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George AJ. Ethics, virtues and xenotransplantation. Perfusion 2024; 39:334-343. [PMID: 36382884 PMCID: PMC10900854 DOI: 10.1177/02676591221140767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Early in 2022 the first pig to human cardiac xenotransplant was performed. The graft initially performed well, and rejection was well controlled. However, the graft failed, and the patient died 60 days after the procedure. The ethical issues relating to xenotransplantation include the risk/benefit to the individual, the risk of porcine-derived infectious agents crossing into humans, animal welfare and rights, issues of human and animal identity and concerns relating to fair allocation of organs and appropriate use of resources.These ethical issues are often addressed using emotional arguments, or through consequentialist or deontological lens. An alternative is to use approaches based on virtue ethics to understand the moral purpose (telos) of the research and the virtues (character traits) needed to be a good research clinician. In this review we will consider the virtues of justice, courage, temperance and practical wisdom, as well as the role of clinical curiosity, and their application to xenotransplantation. This provides an alternative approach for the clinical academic and others involved in the research to reflect on their practice.
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Affiliation(s)
- Andrew Jt George
- Department of Surgery and Cancer, Imperial College London, London, UK
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2
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Martínez-Alarcón L, Flores-Medina J, Ramis G, Gómez-Laguna J, Moll X, Falceto V, San Román-Ascaso F, San Román-Llorens F, Quereda JJ, Herrero JM, Mendonça L, Martin-Barrasa JL, Fernández OM, Muñoz A, Ramírez P, Gutiérrez P, López-Chicheri I, López-Navas A, Ríos A. Organ xenotransplantation acceptance in veterinary students: A multicentric opinion study in Spain. Xenotransplantation 2023; 30:e12823. [PMID: 37695105 DOI: 10.1111/xen.12823] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/27/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The shortage of available transplant organs has made it necessary to search for alternatives, one of which is xenotransplantation. However, the use of animal organs could face rejection from society and the personnel involved in its implementation. OBJECTIVES (a) to analyze the attitudes of Veterinary Degree students in six Spanish Universities towards xenotransplantation; and (b) to determine the factors that affect its acceptance. METHODS Of the 2815 students surveyed in the degree program, 2683 valid surveys were obtained. Attitudes towards organ xenotransplantation were evaluated using a validated questionnaire of organ donation. RESULTS If xenotransplantation was confirmed as a clinical reality, 93% (n = 2493) of those surveyed would accept a xenotransplanted organ, whilst 7% would not. If the results of xenotransplantation were worse than those obtained with human donors and it entailed more risk, 12% (n = 318) would be in favor. 56% (n = 1497) of the students would accept a xenotransplantation provisionally pending the arrival of a human organ. Attitudes towards xenotransplantation were affected by the academic year in which a student was studying, with more favorable attitudes among students in the last year (88% in first year vs. 95% in fifth year; p < .001). More favorable attitudes are also observed depending on the attitude they have towards organ transplantation, with those students being more in favor of donating their organs when they die (94% vs. 88%; p < .001). CONCLUSION Veterinary students would have a very favorable attitude toward xenotransplantation if these animal organs functioned as well as human organs. Therefore, these students could play an important role in the future promotion of this technique.
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Affiliation(s)
- Laura Martínez-Alarcón
- International Collaborative Donor Project, Murcia, Spain
- Surgery Service, Transplant Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Juan Flores-Medina
- Department of Psychology, Faculty of Medicine, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Guillermo Ramis
- International Collaborative Donor Project, Murcia, Spain
- Surgery Service, Transplant Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology, University of Murcia, Murcia, Spain
- Department of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
| | - Jaime Gómez-Laguna
- Department of Anatomy and Comparative Pathology and Toxicology, University of Córdoba, Córdoba, Spain
| | - Xavier Moll
- Faculty of Veterinary Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Victoria Falceto
- Department of Animal Pathology, Faculty of Veterinary Medicine, University of Zaragoza, Zaragoza, Spain
| | - Fidel San Román-Ascaso
- Department of Animal Medicine and Surgery, Faculty of Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Fidel San Román-Llorens
- Department of Animal Pathology, Faculty of Veterinary, University of Zaragoza, Zaragoza, Spain
| | - Juan José Quereda
- Department of Animal Production and Health, Veterinary Public Health and Food Science and Technology, Faculty of Veterinary, University Cardenal Herrera-CEU, Valencia, Spain
| | - Juan Manuel Herrero
- Department of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
| | - Livia Mendonça
- Faculty of Veterinary, Universidade Federal de Goiás, Goiania, Brazil
| | - José Luis Martin-Barrasa
- Experimental Animal Facility, Research Unit, Hospital Universitario de Gran Canaria, Dr. Negrín, Las Palmas de Gran Canaria, Arucas, Spain
