Bioethics Dissertation: The Ethical Issue Of Xenotransplantation

Bioethics dissertation

Is xenotransplantation ethical

End-stage organ failure or cellular dysfunction has been one reason that causes the morbidity and mortality rate to be higher. Organ transplantation, replacing of dead or dying tissues or organs is one of the miracles that the medical field has been achieved. Nevertheless, this organ transplantation itself has a huge issue with the imbalance between organ transplant applicants and the number of organ donors. Stat Xenotransplantation or cross-species transplantation is one of the most suitable alternative options for allogeneic transplantation. Xenograft is the organ or tissue that has taken from the donor animal to recipient animal or human. The most studied donor animal species for xenograft is Sus scrofa (pig). Even though the pig is not a primate their pregnancy period is short, growth is rapid and mainly the organ size is similar to human.

The concept of xenotransplantation was proposed more than 300 years ago. In the 17th-century animal, blood transfusion was attempted by Jean Denis. In the late 20th century another attempt was done by transplanting a baboon liver. However, this patient was only lived up to 70 days. During 20th and 21st century preclinical trials using pig heart, kidney, liver, islets and tissues were done which promises the clinical trial in the near future. However, bioprosthesis where pig heart valves were used as xenografts for human for more than 50 years but still has not been successful for adolescents and young adults. As for the major drawback in xenotransplantation is the reduced lifespan of patients due to immunological reactions. The immune system in the patients' body identified the transplanted organ or tissue as foreign which cause the immune system to produce rejection reactions. The emergence of genetic manipulation has given the solution for this immune reaction by manipulating the pig that more compatible with human species. According to Cooper, et al. , (2018) there are some genetically engineered pigs that express six different gene modifications that result in reduced immune rejections. Maximum pig kidney graft survival has increased from minutes to months, and occasionally to >1 year in 2017. Xenotransplantation might just be that kind of move since we utilize other living beings for the benefit of humans in a hitherto unprecedented manner.

Ethical considerations

Xenotransplantation has been a major topic when it comes to medical controversial ethical dilemmas. This issue is unique with respect to other medical procedures as it involves the creation of chimeric cells. Debating about xenotransplantation was stimulated with the Baby Fae case in 1984 in which Dr Leornard Bailey and colleagues transplant a baboon heart to a neonate who has survived for 20 days. Ethics regarding xenotransplantation can describe in terms of medical and social perspectives. The ethical dilemma regarding xenotransplantation can be discussed under several topics;

• Playing god concept
• Animal ethics
• Zoonosis
• Informed consent
• Playing God

Playing god or try to be a creator is an important criticism in xenotransplantation. Some atheists tend to replace this playing god argument with some notion of nature. According to critics using genetic engineering and xenotransplantation, mankind can be able to create new living creatures which are against the will of nature and also much unethical. In Christian ethics, even though all animals human was born through soil still human has the breath of the god hence they strongly against for xenotransplantation as it neglects the gods' creation. Philosophers such as Bernard Rollin argue that if man made new creations are unnatural and bad how come natural disasters such as flood is disastrous. Furthermore ethically justified allotransplantation, animal breeding or agriculture, fighting against diseases, inventions and constructions also assume to be unnatural as they are also manmade. Furthermore, if transplantation between one animal species to another violates the divine order then crossings between plants also violate the order of nature. Basically, this playing god argument is slipper-slop kind (that suggest taking one action will lead to inevitable consequences). Some might think that we do not need to interfere with the order of nature even though it causes damage to human as well as if our surroundings are the sole result of human activity then it has distorted our existence within nature. Again some philosophers suggest that some people get diseases due to their own behaviours, therefore, it should not be a reason to go against the natural rules. In terms of society, they again can believe that xenotransplantation damage human dignity as during the procedure human has to incorporate a part of an animal.

Animal welfare and rights

In the procedure of xenotransplantation, it solely depends on animals. Hence in order to carry out with the xenotransplantation animal farming has to be done as the only purpose to gain their organs (as an instrument) which shows disregard for animal dignity and perverted ourselves in humanity. After all, it does so in meat production. A medical procedure such as xenotransplantation cannot be done without prior clinical studies and specialized breedings. During these developments, sufferings towards animal cannot be avoided. Most of the time those lab animals had to go through sufferings such as thirst, hunger, pain and psychological tensions during the experiments. In addition, as there is a risk of infections through xenotransplantation in order to prevent, those animal has to grow in a quarantine environment with specialized diets. Deontology and consequentialism are the main ethical theories in xenotransplantation. In the deontological theory focus on how actions can be morally accepted rather than considering the consequences. Consequentialism ethics focus on the outcomes of an action. Utilitarianism is one form of the consequentialism, with the principal of the greatest good for the greatest number.

