Addressing Concerns toward Xenotransplantation
To the editor:
Social and ethical implications of xenotransplantation are receiving
increasing attention as clinical trials are projected to take place
soon. Unfortunately, the recent commentary by Loebe and Parker11Loebe
M, Parker B. Don’t pig(!) the wrong heart! [published online ahead
of print, 2021 Jul 26]. J Card Surg . 2021;10.1111/jocs.15842.
addresses the ethical issues superficially. We agree that great need
exists to find long-term relief to end-stage organ dysfunction, but our
viewpoints differ in some key areas.
The arguments for mechanical circulatory devices they make are not
applicable to infants with life-threatening congenital heart disease, in
whom the outcomes of device support are
disappointing.1 There is also disregard for the
scientific evidence that indicates that, because of their immature
immune system, infants pose a unique biological opportunity over adults
with heart failure.2
The authors reference several of our studies that raise the very
concerns they note but disregard the conclusions reached. Our
interdisciplinary group has conducted multiple research surveys and
focus groups to elicit the public’s perception of pediatric cardiac and
adult kidney xenotransplantation.3-5 We have consulted
numerous stakeholders, including religious leaders, organ procurement
staff/administrators, healthcare providers who care for possible future
candidates, patients themselves, parents of children who may need an
organ or are transplant recipients, and local
businesspersons.3-5 In summary, these studies found
little or no religious, ethical, or social concerns among these
stakeholders, with considerable support for xenotransplantation given
results are comparable to allotransplantation (which, of course, is not
yet known). There was also support for its use to bridge patients until
a deceased human donor organ could be obtained, which is our suggested
therapy for infants. This would not commit the child to a lifetime of
support by a pig heart.
Although, as the authors state, the results of pig heart transplantation
in nonhuman primates do not yet support a clinical trial, progress is
certainly being made. The fact that it has taken decades to explore this
alternative can be evidence of the tactful and serious standards the
scientific community is taking before its consideration. We agree more
work remains especially in the pediatric field and suggest openness to
the potential of xenotransplantation remains warranted.