- Animal Infectious Diseases and Ictiopatology, University Institute of Animal Health (IUSA), University of Las Palmas de Gran Canaria, Arucas, Spain
| | - Olga María Fernández
- Animalario libre de Patógenos Arrixaca-Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Antonio Muñoz
- Department of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
| | - Pablo Ramírez
- International Collaborative Donor Project, Murcia, Spain
- Surgery Service, Transplant Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology, University of Murcia, Murcia, Spain
- Department of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
| | - Pedro Gutiérrez
- Urology Service, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
- Departmen of Surgery, University of La Laguna, San Cristóbal de la Laguna, Tenerife, Spain
| | - Isabel López-Chicheri
- Department of Psychology, Faculty of Medicine, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Ana López-Navas
- International Collaborative Donor Project, Murcia, Spain
- Department of Psychology, Faculty of Medicine, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Antonio Ríos
- International Collaborative Donor Project, Murcia, Spain
- Surgery Service, Transplant Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology, University of Murcia, Murcia, Spain
- Department of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
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3
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Bayliss G. Practical ethical concerns in allocation of pig kidneys to humans. Clin Kidney J 2022; 15:2161-2168. [PMID: 36381360 PMCID: PMC9664566 DOI: 10.1093/ckj/sfac125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Indexed: 01/04/2024] Open
Abstract
The fundamental ethical question of whether pig organs should be transplanted into humans has been settled, as recent surgeries demonstrating proof of concept demonstrate. Other issues need to be considered and reconciled before xenotransplantation of pig kidneys becomes a solution to the organ shortage for people waiting for a kidney transplant or as a viable alternative to the deceased donor or living donor human kidneys. Human trials will be needed beyond brain-dead individuals to show that xenotransplantation is safe from immunologic and infectious standpoints. Transplant centers will need to show that xenotransplantation provides a long-term benefit to recipients and is financially viable. If trials are successful and receive regulatory approval, pig xenotransplants may become another option for people waiting for a kidney. Before patients are discharged with a functioning xenograft, practical issues with ethical implications remain.
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Affiliation(s)
- George Bayliss
- Alpert Medical School, Brown University, Providence, RI, USA
- Rhode Island Hospital Division Organ Transplantation, Providence, RI, USA
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4
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Xenotransplantation and Risks: The Opinion of Veterinary Students at Spanish Universities. Transplant Proc 2022; 54:2411-2413. [DOI: 10.1016/j.transproceed.2022.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/01/2022] [Indexed: 11/13/2022]
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5
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Reyneke M, Kerckhof N, Dherwani R, Borry P. Should you need an organ… Flemish secondary school students' attitudes toward xenotransplantation and transgenetic organ donation. Xenotransplantation 2021; 28:e12707. [PMID: 34850461 DOI: 10.1111/xen.12707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/07/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The supply of human organs available for transplantation remains grossly inadequate globally. Animal-to-human transplantation, and even more so humanized organ grown in animals, holds promising results for the start of clinical trials in humans. Very little is known about the public's willingness to accept different xenotransplantation techniques. This study aims to determine attitudes toward human-to-human transplantation, animal-to-human transplantation, and chimera-to-human transplantation in the Belgium context. METHODS Secondary school students from Flanders, Belgium, were surveyed between January and June 2019. Socio-demographic details likely to influence participants' attitudes were gathered. Participants were presented with three hypothetical cases (human-to-human transplantation, animal-to-human transplantation, and chimera-to-human transplantation) and asked about their willingness to accept the particular organ. Their risk appetite to accept organs with potentially worse outcomes than the status quo was also evaluated. RESULTS Seven hundred forty-one complete questionnaires were analyzed. It can be concluded that Flemish secondary school students favored the techniques of xenotransplantation to a lesser extent than allotransplantation; however, most of them did consider it a good solution for organ shortage. Compared to animal-to-human transplantation, chimera-to-human transplantation showed a more positive attitude among the respondents when considered a good organ transplantation solution. CONCLUSION Flemish secondary school students favored the techniques of xenotransplantation to a lesser extent than allotransplantation; however, most of them did consider it a good solution for organ shortage. In comparison to animal-to-human transplantation, chimera-to-human transplantation showed a more positive attitude among the respondents when considered a good solution for organ transplantation.
