Ethical, Theological, and Social Considerations of Xenotransplantation

Written By: Thomas Liang

Xenotransplantation, one of the most innovative medical procedures of the 21st century, is defined as the cross-species organ transplantation between a non-human species and humans. For context, according to the Food and Drug Administration (FDA), approximately 10 patients in the United States die every day while waiting for a vital organ transplant via allotransplantation - the organ transplantation between two individuals of the same species (2021). Thus, experts such as Dr. Esker, an associate professor of surgery at the Indiana University School of Medicine, and Dr. Yang, a researcher at the Harvard Medical School, argue that xenotransplantation is an effective solution to treat the severe shortage of transplantable human organ donors (Esker et al., 2017; Yang & Sykes, 2007).

Although xenotransplantation is primarily a medical speciality, it raises many socioscientific concerns as well, such as the morality of the procedure, the potential for human and animal rights abuse, and how certain religious or social groups (e.g., vegans) may react. Therefore, it is imperative to consider how these ethical, theological, and social considerations may impact the societal acceptance of xenotransplantation.

Ethical Concerns

The morality of xenotransplantation is often debated and answers differ greatly depending on the audience. Cengiz and Wareham, two researchers of bioethics, found several ethical concerns with the treatment: First, the three monothestic religions (i.e., Christianity, Islam, Judaism) broadly seem to express a moderate level of acceptance (Cengiz & Wareham, 2020). On the other hand, xenotransplantation may violate personal virtues and moral taboos (Cengiz & Wareham, 2020); veganism and pro-animal movements may therefore provide strong resistance to the treatment. Next, some critics may disapprove of how xenotransplantation manipulates the laws of nature and allows humanity to “play God” (Cengiz & Wareham, 2020). Finally, xenotransplantation poses potential threats to both animal rights and human dignity (Cengiz & Wareham, 2020); However, in regards to the potential violation of human dignity, this “disruption of bodily integrity” is usually passed as acceptable due to the benefits attained by the xenograft-recipient (Cengiz & Wareham, 2020).

Drs. Loike and Kadish from Touro College pointed out that, although the three monothestic religions generally accept xenotransplantation, certain religious beliefs may fundamentally object to the treatment; for example, the use of porcine organs is forbidden in the Islamic religion (2018). They also highlighted the importance of animal rights and human dignity in this discussion, and identified two additional concerns: the principle of nonmaleficence (“do no harm”) and the existence of a slippery slope (Loike & Kadish, 2018).

Fortunately, rapid development of technologies and strategies can help us overcome these ethical obstacles (Cengiz & Wareham, 2020). For instance, CRISPR-based biotechnologies can minimize xenograft rejection and improve tolerance in recipients (Cengiz & Wareham, 2020). Similarly, it is important to understand what it means to be “human” and how society would like to define personhood - how would a patient’s identity be affected if they were living with a porcine organ? (Loike & Kadish, 2018). Only then will it be possible to determine if the benefits of xenotransplantation truly outweigh the ethical concerns (Loike & Kadish, 2018). 

Theological Perspectives

            Religious beliefs may heavily influence individual opinions towards xenotransplantation. Dr. Paris, a professor of Social Work, admitted that theologians do not always agree with the viability of xenotransplantation, and may consider the procedure through different rationale (2018). In particular, the three Abrahamic religions of Judaism, Christianity, and Islam all express similar sentiments of accepting xenotransplantation. First, Judaism does not openly object to the use of xenotransplantation to prolong and save human life (Paris et al., 2018). Because a principle of the Deuteronomy (a sacred Jewish text) is to prioritize life over death, preserving life outweighs almost all over values without exception (Paris et al., 2018). Thus, xenotransplantation is welcomed as a “life-sustaining medical intervention” in the Jewish perspective (Paris et al., 2018). In the Christian faith, humans are encouraged to make use of animals to achieve greater human potential; xenotransplantation is therefore justified as long as human dignity and integrity is preserved and ethical standards are met (Paris et al., 2018). In Islam, the bioethical consensus is unclear. Many Islamic cultures do not allow the use of porcine organs, including heart valves to replace defective human organs; however, because the patient would die without the porcine organ, this restriction may be temporarily suspended (Paris et al., 2018).

