What does it take to consent to islet cell xenotransplantation?: Insights from an interview study with type 1 diabetes patients and review of the literature

Engineering organs, hopes and hybridity: considerations on the social potentialities of xenotransplantation

The development of replacing human organs with those from genetically modified pigs holds immense potential for alleviating the shortage of organs necessary for patients in need of transplants. This medical advancement is also accompanied by significant social changes, including the emergence of a bioeconomy, new modes of biotechnology governance, altered human-animal relations and increased public engagement. Some aspects, such as the impact on the transplant allocation system, effects on clinical practice and healthcare provision, global trajectories and most importantly the consequences for patients and their families remain unpredictable. Given that xenotransplantation occurs within a societal context and its success or failure will not be confined to technical feasibility alone, it is essential to engage a social sciences perspective to highlight the social implications and emphasise the importance of social research in accompanying future developments.

Ethical Implications of Social Science Research on Xenotransplantation

Social science research has generated extensive knowledge on xenotransplantation, encompassing the perspectives of actual and potential patients, other stakeholders, public opinion and debate, human-animal relationships, animal production and husbandry, bioeconomy, as well as biotechnology governance and regulation. We therefore convened social science researchers to discuss the latest developments in xenotransplantation research and practice in late 2023. Based on a brief workshop report, we aim to highlight the various ethical implications of this debate. After outlining the role of social science research in the ethical evaluation of xenotransplantation, we elaborate three critical points that may become pivotal in the future evolution of xenotransplantation: the framing of xenotransplantation in the clinical setting and in the public, the potential impact of religious beliefs on patients' transplant choices, and the consequences for the allotransplantation system if xenotransplantation becomes clinically established, including the allocation of allo- and xeno-organs.

Current Status of Cardiac Xenotransplantation: Report of a Workshop of the German Heart Transplant Centers, Martinsried, March 3, 2023

This report comprises the contents of the presentations and following discussions of a workshop of the German Heart Transplant Centers in Martinsried, Germany on cardiac xenotransplantation. The production and current availability of genetically modified donor pigs, preservation techniques during organ harvesting, and immunosuppressive regimens in the recipient are described. Selection criteria for suitable patients and possible solutions to the problem of overgrowth of the xenotransplant are discussed. Obviously microbiological safety for the recipient and close contacts is essential, and ethical considerations to gain public acceptance for clinical applications are addressed. The first clinical trial will be regulated and supervised by the Paul-Ehrlich-Institute as the National Competent Authority for Germany, and the German Heart Transplant Centers agreed to cooperatively select the first patients for cardiac xenotransplantation.

Organ transplants of the future: planning for innovations including xenotransplantation

The future clinical application of animal-to-human transplantation (xenotransplantation) is of importance to society as a whole. Favourable preclinical data relevant to cell, tissue and solid organ xenotransplants have been obtained from many animal models utilizing genetic engineering and protocols of pathogen-free husbandry. Findings have reached a tipping point, and xenotransplantation of solid organs is approaching clinical evaluation, the process of which now requires close deliberation. Such discussions include considering when there is sufficient evidence from preclinical animal studies to start first-in-human xenotransplantation trials. The present article is based on evidence and opinions formulated by members of the European Society for Organ Transplantation who are involved in the Transplantation Learning Journey project. The article includes a brief overview of preclinical concepts and biology of solid organ xenotransplantation, discusses the selection of candidates for first-in-human studies and considers requirements for study design and conduct. In addition, the paper emphasizes the need for a regulatory framework for xenotransplantation of solid organs and the essential requirement for input from public and patient stakeholders.