Xenotransplantation: ethical acceptability

Animal organs for human transplantation: how close are we?

Solid organ transplantation has been, by most measures, a phenomenal success. Nonetheless, the field is plagued by extreme shortages of available organs from a very limited number of donors. One potential solution to this organ availability crisis is the use of animals as organ donors for humans (xenotransplantation). Though the concept remains theoretical, significant advances are being made in the field of genetics and in our understanding of the immunological barriers to xenotransplantation. With these advances also comes increased knowledge about the potential risks of xenotransplants, especially disease transmission. The eventual clinical application of animal-to-human transplants will require a careful, balanced appraisal of these issues.

Attitudes and behavior of young European adults towards the donation of organs--a call for better information

Public perception of organ donation critically affects the availability of organ transplantation in the Western world. To assess the attitude of young adults towards the donation of organs and to investigate potential factors influencing their knowledge and actual behavior regarding organ transplantation, we evaluated a handout questionnaire survey of all Swiss-Italian recruits during six of the years 1989-98 (n = 7272). The attitude of recruits towards organ donation did not change significantly within the 10-year survey period: 61% of young men would personally donate their organs in the case of brain death, 13% would refuse, and 26% had not made up their mind. If they had to decide for close relatives, 50% would consent; 60% of recruits neither knew their next of kin's attitude nor had informed them about their own opinion; 80% felt they were insufficiently informed about organ transplantation. A significantly more positive attitude towards organ donation was found among men who felt they were sufficiently informed, who had close next of kin who were aware of their personal attitude (p < 0.0001), who had contacts with transplanted persons (p < 0.015), or who believed in an existence after death (p < 0.001; chi2-test). Our results suggest that there is potentially large support towards organ donation in this population. To minimize the high rate of indecisiveness, young adults need more appropriate information on the subject and they ask for it.

Ethical issues in lung transplantation

Lung transplantation is now an accepted therapeutic option for many patients with incurable end-stage lung or pulmonary vascular disease processes for which other treatment options have been expended. However, as lung transplantation has evolved as a recognized discipline over the past decade, a variety of ethical issues related to the transplant process are emerging. This article considers those issues through a discussion of the four fundamental principles of biomedical ethics.