Xenotransplantation - current social, ethical, religious, and legal aspects
DOI:
https://doi.org/10.12775/JEHS.2023.43.01.019Keywords
xenotransplantation, transgenic animals, ethics, animal rights, xenozoonosis, xenotransplantologyAbstract
Introduction: Xenotransplantology, the field of transplantation involving organs or tissues between different species, holds great promise for addressing the global organ shortage crisis. However, the development of new technologies without proper legislative preparation raises significant moral and ethical considerations. This paper provides an overview of the current state of xenotransplantology, highlighting its revolutionary potential alongside the moral dilemmas it entails.
Aim of the study: The aim of this study is to assess current social, ethical, religious, and legal trends regarding the issue of xenotransplantation.
Materials and methods: To obtain up-to-date information concerning trends in xenotransplantation, a review of the PubMed and Google Scholar databases, along with the latest legislative reports in both Europe and Poland, was performed.
Conclusions: Firstly, the authors briefly report on the current situation concerning transplantology and the widely spread organ donor crisis. Next, the issue of species boundaries and the moral status of non-human animals is addressed. The assessment of ethical implications of utilizing animals as organ donors is examined, along with the legal acts regulating this issue. Moreover, the authors attempt to evaluate the cultural and religious differences related to this concern. Furthermore, this study discusses the allocation and distribution of xenotransplants, considering issues of justice, fairness, and access to this innovative medical technology. Lastly, the paper delves into the risks and uncertainties associated with xenotransplantation, including the possibility of cross-species disease transmission and intensified course of organ rejection disease.
References
Zhai, X. Xenotransplantation—reflections on the bioethics. Health Care Sci. 2022; 1: 86– 92. https://doi.org/10.1002/hcs2.18
Melo H, Brandao C, Rego G, Nunes R. Ethical and legal issues in xenotransplantation. Bioethics. 2011; 15(5–6): 427– 42. https://doi.org/10.1111/1467-8519.00252
Guzik-Makaruk, E., Transplantacja organów, tkanek i komórek w ujęciu prawnym i kryminologicznym. Studium prawnoporównawcze. 2008.
T.L. Beauchamp, J.F. Childress. Zasady etyki medycznej. Warszawa 1996
Welin S. Starting clinical trials of xenotransplantation—reflections on the ethics of the early phase. J Med Ethics. 2000; 26(4): 231– 6. https://doi.org/10.1136/jme.26.4.231
Johnson, L. Syd M. (2022). Existing Ethical Tensions in Xenotransplantation. Cambridge Quarterly of Healthcare Ethics 31 (3):355-367.
Wang H, Shi Y, Zhou Z, Lin S, Fan J. 2019 China organ donation and transplantation waiting status analysis. Chin J Organ Transplant. 2021; 42(6): 324– 5 (in Chinese). https://doi.org/10.3760/cma.j.cn421203-20210108-00014
Polska transplantologia w kryzysie - Najwyższa Izba Kontroli. (2022, 27 maja). Najwyższa Izba Kontroli.
Carrier AN, Verma A, Mohiuddin M, Pascual M, Muller YD, Longchamp A, Bhati C, Buhler LH, Maluf DG, Meier RPH. Xenotransplantation: A New Era. Front Immunol. 2022 Jun 9;13:900594. doi: 10.3389/fimmu.2022.900594. PMID: 35757701; PMCID: PMC9218200.
De Vito Dabbs A, Dauber JH, Hoffman LA. Rejection after organ transplantation: a historical review. Am J Crit Care. 2000 Nov;9(6):419-29. PMID: 11072558.
Deschamps JY, Roux FA, Saï P, Gouin E. History of xenotransplantation. Xenotransplantation. 2005 Mar;12(2):91-109. doi: 10.1111/j.1399-3089.2004.00199.x. PMID: 15693840.
Farr AD. The first human blood transfusion. Med Hist. 1980 Apr;24(2):143-62. doi: 10.1017/s0025727300040138. PMID: 6990126; PMCID: PMC1082701.
Rafael Oriol, Serge Voronoff, „Xenotransplantation”, 8 (2), 2001, s. 149–150, DOI: 10.1034/j.1399-3089.2001.008002149.x
R. A. Valdez-Gonzalez. Xenotransplantation of porcine neonatal Islets of Langerhans and Sertoli cells: A 4-year study. „European Journal of Endocrinology”. 153 (3), s. 419–427, September, 2005. (ang.).
