When Are Xenotransplants Right?
Q.Do you have more of a problem using baboons as a source of organs, compared to pigs?
Q.Who should make the decision about a xenotransplant?
Q.What other ethical questions do xenotransplants raise?
Q.Would society's resources be better spent by recruiting more human organ donors, rather than spending money on the expensive, risky xenotransplants? [Liver transplants run upwards of $100,000 apiece, and transplants from pigs or baboons will be even more expensive.]
The WhyFiles spoke with Dr. Norman Fost, a medical ethicist at the University of Wisconsin-Madison, about the ethics of inter-species transplants.
A.There's a lot of data showing that large primates are almost indistiguishable from us in their psychosocial lives. If you take a baboon out of the family structure, for example, he or she is likely to be missed. So, to me, [exploiting primates] is a legitimate concern. I have less concern when pigs are the source of organs, since their psychological experience is less similar to that of humans.
A.When a young patient comes to a doctor with acute liver failure, and is going to die in 24 hours, the hospital medical ethics committee has to decide quickly. Their responsibility, and the treating doctor's responsibility, is to the patient. There's a big question in my mind, whether this committee has any business weighing the social risks of all this. If the FDA or legislature wants to prohibit xenotransplants [out of concern for viral infection, for example] they can do so.
A.Are you really saving lives when you use a baboon or pig liver as a "bridge" transplant for somebody with acute liver disease? Given that livers for transplantation are in short supply, you are just depriving someone else on the waiting list for organs. You're also raising the overall cost since at least twice as many operations would be needed. And you are running the risks of viral infection from the xenotransplant. On the other hand, these patients are young and have fewer chronic illnesses -- the typical person on a liver-transplant waiting list is older and likely to have underlying disease -- so the younger person can expect more years with a good quality of life. I haven't heard this issue discussed on the national level.
A.Far and away the most important ethical implication of xenotransplants is the issue of social justice. This country claims it's broke as far as health care is concerned; it's the only industrialized country in the world that "can't afford" basic health care for 40 to 60 million people, where there are people who are brain-damaged or otherwise diseased, for preventable reasons. We say we don't have another dime for health care, then we suddenly find huge amounts of money for xenotransplants which will help a couple of liver patients, or a couple of hundred patients. What is that compared to the millions who are totally outside the health care system?
