The first successful transplant of a pig’s heart to a human took place in Baltimore. 57-year-old American David Bennett, who underwent the world’s first heart transplant from a genetically modified pig, is doing well three days after the experimental 7-hour operation. According to doctors, Bennett’s condition was too severe for a human heart transplant. Many have rushed to call this operation a true breakthrough in medicine that will help reduce the waiting time for organ transplants and improve the lives of patients around the world. But there are also those who question whether such an operation is ethically justified. They point to potential moral issues such as patient safety, animal rights, and religious considerations.
So what are the contradictions involved in transplanting pig organs into humans? The procedure is experimental and carries enormous risks for the patient. Even well-matched human donor organs can be rejected after transplantation, and this risk is likely to increase with animal organs. Doctors have been experimenting with xenotransplantation (the transplantation of animal organs into humans) for several decades, with varying degrees of success. We explain quickly, simply, and clearly what happened, why it matters, and what happens next.
In 1984, doctors in California tried to save a little girl by transplanting a baboon’s heart, but she died after 21 days. Although such operations are associated with very high risks, some medical ethicists believe that they should be performed if the patient is aware of the risks. “You can never know in advance whether a person will die shortly after the operation, but if you don’t take risks, you don’t move forward,” says Julian Savulescu, professor of applied ethics at the University of Oxford. “I believe that if a person fully understands the extent of the risk, they should have the right to sign up for such a radical experiment.” At the same time, the professor emphasizes that it is important for patients to have the choice of all available options, including artificial hearts and human transplants. According to the doctors who worked with Bennett, the surgery was justified in his case because there were no other options and he would have died without the transplant.
Professor Savulescu notes that before any such operation, it is necessary to carry out a very careful analysis of the tissues and experiments on animals in order to ensure its safety. Meanwhile, Bennett’s heart transplant was not performed as part of a clinical trial, as is usually required for experimental treatments. And the drugs they gave him had not even been tested on primates. But as Dr. Christine Lau of the University of Maryland School of Medicine, who helped develop the surgery for Bennett, says, the doctors were thorough in everything they did. “We’ve been doing this for decades with primates in the lab, trying to make it safe for humans,” she told the BBC. Bennett’s surgery has reignited debate about the use of animal organs for human transplants, a practice opposed by many animal rights groups.
Animal rights activists claim that it is wrong to modify the genes of animals to make them more compatible with humans. In order for Bennett’s body not to reject the transplant, scientists had to modify 10 genes in the pig that served as the heart donor. The heart was removed the morning of the scheduled surgery. As a representative of the British animal rights organization Animal Aid told the BBC, his organization is opposed to genetic modification of animals or xenotransplantation “under any circumstances”. “Animals have the right to live their own lives, without genetic manipulation and all the pain and trauma that goes with it, for the sole purpose of being killed and used for organs,” said a representative from Animal Aid. In addition, some activists are concerned about the unknown long-term effects of genetic modification on the health of pigs. Catherine DeWolder, a bioethics specialist and researcher at the University of Oxford, believes that we have the right to use organs from genetically modified pigs only if we can “ensure that they do not cause unnecessary suffering. “Using pigs for meat causes many more problems than using them to save lives, but of course that is no reason to ignore animal welfare,” says Dr. Devolder.
Another problem may arise for those who have religious objections to receiving animal organs. Pigs were chosen because their organs are the best size for humans, and because they are relatively easy to breed in captivity. But how can this affect Jews and Muslims, whose religion has very strict rules regarding these animals? Although religion forbids Jews from raising or eating pigs, transplanting a pig’s heart “in no way violates kashrut,” says Dr. Moshe Friedman, a London rabbi who sits on the Moral and Ethical Affairs Group (MEAG) of the British Ministry of Health. “Since the primary purpose of Jewish law is to preserve human life, a Jewish patient is obligated to accept an animal transplant if it will increase his chances of survival and improve his quality of life in the future,” Rabbi Friedman explained in an interview with the BBC. In Islam there is a similar postulate that the use of animals is permitted if it leads to the saving of human life. The Supreme Council of Religious Decrees in Egypt, “Dar al-Ifta,” issued a fatwa stating that the use of porcine heart valves is permissible in cases of “threat to human life, loss of any organ, aggravation or persistence of disease, or serious deterioration of the body’s condition.” According to Professor Savulescu, if someone refuses an animal transplant for religious or ethical reasons, it does not necessarily mean that they should be denied priority in receiving a human donor organ. “Some may argue that if you had the opportunity to receive an organ but refused, you should be moved down the waiting list, but others will point out that you should have the same rights as everyone else,” the professor says. “And we have to reconcile those two points of view.”