Jeremy Bentham a utilitarianism ethicist had introduced animal as a resident in an ethical society which gives rise two aspects regarding animals; animal rights and welfare. In terms of animal rights, it considers animal as holders of rights and should consider them in the same interest as human. Animal rights same as the deontological ethics about the animal as breaking species boundary is wrong regardless of the consequences. Furthermore, Tom Regan, an animal right follower said that “ Torturing and killing animals to transplant their organs to human beings is fundamentally unethical and means lowering animals’ status”. On the contrary, in animal welfare it is believed that human has a right to use animals if the more benefits are for human. A philosopher, Peter Singer state that 'According to justified requirements and if the benefits overcome the of pain and suffering to animals, they can be used to meet human’s needs while treating them properly'. However, Peter Singer was against the idea of making transgenic animals. The animal welfare can be summarized as ‘Three R s: reduction, replacement and refinement’, especially for laboratory animals. However, philosophers believe that it xenotransplantation experiment can do just using a few numbers of animals then it is unethical to use more than that.

Zoonosis

Zoonosis, a disease that transmitted from animal to human which can cause serious viral infections. Normally causative organisms for zoonosis are innocuous within their original host (animal) but pathogenic for the human. Sometimes those organisms can be non-pathogenic but due to mutations after transfer, they can be pathogenic. Those causative organisms can be either bacteria, fungal or virus. History can give so many evidence for zoonosis such as the emergence of influenza, rabies and Ebola. In terms of xenotransplantation, the most common zoonosis that reported was porcine endogene retrovirus (PERV). This PERV is integrated into pigs' genome hence curing is much difficult than other bacterial or fungal infections. In clinical studies with a pig to mice xenotransplantation shows generate transmission of PERV. However, in vitro studies about PERV suggest that it can infect human but rare in vivo condition. But according to hepatitis E virus can infect human cells through porcin xenografts in vitro or in vivo. Still, the risk of zoonosis from pigs is less possible than transplanting organs from non-human primates to humans or even from Allografts

Therefore some can argue that due to this zoonosis xenotransplantation should be avoided. Because of this issue animal husbandries and xenografts must be carefully inspected before transplantation using specialised detection methods. New and improved methods are under development to detect potentially zoonotic microorganisms. Center for disease control in the US has defined guidelines for centres to reduce the probability of infection through xenografts. Currently, biotechnologists have successfully knock-out PERV in immobilised PK-15 pig cells using Clustered regularly interspaced short palindromic repeats/CRISPR-associated (CRISPR/Cas9) technique. However, even if PERV is totally eliminated there will always be a risk of unknown infections. Hence life long monitoring of the patient has to be done. Furthermore, processing and transport of xenografts should be done under sterile conditions to avoid contaminations.

Inform Consent

Clinical studies for xenotransplantation is essential to provide evidence for success. But in order to carry out with clinical trials giving the informed consent is a must for patients as xenotransplantation is not just a risky procedure for the patient but also a burden for patients relatives. Autonomy belongs to principalism ethics, that implies the integration of a person thought in order to make a decision, in conveying this procedure should be accepted from the patient according to patients own thoughts and decisions. The patent should be well informed about the whole experiment with consequences. Among the conditions in informed consent, it should state about the life long monitoring, side effects, cautions and accepting quarantine in case of infections. However, if the patient is critical obtaining an informed consent if difficult as at that moment patient might think in a pessimistic way about own self.

Сonclusion

Аt the present no real ethical knock-down argument against have strongly Even though human seek for zero risks in everything regarding public health, there is never any zero risks in anything that we engaged with, there for as insufficient of organs and tissues for transplantations has been a global issue go ahead with xenotransplantation would be a solution but it has to be done with precautions. In order to increase the safety and efficiency within the xenotransplantation, more clinical studies must be carried out.