Jaboulay M. Greffe de reins au pli de coude par soudures artér ielles et veineuse. Lyon Med 1906:10:575.
Unger E. Nierentransplantationem. Klin Wochenschr 1910:47:573.
Anzani A. Trapianto d'organo: problemi etici, aspetti sociali. Milano: Lauri; 1996.
Reemtsma K, Mccracken BH. Schlegel JU, Pearl MA. Pearce CW, Dewitt CW, et al. Renal heterotransplantation in man. Agn Surg 1964:160:384-410.
Stefanini P. Cortesini R, Casciani C, Arullani A, Cucchiara G. Ancarani E. al. Kidney transplantation. Int Surg ct 1968:49:181-6.
Keith Reemtsma, Xenotransplantation: A Historical Perspective, ILAR Journal, Volume 37, Issue 1, 1995, Pages 9–12, https://doi.org/10.1093/ilar.37.1.9
Cooper DKC, Ekser B, Tector AJ. A brief history of clinical xenotransplantation. Int J Surg. 2015 Nov;23(Pt B):205-210. doi: 10.1016/j.ijsu.2015.06.060. Epub 2015 Jun 26. PMID: 26118617; PMCID: PMC4684730.
Carbone, M., & M. Neuberger, J. (2014). Solid Organ Transplantation. W Regenerative Medicine Applications in Organ Transplantation (s. 17–28). Elsevier. https://doi.org/10.1016/b978-0-12-398523-1.00002-1
Barnard CN, Wolpowitz A, Losman JG. Heterotopic cardiac transplantation with a xenograft for assistance of the left heart in cardiogenic shock after cardiopulmonary bypass. S Afr Med J 1977;52:1035-8.
Sharp PM, Hahn BH. Origins of HIV and the AIDS pandemic. Cold Spring Harb Perspect Med. 2011 Sep;1(1):a006841. doi: 10.1101/cshperspect.a006841. PMID: 22229120; PMCID: PMC3234451.
Bloom ET. Xenotransplantation: regulatory challenges. Curr Opin Biotechnol. 2001 Jun;12(3):312-6. doi: 10.1016/s0958-1669(00)00218-4. PMID: 11404112.
Tissue Guidances. (b. d.). U.S. Food and Drug Administration. https://www.fda.gov/vaccines-blood-biologics/biologics-guidances/tissue-guidances
N. Goodman, Letter, "This is Where I Start to Draw the Line," British Medical Journal, 313 (1996): 696. Neville
Clark, M. (1999). This Little Piggy Went to Market: The Xenotransplantation and Xenozoonose Debate. Journal of Law, Medicine & , 27(2), 137-152. doi:10.1111/j.1748-720X.1999.tb01446.x
Crowden A. Professional boundaries and the ethics of dual and multiple overlapping relationships in psychotherapy. Monash Bioeth Rev. 2008 Oct;27(4):10-27. doi: 10.1007/BF03351302. PMID: 19760852.
See J. Goodall, "Ethical Concerns in the Use of Animals as Donors," in Hardy, supra note 22, at 335-49.
Alexander, Larry. “Lesser Evils: A Closer Look at the Paradigmatic Justification.” Law and Philosophy, vol. 24, no. 6, 2005, pp. 611–43. JSTOR, http://www.jstor.org/stable/30040366. Accessed 12 July 2023.
Rankin DJ, Bargum K, Kokko H. The tragedy of the commons in evolutionary biology. Trends Ecol Evol. 2007 Dec;22(12):643-51. doi: 10.1016/j.tree.2007.07.009. Epub 2007 Nov 5. PMID: 17981363.
Animal-to-Human Transplants: The Ethics of Xenotransplantation. 1996 Available online: https://www.nuffieldbioethics.org/publications/xenotransplantation
David K.C. Cooper, Robert Wagner, in Nonhuman Primates in Biomedical Research (Second Edition), Volume 1, 2012
Rollin BE. Ethical and Societal Issues Occasioned by Xenotransplantation. Animals (Basel). 2020 Sep 19;10(9):1695. doi: 10.3390/ani10091695. PMID: 32961658; PMCID: PMC7552641.