            Dr. Sautermeister, a professor of theology specializing in bioethics, and colleagues confirmed that the monothesitic religions are moderately anthropocentric (2015). This means that human beings are of utmost importance, and should be given priority over other animals (Sautermeister et al., 2015). As a result, utilizing animals for humanity’s benefit is permissible given that they are treated with respect and responsibility (Sautermeister et al., 2015). The most important conclusion, however, is that the three Abrahemic religions do not hold any fundamental religious reasons that prohibit the use of xenotransplantation to treat grave or life-threatening organ deficiencies (Sautermeister et al., 2015). From a religious standpoint, xenotransplantation is appreciated and somewhat encouraged, given that patients and animals are treated with attentiveness and dignity. 

Social Attitudes

            Negative attitudes and perceptions from the public may deter the societal acceptance of xenotransplantation, therefore limiting the field’s overall success. According to Dr. Cook, a sociologist specializing in medical science and technology, the public acceptance rate of xenotransplantation varies significantly in different areas of the world (2013). Citizens in the United States reported a higher acceptance rate of 47%, with 54% accepting xenotransplantation as a last resort (i.e., they would die without the procedure), while only 34% of Italian citizens deemed xenotransplantation as acceptable (Cook, 2013). In addition, the opinions of primary stakeholders (e.g., transplant recipients, people waiting for a transplant) are highly considered. On average, these patients reported a higher acceptance of xenotransplantation, most likely because they are in critical condition and have no choice but to accept the procedure, even if it is unfavourable (Cook, 2013). However, the public skepticism surrounding xenotransplantation may be attributed to the fact that ordinary citizens are viewed as “deficit in knowledge and requiring proper, scientific education” (Cook, 2013).

            Fortunately, studies have shown that re-education strategies are effective in altering public opinions. Kögel and Dr. Marckmann, two researchers of ethics, conducted a three-week program in which 18 German citizens participated in a conference: They learned more about xenotransplantation from various experts in the field and engaged in intensive group discussions (2020); at the end, they wrote a common statement, summarizing their perspectives. In the final opinion poll, citizens reported that, although they would reject xenotransplantation from their initial skeptic position, they mostly expressed supportive attitudes near the end of the conference (Kögel and Marckmann, 2020). This study demonstrates how citizen participation in current issues is not only possible, but that citizens are also willing to learn and readapt their position once they are well-informed, thus revealing the importance of correct education (Kögel and Marckmann, 2020).

Conclusion

In response to the shortage of transplantable human organs, xenotransplantation strongly presents itself as an excellent alternative to allotransplantation. Although the overall consensus towards the field is positive, ethical concerns, theological perspectives, and public attitudes must be evaluated as part of the discussion. Understanding these determinants will not only allow for a comprehensive risk-benefit analysis of xenotransplantation, but also accelerate the rate of which xenotransplantation is accepted by society.

 
Works Cited

Cengiz, N., & Wareham, C. S. (2020). Ethical considerations in Xenotransplantation: A Review. Current Opinion in Organ Transplantation, 25(5), 483–488. https://doi.org/10.1097/mot.0000000000000796

Cook, P. S. (2013). The Social Aspects of Xenotransplantation. Sociology Compass, 7(3), 237–254. https://doi.org/10.1111/soc4.12022

Ekser, B., Li, P., & Cooper, D. K. C. (2017). Xenotransplantation: past, present, and future. Current Opinion in Organ Transplantation, 22(6), 513–521. https://doi.org/10.1097/mot.0000000000000463

Food and Drug Administration. (2021). Xenotransplantation. U.S. Food and Drug Administration. https://www.fda.gov/vaccines-blood-biologics/xenotransplantation

Kögel, J., & Marckmann, G. (2020). “Xenotransplantation challenges us as a society.” EMBO Reports, 21(9). https://doi.org/10.15252/embr.202050274

Loike, J. D., & Kadish, A. (2018). Ethical rejections of xenotransplantation? EMBO Reports, 19(8). https://doi.org/10.15252/embr.201846337

Paris, W., Seidler, R. J., FitzGerald, K., Padela, A. I., Cozzi, E., & Cooper, D. K. (2018). Jewish, Christian and Muslim theological perspectives about xenotransplantation. Xenotransplantation, 25(3). https://doi.org/10.1111/xen.12400

Sautermeister, J., Mathieu, R., & Bogner, V. (2015). Xenotransplantation-theological-ethical considerations in an interdisciplinary symposium. Xenotransplantation, 22(3), 174–182. https://doi.org/10.1111/xen.12163

Yang, Y.-G., & Sykes, M. (2007). Xenotransplantation: Current status and a perspective on the future. Nature Reviews Immunology, 7(7), 519–531. https://doi.org/10.1038/nri2099