Xenotransplantation: the potential and the challenges

Psychosocial aspects of the organ transplant experience: what has been established and what we need for the future

This article briefly describes the current status and limitations of the organ transplant process that has now become a routine medical procedure. The article discusses how transplantation is not a cure for end-stage organ disease but an alternative form of treatment with both potential medical and psychosocial problems. Both transplant candidates and recipients encounter psychosocial problems. The article examines how these psychosocial problems affect transplant patients prior to transplant, immediately following surgery, and posttransplant. The psychosocial problems include psychiatric diagnoses, individual and family adjustment and relationship problems, sexual dysfunction, return-to-work (RTW) difficulties, and compliance problems and variables related to noncompliance. The article also reviews the special problems of pediatric and adolescent transplant recipients. The need for empirically supported interventions is noted in each of the problem areas. The author outlines problems with previous research studies that hamper solid interpretations of the data, and discusses literature suggesting that the psychosocial problems of transplant candidates and recipients are likely to be underreported. The article concludes with recommendations about the need to switch research efforts toward intervention studies in the problem areas already solidly identified by the literature.

Xenogeneic infections and public health

1. The scarcity of available human donor organs for use in allotransplantation has fuelled interest in xenotransplantation, the therapeutic use of living animal tissue in humans. The use of living animal tissue for therapeutic purposes in humans has raised concerns that xenotransplantation clinical trials may pose a presently unquantifiable but undeniable risk to public health. 2. Xenotransplantation has the potential to introduce new infections to the human community by infecting human recipients with agents that were not previously endemic in human populations (xenogeneic infections). 3. Manipulations intended to prevent xenograft rejection may also facilitate the transmission of agents that rarely or never infect humans under natural circumstances. 4. The US Food and Drug Administration (the government agency responsible for monitoring drug safety) has chosen to allow limited numbers of xenotransplantation clinical trials to proceed under carefully monitored conditions outlined in the Public Health Service (PHS) Guideline on Infectious Disease Issues in Xenotransplantation. 5. This PHS guideline particularly emphasizes the importance of pretransplantation screening and post-transplantation surveillance for safety monitoring. 6. Laboratory based surveillance for endogenous retroviruses and other identifiable agents that cannot be removed from the xenograft can augment clinical surveillance. 7. Laboratory based studies of xenograft survivors increase our ability to quantify xenotransplant-associated risks and, thereby, expand our capacity to make science-based assessments of appropriate public policy.