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Affiliation(s)
- Maryn Reyneke
- Department of Public Health and Primary Care, KU Leuven, Centre for Biomedical Ethics and Law, Leuven, Belgium
| | - Nel Kerckhof
- Department of Public Health and Primary Care, KU Leuven, Centre for Biomedical Ethics and Law, Leuven, Belgium
| | - Rachna Dherwani
- Department of Biology, Rutgers University, Camden, New Jersey, USA
| | - Pascal Borry
- Department of Public Health and Primary Care, KU Leuven, Centre for Biomedical Ethics and Law, Leuven, Belgium
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6
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Cozzi E, Schneeberger S, Bellini MI, Berglund E, Böhmig G, Fowler K, Hoogduijn M, Jochmans I, Marckmann G, Marson L, Neuberger J, Oberbauer R, Pierson RN, Reichart B, Scobie L, White C, Naesens M. Organ transplants of the future: planning for innovations including xenotransplantation. Transpl Int 2021; 34:2006-2018. [PMID: 34459040 DOI: 10.1111/tri.14031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/10/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022]
Abstract
The future clinical application of animal-to-human transplantation (xenotransplantation) is of importance to society as a whole. Favourable preclinical data relevant to cell, tissue and solid organ xenotransplants have been obtained from many animal models utilizing genetic engineering and protocols of pathogen-free husbandry. Findings have reached a tipping point, and xenotransplantation of solid organs is approaching clinical evaluation, the process of which now requires close deliberation. Such discussions include considering when there is sufficient evidence from preclinical animal studies to start first-in-human xenotransplantation trials. The present article is based on evidence and opinions formulated by members of the European Society for Organ Transplantation who are involved in the Transplantation Learning Journey project. The article includes a brief overview of preclinical concepts and biology of solid organ xenotransplantation, discusses the selection of candidates for first-in-human studies and considers requirements for study design and conduct. In addition, the paper emphasizes the need for a regulatory framework for xenotransplantation of solid organs and the essential requirement for input from public and patient stakeholders.
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Affiliation(s)
- Emanuele Cozzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Transplant Immunology Unit, Padua University Hospital, Padua, Italy
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Maria Irene Bellini
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
- Department of Emergency Medicine and Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Erik Berglund
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Transplantation Surgery, Karolinska Institute and ITB-MED, Stockholm, Sweden
| | - Georg Böhmig
- Division of Nephrology and Dialysis, Medical University Vienna, Vienna, Austria
| | - Kevin Fowler
- The Voice of the Patient, Inc., Chicago, IL, USA
| | - Martin Hoogduijn
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ina Jochmans
- Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Georg Marckmann
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lorna Marson
- The Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Richard N Pierson
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Bruno Reichart
- Walter Brendel Center for Experimental Medicine, LMU Munich, Munich, Germany
| | - Linda Scobie
- Department of Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Maarten Naesens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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7
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Loebe M, Parker B. Don't pig(!) the wrong heart! J Card Surg 2021; 36:3802-3804. [PMID: 34309898 DOI: 10.1111/jocs.15842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
Cardiac xenotransplantation is believed to have approached clinical application. However, this approach to advanced heart failure is burdened with a multitude of ethical issues. These issues need to be addressed openly and be broadly discussed in public. Only through an honest and transparent approach, it will be possible to engage the lay audience in the evaluation of pig to human transplant.
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Affiliation(s)
- Matthias Loebe
- Department of Surgery, University of Miami, Miami, Florida, USA
| | - Brandon Parker
- Department of Surgery, University of Miami, Miami, Florida, USA
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8
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Meier RPH, Longchamp A, Mohiuddin M, Manuel O, Vrakas G, Maluf DG, Buhler LH, Muller YD, Pascual M. Recent progress and remaining hurdles toward clinical xenotransplantation. Xenotransplantation 2021; 28:e12681. [PMID: 33759229 DOI: 10.1111/xen.12681] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/12/2021] [Accepted: 02/21/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Xenotransplantation has made tremendous progress over the last decade. METHODS We discuss kidney and heart xenotransplantation, which are nearing initial clinical trials. RESULTS Life sustaining genetically modified kidney xenografts can now last for approximately 500 days and orthotopic heart xenografts for 200 days in non-human primates. Anti-swine specific antibody screening, preemptive desensitization protocols, complement inhibition and targeted immunosuppression are currently being adapted to xenotransplantation with the hope to achieve better control of antibody-mediated rejection (AMR) and improve xenograft longevity. These newest advances could probably facilitate future clinical trials, a significant step for the medical community, given that dialysis remains difficult for many patients and can have prohibitive costs. Performing a successful pig-to-human clinical kidney xenograft, that could last for more than a year after transplant, seems feasible but it still has significant potential hurdles to overcome. The risk/benefit balance is progressively reaching an acceptable equilibrium for future human recipients, e.g. those with a life expectancy inferior to two years. The ultimate question at this stage would be to determine if a "proof of concept" in humans is desirable, or whether further experimental/pre-clinical advances are still needed to demonstrate longer xenograft survival in non-human primates. CONCLUSION In this review, we discuss the most recent advances in kidney and heart xenotransplantation, with a focus on the prevention and treatment of AMR and on the recipient's selection, two aspects that will likely be the major points of discussion in the first pig organ xenotransplantation clinical trials.
