A sensible alternative to xenotransplants by Alan H. Berger
From ANIMAL PEOPLE, September 1995:
Transplanting vital organs has become a rela-
tively common medical procedure, readily accepted by
the public, with about 12,000 such operations performed
each year in the United States. Patients who need organ
transplants can sign on to the waiting list of the United
Network for Organ Sharing, a Richmond, Virginia, non-
profit group that under a federal contract allocates organs
nationally. But being listed does not guarantee receiving
an organ.
In 1993, of 50,169 patients who registered with
UNOS, 2,887 died while waiting to receive donor
organs. Of 7,039 candidates for liver transplants, 558
died waiting for a suitable liver. Nationally, mortality on
transplant lists is 8% for liver, 12.2% for heart, and 3.8%
for kidney.
These deaths occur because only about one per-
son in five has consented to donate organs at death. Thus
a chronic shortage of healthy human organs has led many
transplant centers to consider using substitute organs from
sheep, pigs, and nonhuman primates.
The Animal Protection Institute contends that
transplants from one species to another, called xenotrans-
plants, are unnecessary:
• The costs are huge. Even a human-to-human
heart or liver transplant can run more than $400,000,
with three-year survival rates varying from 68% to 85%.
This doesn’t include the soaring price of longterm medical
care and lifelong anti-rejection medication. Xenotrans-
plants, still experimental, are even more costly.
• Donor animals must be free of specific
pathogens. Such animals are difficult to provide in quan-
tity and impossible to guarantee. Lethal viruses are often
not readily detectable until they are transmitted to
humans, often with devastating results. A baboon used
in a 1992 xenotransplant in Pittsburgh was later found to
have been infected with at least three DNA
viruses––Simian cytomegalovirus, Epstein-Barr virus,
and Simian Agent 8––and possibly by others still
unknown. A virus that is relatively benign in its native
host can be devastating when introduced to a human.
Examples include the macaques herpes B virus, which
when transmitted to a human by a monkey bite causes
encephalitis, and the 90% fatal Ebola virus, recently
rampaging in Zaire.
• The failure rate is 100%. Organ rejection is
always a concern with transplants, and the risk is greatly
magnified when the transplant involves a cross-species
donor. Even the desperation that drives a doctor and
patient to consider a xenotransplant hardly justifies the
expenditure when there is no hope of survival.
• The ethics of ever using animals in science
and research aside, the slaughter of an innocent animal
for a procedure that always results in death for both the
human and the nonhuman is inhumane to all concerned.
Presumed consent
However, xenotransplants would no longer be
an option if there were no shortage of human organ
donors. Current U.S. law requires that the donor grant
prior permission for the use of his or her organs at death
or that the family of the deceased grant permission,
which is often sought during a time of bereavement,
when donating organs may seem more abhorent to the
survivors than it may have been to the deceased.
Despite widespread efforts to promote organ
donation, the number of people who give their prior
consent, usually through a donor card or driver’s license,
remains disappointingly low. Needed is a new law
reversing the presumption of the current organ donation
law, to presume consent.
The adoption of such a law in three European
countries has resulted in a dramatic increase in the avail-
ability of donor organs. In Belgium, which enacted its
presumed consent law in 1986, the total number of
organs available for transplant increased 183% between
1984 and 1988, and has continued to rise. In Austria,
organ availability quadrupled after the present presumed
consent law was implemented.
Does a presumed consent law truly protect the
right of the individual to say yes or no?
The European model offers a clearly successful
example. The legal presumption is that anyone who has
not declared an opposite wish is a potential organ donor.
Once presumed consent is in place, family members
need not extend permission to “harvest” the deceased’s
organs. In Belgium, objections to post-mortem organ
removal can be recorded in a central registry, continu-
ously accessible to the transplant centers through an
online network.
To counter fears that transplant centers may
take organs prematurely, the diagnosis of brain death is
done by an independent neurological team.
As M.F.X. Gnant et al wrote four years ago in
the journal Transplantation Proceedings, “Presumed
consent legislation offers the most ethical solution to the
problem of organ donation. It shifts the responsibility of
decision about organ donation from the relatives to the
individual, maximally respecting his/her right of self
determination.”
“If we knew that only one or two persons in ten
would autonomously donate their organs,” says
University of Michigan professor of medical ethics and
philosophy Carl Cohen, Ph.D., “a system that presumed
consent, protecting 10% automatically but obliging the
other 90% to register their objections to make their will
effective, would be unfair. But if we have good reasons
to believe that seven or eight of ten, or even six of ten,
would in fact choose to donate their own organs for
livesaving uses after death, a system that presumes the
absence of consent similarly…is then unfair.”
In that presumed consent does represent a
majority view, in this country, in Europe, and else-
where in the developed nations, such a law is morally
right. It permits us to potentially improve and prolong
the lives of those who might die without a necessary
transplant. Grieving families are spared the stress of
having to make this decision at a time of loss, when the
unvoiced preference of the deceased may result in an
unwarranted denial of permission.
A presumed consent law in the U.S would save
many lives by using organs that would would otherwise
be wasted. Creating a data base allowing each and every
person to state his or her preference regarding organ
donation is the first step in the right direction. As for the
many who fail to do so, it should be assumed that they
do choose to give life to another after their own deaths.