Jasiński A. (2006). Transplantacja narządów - wyzwanie dla biotechnologii. Biotechnologia, Artykuł 1.
Johnson, L. (2022). Existing Ethical Tensions in Xenotransplantation. Cambridge Quarterly of Healthcare Ethics, 31(3), 355-367. doi:10.1017/S0963180121001055
Manesh S.B., Samani R.O., Manesh S.B. Ethical issues of transplanting organs from transgenic animals into human beings. Cell J. 2014;16:353–360.
Meier RPH, Muller YD, Balaphas A, Morel P, Pascual M, Seebach JD, Buhler LH. Xenotransplantation: back to the future? Transpl Int. 2018 May;31(5):465-477. doi: 10.1111/tri.13104. Epub 2018 Jan 4. PMID: 29210109.
Mohiuddin MM, Singh AK, Corcoran PC, Thomas Iii ML, Clark T, Lewis BG, Hoyt RF, Eckhaus M, Pierson Iii RN, Belli AJ, Wolf E, Klymiuk N, Phelps C, Reimann KA, Ayares D, Horvath KA. Chimeric 2C10R4 anti-CD40 antibody therapy is critical for long-term survival of GTKO.hCD46.hTBM pig-to-primate cardiac xenograft. Nat Commun. 2016 Apr 5;7:11138. doi: 10.1038/ncomms11138. PMID: 27045379; PMCID: PMC4822024.
Goerlich CE, Chan JL, Mohiuddin MM. Regulatory barriers to xenotransplantation. Curr Opin Organ Transplant. 2019 Oct;24(5):522-526. doi: 10.1097/MOT.0000000000000678. PMID: 31361629; PMCID: PMC10243300.
Arnason G. The Emergence and Development of Animal Research Ethics: A Review with a Focus on Nonhuman Primates. Sci Eng Ethics. 2020 Aug;26(4):2277-2293. doi: 10.1007/s11948-020-00219-z. Epub 2020 Apr 29. PMID: 32350758; PMCID: PMC7417401.
Robinson NB, Krieger K, Khan FM, Huffman W, Chang M, Naik A, Yongle R, Hameed I, Krieger K, Girardi LN, Gaudino M. The current state of animal models in research: A review. Int J Surg. 2019 Dec;72:9-13. doi: 10.1016/j.ijsu.2019.10.015. Epub 2019 Oct 15. PMID: 31627013.
Fernandes MR, Pedroso AR. Animal experimentation: A look into ethics, welfare and alternative methods. Rev Assoc Med Bras (1992). 2017 Nov;63(11):923-928. doi: 10.1590/1806-9282.63.11.923. PMID: 29451652.
Jura, J., Słomski, R., Smorąg, Z., Gajda, B., Wieczorek, J., Lipiński, D., … Zeyland, J. (2006). Uzyskiwanie świń wykorzystywanych w ksenotransplantacji.
Smorąg, Z., Skrzyszowska, M., Jura, J. (2011). Transgeniczne świnie jako dawcy tkanek i narządów do transplantacji u ludzi. Przegląd Hodowlany.
Position Paper of the Ethics Committee of the International Xenotransplantation Association. Xenotransplantation 10, 2003, 194-203.
Primates as recipients; animal arguments; pigs and people. Excerpts from Organ Farm by Jenny Bryan and John Clare, 2001.
Prospects for xenotransplantation; Scientific aspects and ethical considerations. Pontificial Academy for Life.
Suchy F, Nakauchi H. Lessons from Interspecies Mammalian Chimeras. Annu Rev Cell Dev Biol. 2017 Oct 6;33:203-217. doi: 10.1146/annurev-cellbio-100616-060654. Epub 2017 Aug 14. PMID: 28806099.
Cyranoski D. Japan approves first human-animal embryo experiments. Nature. 2019 Jul 26. doi: 10.1038/d41586-019-02275-3. Epub ahead of print. PMID: 32710002.
Kano M, Mizutani E, Homma S, Masaki H, Nakauchi H. Xenotransplantation and interspecies organogenesis: current status and issues. Front Endocrinol (Lausanne). 2022 Aug 5;13:963282. doi: 10.3389/fendo.2022.963282. PMID: 35992127; PMCID: PMC9388829.
