researchers. One type of rejection is hyper-acute rejection which occurs "when the recipient's blood already contains antibodies to the foreign tissue" (Mani 56). Ultimately, the blood vessels in the transplanted organ are broken down (Mani 56). One of the major problems researchers have in proceeding forward with xenotransplantation is hyper-acute rejection along with acute vascular rejection which coagulates the blood of the patient that has circulated into the foreign organ, and cell mediated rejection, in which surface antigens on the cells of the new organs are perceived as foreign and attacked by cytotoxic T lymphocytes (Weiss 932). Since rejection cannot be controlled with immunosuppressive drugs, problems will continue to arise (Mani 56). Clark states that "Xenograft rejection is often quicker and more violent that allograft rejection. However, Harold Vanderpool opposes Clarks view and argues:

The medical risks that patients will eventually face will not exist in the forms detailed by Clark. [Hyper-acute rejection] and [acute vascular rejection] are now being investigated via xenotransplants between non-human - in particular, pig-to-non-human primate experiments. Based on these experiments, it appears that, after some thirty years trying, [hyper-acute rejection] is being overcome. (153)

One of the methods being used to overcome rejection is genetically mutating the cells in pig organs to resemble human organs. If the human cells cannot recognize the cells in the pig organs as foreign, organ rejection will be eliminated. The lengths to which researchers have gone to make xenotransplantation a reality, should justify the continuation of the procedure. Since the risk of rejections is soon to be overcome, the risks of xenotransplantation to the patients receiving organs will be greatly reduced, and people who would have died due to organ failure will have the chance to survive.

One major concern for patients receiving xenotransplants is the psychological welfare of the patients. Since patients are receiving organs from animals, they may feel depression. Sara Derenge and Marilyn Bartucci agree when they argue:

When receiving a human organ, it is common for patients to experience depression, anger, isolation, guilt, changes in body image, sexual dysfunction, and lowered self-esteem. It is only logical to assume that this same trauma could be evident in patients who receive animal organs. (2)

Many people with organ failure have been interviewed and 80% of them would consider xenotransplantation as an option to save their lives (Derenge 3). Xenotransplantation should not make patients feel they are inferior, because they are given animal organs. They should see the new organ they receive as a blessing. Many animals are sacrificing their lives for the benefit of humans. Recipients should not dishonor the animals by seeing themselves as inferior. Instead, honor the animals by being proud and thankful to be alive. However, patients are going to have psychological problems. Therefore, patients should be given psychological evaluations before and after receiving transplants as well as receiving counseling until a professional sees the patient fit to discontinue sessions. With proper precautions being taken, patients should be able to come through surgeries with sound mental health.

Some people feel that by transplanting animal organs into human bodies doctors are interfering with nature. They feel that if a person is not born with the organs they should not have the right to have them in their bodies. However, Jonathan Hughes claims: "On one account everything humans do is by definition unnatural, because it constitutes an interference with the non-human natural order. On another account nothing that humans do is unnatural, since humans are themselves a part of nature. If nothing we do is unnatural then nothing we do can be unnatural and therefore wrong" (19).

Humans are a part of nature, and nature is constantly progressing and evolving. Medical advances are a natural progression of humans. Therefore, xenotransplantation is a natural process in human ingenuity. Ultimately, putting an end to xenotransplantation research, because it is not natural seems to be a drastic approach. Instead, patients should use their belief to guide the way they choose to be involve in xenotransplantation. If people agree xenotransplantation is natural, they should support the procedure. On the other hand, people who see xenotransplantation as unnatural and wrong should use their opinions to make decisions according to their beliefs.

Another issue for transplant candidates is financial considerations. Receiving an organ through xenotransplantation may be considerably more expensive than receiving a human organ, and some believe organs will only be available for those who can afford them (Derenge 4). However, due to the advances that have been made and that are being made, xenotransplantation will soon become a mainstream procedure. If there are not other options available for the patients in organ failure, insurance companies will be forced to pay on the surgeries that need to be done. Not to mention, the beginning trials will most likely be funded by grants or other types of funds. Finally, as more information is gained on the procedure and transplants become less dangerous, and surgery costs could possibly decrease. In most cases, patients in critical condition will get transplants whether they have the financial means or not, because many hospitals will not allow people to die. The future costs of xenotransplantation are not certain. However, there seem to be many options that could allow people to receive the life saving transplants they need.

There are many debates concerning xenotransplantation. However, arguments can be made to overcome the concerns threatening to end xenotransplantation research. To begin with, there is a shortage of organs for human-to-human organ transplant. So, xenotransplantation was introduced. Also, primates should not be used due to the problems they encounter in isolation, but pigs should be used due to all of the positive aspects they could contribute as an organ donor. In addition, animal rights over human rights is an issue. However, proof is given to show that human life is significantly more important than the lives of animals. Religion is then considered, but is better left as a personal choice instead of a viable reason to stop xenotransplantation research. Next, the risk of new diseases or viruses is an important issue of debate, but researchers are working to overcome the chance of patients contracting a disease or virus. Another important issue is the psychological welfare of the people receiving the transplants. Finally, the issue that could hurt xenotransplantation the most could be the price allotted to transplants. However, many things could be done to help patients receiving transplants. Overall many positive steps are being taken to ensure the safety of the patients as well as the donor animals. Not to mention the potential benefit that will be received from the approval of the transplants. When xenotransplantation becomes an option for patients with organ failure, many lives will be saved and many families will be able to stay together as a result of the hard work and sacrifice being made to make xenotransplantation successful.

Works Cited

Clark, Margaret A. "This Little Piggy Went to Market: The Xenotransplantation and Xenozoonose Debate." The Journal of Law, Medicine, and Ethics 27.2 (1999): 137-52.

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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