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Affiliation(s)
- Raphael P H Meier
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alban Longchamp
- Department of Vascular Surgery, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Muhammad Mohiuddin
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Oriol Manuel
- Transplantation Center, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Georgios Vrakas
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel G Maluf
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Leo H Buhler
- Faculty of Science and Medicine, Section of Medicine, University of Fribourg, Fribourg, Switzerland
| | - Yannick D Muller
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Manuel Pascual
- Transplantation Center, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
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9
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Rao JS, Burlak C. Xenotransplantation literature update for September - October 2020. Xenotransplantation 2020; 28:e12665. [PMID: 33314409 DOI: 10.1111/xen.12665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/20/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Joseph Sushil Rao
- Department of Surgery, Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, USA.,Solid Organ Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Christopher Burlak
- Department of Surgery, Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, USA
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10
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Cooper DKC, Hara H, Iwase H, Yamamoto T, Wang ZY, Jagdale A, Bikhet MH, Nguyen HQ, Foote JB, Paris WD, Ayares D, Kumar V, Anderson DJ, Locke JE, Eckhoff DE. Pig kidney xenotransplantation: Progress toward clinical trials. Clin Transplant 2020; 35:e14139. [PMID: 33131148 DOI: 10.1111/ctr.14139] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/09/2020] [Accepted: 10/24/2020] [Indexed: 12/16/2022]
Abstract
Pig organ xenotransplantation offers a solution to the shortage of deceased human organs for transplantation. The pathobiological response to a pig xenograft is complex, involving antibody, complement, coagulation, inflammatory, and cellular responses. To overcome these barriers, genetic manipulation of the organ-source pigs has largely been directed to two major aims-(a) deletion of expression of the known carbohydrate xenoantigens against which humans have natural (preformed) antibodies, and (b) transgenic expression of human protective proteins, for example, complement- and coagulation-regulatory proteins. Conventional (FDA-approved) immunosuppressive therapy is unsuccessful in preventing an adaptive immune response to pig cells, but blockade of the CD40:CD154 costimulation pathway is successful. Survival of genetically engineered pig kidneys in immunosuppressed nonhuman primates can now be measured in months. Non-immunological aspects, for example, pig renal function, a hypovolemia syndrome, and rapid growth of the pig kidney after transplantation, are briefly discussed. We suggest that patients on the wait-list for a deceased human kidney graft who are unlikely to receive one due to long waiting times are those for whom kidney xenotransplantation might first be considered. The potential risk of infection, public attitudes to xenotransplantation, and ethical, regulatory, and financial aspects are briefly addressed.
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Affiliation(s)
- David K C Cooper
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hidetaka Hara
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hayato Iwase
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Takayuki Yamamoto
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zheng-Yu Wang
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Abhijit Jagdale
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mohamed H Bikhet
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Huy Q Nguyen
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeremy B Foote
- Department of Microbiology and Animal Resources Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wayne D Paris
- Department of Social Work, Abilene Christian University, Abilene, TX, USA
| | | | - Vineeta Kumar
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Douglas J Anderson
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jayme E Locke
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Devin E Eckhoff
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Knoll MF, Cooper DKC, Bottino R. How the COVID-19 pandemic may impact public support for clinical xenotransplantation in the United States? Xenotransplantation 2020; 27:e12623. [PMID: 32596829 PMCID: PMC7361153 DOI: 10.1111/xen.12623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/06/2020] [Indexed: 12/11/2022]
Abstract
Many patients who would undergo organ transplantation cannot proceed due to the inability of human organ donation to satisfy medical needs. Xenotransplantation has the potential to offer unlimited availability of pig organs for transplantation, and pig-to-non-human primate models have demonstrated outcomes that may soon justify clinical trials. However, one of the unique ethical challenges faced by xenotransplantation is that the risk of introducing potential zoonotic disease into the community must be weighed along with the benefit to the patient. While most experts believe that zoonosis is manageable, apprehension over disease transmission from animal donors to human recipients remains a frequent concern of many who are undecided or opposed to clinical xenotransplantation. The COVID-19 pandemic represents a scenario (rapid worldwide spread of a highly contagious novel zoonotic disease with no natural defense in humans) that would seem to justify apprehension, especially in the United States, which has largely avoided previous pandemic outbreaks. However, there are many differences between zoonosis found in the wild or after xenotransplantation that favor the safety of the latter. Still, these differences, as well as the benefits of xenotransplantation, are not widely understood outside of the field. We must therefore ask what impact the COVID-19 pandemic will have on attitudes toward xenotransplantation.
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Affiliation(s)
- Michael F Knoll
- Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, PA, USA
| | - David K C Cooper
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rita Bottino
- Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, PA, USA.,Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, PA, USA
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