Hyun I, Clayton EW, Cong Y, Fujita M, Goldman SA, Hill LR, Monserrat N, Nakauchi H, Pedersen RA, Rooke HM, Takahashi J, Knoblich JA. ISSCR guidelines for the transfer of human pluripotent stem cells and their direct derivatives into animal hosts. Stem Cell Reports. 2021 Jun 8;16(6):1409-1415. doi: 10.1016/j.stemcr.2021.05.005. Epub 2021 May 27. PMID: 34048695; PMCID: PMC8190667.
Ustawa z dnia 1 lipca 2005 r. o pobieraniu, przechowywaniu i przeszczepianiu komórek, tkanek i narządów, Art. 20 ust. 1 i 2
Ustawa z dnia 1 lipca 2005 r. o pobieraniu, przechowywaniu i przeszczepianiu komórek, tkanek i narządów, Art. 41 ust. 1, 6, 7 i 8
Ustawa z dnia 1 lipca 2005 r. o pobieraniu, przechowywaniu i przeszczepianiu komórek, tkanek i narządów, Art. 20 ust. 3
Ustawa z dnia 5 grudnia 1996 r. o zawodach lekarza i lekarza dentysty Art. 21
Gądzik, Zuzanna. (2018). Prawnokarne aspekty transplantacji ksenogenicznych.
Ustawa z dnia 5 grudnia 1996 r. o zawodach lekarza i lekarza dentysty Art. 22 i Art. 29
Ustawa z dnia 5 grudnia 1996 r. o zawodach lekarza i lekarza dentysty Art. 23, Art. 24, Art. 25, Art. 27
Ustawa z dnia 5 grudnia 1996 r. o zawodach lekarza i lekarza dentysty Art. 28
Ustawą z dnia 21 sierpnia 1997r. o ochronie zwierząt Art. 5
Ustawą z dnia 21 sierpnia 1997r. o ochronie zwierząt Art. 6 ust. 1
Ustawa z dnia 15 stycznia 2015 r. o ochronie zwierząt wykorzystywanych do celów naukowych lub edukacyjnych Art. 2 ust. 1 pkt. 6
Ustawą z dnia 21 sierpnia 1997r. o ochronie zwierząt Art. 6 ust. 2 pkt. 1
Recommendation No. R (97) 15 Of The Committee Of Ministers To Member States On Xenotransplantation (Adopted by the Committee of Ministers on 30 September 1997 at the 602nd meeting of the Ministers' Deputies)
Xenotransplantation: Guidance on Infectious Disease Prevention and Management; World Health Organization; Geneva, Switzerland, 1998. WHO/ECM/ZOO/98.1
Xenotransplantation, International Policy Issues; OECD, Paris, France (1999)
OECD/WHO Consultation on Xenotransplantation Surveillance: Summary Report; DSTI/STP/BIO(2001)11/FINAL
Report of WHO on xenotransplantation; World Health Organization; Geneva, Switzerland, 28-30 October 1997. WHO/ECM/ZOO/98.2
Opinion on the State of the Art concerning Xenotransplantation, European Union, European Commission, Health & Consumer Protection Directorate-General, 1st October 2001
Second WHO Global Consultation on Regulatory Requirements for Xenotransplantation Clinical Trials October 17-19 2011, WHO, Geneva, Switzerland WHO/HTP/EHT/CPR/2011.01
Kim MK, Choi HJ, Kwon I, Pierson RN 3rd, Cooper DK, Soulillou JP, O'Connell PJ, Vabres B, Maeda N, Hara H, Scobie L, Gianello P, Takeuchi Y, Yamada K, Hwang ES, Kim SJ, Park CG; International Xenotransplantation Association. The International Xenotransplantation Association consensus statement on conditions for undertaking clinical trials of xenocorneal transplantation. Xenotransplantation. 2014 Sep-Oct;21(5):420-30. doi: 10.1111/xen.12129. Epub 2014 Sep 1. PMID: 25176471.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Emilia Kucharczyk, Tomasz Busłowicz, Michał Puła, Natalia Kucharczyk, Martyna Zakrocka
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 919
Number of citations: 0
