There are not enough human donors to meet the urgent need for replacement organs. Pigs could solve this problem, in view of organ transplants from animals to humans. But does the end justify the means?
by Titus Rivas
Recently, all adult Dutch citizens could indicate whether (and how) they wish to donate organs for transplantation after their death. The government tried to persuade as many people as possible to postumously make parts of their bodies available to other patients. Since my uncle suffered from a kidney disease and benefited from such a transplant for years, I know this is a good thing. It has been argued that such a transplant would go against the patient's bodily integrity, but then so would death! It would be quite different if one were going to use organs from deceased people who objected to this during their lives. For example, some people believe that the body must be preserved intact for the Day of Judgement. Because it is a fundamental right to decide what should be done with one's own body, transplanting such a person's organs would be incompatible with human dignity. Whereas a person's choice whether or not to donate organs should obviously be respected, when it comes to animals self-determination and freedom do not seem to matter at all. This is invariably the case with so-called "xenotransplantation". (“Xenos” is Greek for stranger, and in this context it refers to the fact that the transplanted organs derive from a “strange” species, namely non-human animals.)
This xenotransplantation does not (just) concern weird perversions of researchers of the category of Frankenstein or Mengele, for there is indeed a reason why people are searching for more bodies for donation. The waiting list for human organ donations has grown longer and longer in recent years due to aging and extended life expectancy in the Western world. It also seems that the wait will only increase.
Xenotransplantation is less new than you might think. For many years now, they have been using heart valves from pigs in cardiac surgery. But the current xenotransplantation attempts aim at the transplantation of complete animal organs.
In Britain it is mainly the biotechnology company Imutran (now part of Novartis pharmaceutical corporation) that has done experiments with xenotransplantation. They use genetically modified . Thus, a human protein is formed around the pig heart cells in order to mislead the immune responses of the human body. In America they have done similar experiments with monkeys, but Imutran focuses on pigs because they reproduce rapidly and thus produce relatively more organs. In December 1992, the first transgenic (i.e. genetically engineered), pig intended for xenotransplantation, named Astrid, was born at Imutran. In 1994, the company already succeeded in keeping the heart of a transgenic pig beating for four hours while human blood was flowing through it. In September 1995, Imutran succeeded in keeping hearts from transgenic pigs beating for more than 60 days after transplantation in two of the ten monkeys used for this purpose. Similar experiments were performed with pig kidneys. Such projects with xenotransplantation in pigs but also mice and monkeys also took place at several U.S. companies.
As it became increasingly clear that it is very possible that in future humans will be walking around with pig hearts, people started asking questions. Meanwhile in England they adopted a moratorium to take a close look at the biotechnological medical issues, and also at the ethical concerns related to xenotransplantation. It seems that the English Imutran is primarily interested in profit, and raises false expectations in the general public. Let's see what kind of objections to this new form of 'donation' we're talking about here.
As we saw in the case of transgenic animals, the organs of pigs naturally are never completely identical to that of humans. This can lead to the rapid rejection of foreign organ by the human immune system. One can try to correct problems by genetic engineering, as I said before, but the limited success of the experiments so far indicates that this is not very easily. In addition, xenotransplantation also implies a high risk of contamination by germs and even whole epidemics. Hence, the animals used for transplantation are kept under as hygienic or sterile conditions as possible. Once again, this is no easy task. Yet it is conceivable that medical science will be able to reduce these problems to an acceptable level. The medical objections to xenotransplantation are therefore important, but ultimately they may prove surmountable.
The ethical objections to xenotransplantation are of a very different order. Now, these objections are mostly relevant for vegans and vegetarians. From a moral point of view, there is no essential difference between killing animals to feed people and "sacrificing" animals for organs. It is true the two situation are not completely the same, as more and more people do not primarily approach meat as an essential nutritional source but as an enjoyable treat. The prevailing view however still is that people are worth the sacrifice of other mammals. In other words, there is speciesism between between different mammalian species. There is still one additional objection that concerns animal welfare. If it is difficult enough, to provide farm animals the kind of housing that is compatible with their ethological needs, animals reared for xenotransplantation should necessarily be kept separate in a sterile environment because of the mentioned risk of infection. Also, it is possible that individual tissues and organs will be removed from them on separate occasions before they die and that they have to be subjected to unpleasant medical examinations. For this reason, advocates of xenotransplantation usually make a distinction between primates and other mammals because they recognize that the life of an animal 'donor' would not exactly be very pleasant. Profit-hungry companies like Imutran clearly do not benefit from the interests of animals and they perform a cost-benefit analysis in which their own interest comes first, namely the selling of organs.
How do we solve the shortage of organs for transplant, if we certainly do not want to make use of xenotransplantation? Various approaches are possible, some of which might seems just as 'exotic' as transplanting animal organs into humans.
The first approach one can take is reducing the demand. People can learn to be more responsible about their own health. This has recently been argued by Joke Andringa in Gezond Idee! (Nr. 40) in her article on heart disease. Obviously, for those who are already suffering from a disease - that may sometimes be beyond their control, and based on hereditary factors - prevention is not a solution anymore. For them, it is important that as many potential human donors make a choice for or against post mortem donation of their own organs, which in the Netherlands is actually happening right now. In addition, in some cases, living persons may sometimes donate an expendible organ while they are still alive. Of course it is essential that poor people are not tempted to donate their organs by being offered what they experience as huge amounts of money. Unfortunately, there are very real risks in this area. A further approach is, just like xenotransplantation itself, closely intertwined with technological progress, as it concerns the development of artificial organs, such as artificial hearts. However unnatural some might find the use of such organs, ethically speaking, a 'bionic' man is always preferable to animal suffering. At present, artificial hearts have certainly been more successful in terms of gain in life expectancy than the hearts used in xenotransplantation experiments.
A next step after the development of artificial organs is the creation of entire human organs. They have already started cloning human tissue.
Furthermore, there is also the little known and controversial approach of psychic healing. The kind of healing that is attributed to Lourdes, shamanic healing and Surinamese winti. Obviously, the success of this approach is difficult to assess because these alternatives have barely been studied.
Finally, if nothing else works, one naturally still has the choice to accept one's destiny. A peculiar problem of Western medicine is that professionals usually assume that personal life ends with physical death. By this assumption, it seems somewhat more understandable that they do anything they can to prolong a patient's life, even if this means sacrificing innocent, sensitive animals like pigs. Here, a more 'spiritual' and less materialistic worldview would certainly bring relief.
Translation of Dutch paper published in Gezond Idee! in the 1990s.