An American became the first person in the world to receive a heart transplant from a genetically modified pig.
David Bennett, 57, who doctors said was too sick to qualify for a human heart, is fine four days after the seven-hour experimental treatment.
- A patient in the US receives the first heart transplant from a pig in history
Surgery is being hailed by many as a medical advance that could shorten transplant wait times and change the lives of patients around the world. But some question whether the procedure can be ethically justified.
They have pointed out potential moral issues related to patient safety, animal rights, and religious concerns.
So how controversial are pig organ transplants?
The medical implications
This is an experimental surgery and carries great risks for the patient. Even well-matched human donor organs can be rejected after transplantation, and with animal organs the danger is likely to be greater.
Doctors have been trying for decades to use animal organs for what is known as xenotransplantation., with mixed success.
In 1984, California doctors tried to save a girl’s life by giving her the heart of a baboon, but she died 21 days later.
While such treatments are very, very risky, some medical ethicists say they still have to go ahead if the patient knows the risks.
“You can never know if the person will die catastrophically shortly after treatment, but you cannot proceed without taking the risk,” said Professor Julian Savulescu, chairman of the Uehiro Chair of Practical Ethics at the University of Oxford.
“As long as the individual understands the full range of risks, I think people should be able to consent to these radical experiments,” he added.
Savulescu said it is important that they are given all available options, including mechanical heart support or a human transplant.
Doctors who worked on Bennett’s case say the operation was justified because I had no other options treatment and would have died without it.
Savulescu said that prior to any surgery, the procedure must have undergone “very rigorous testing on non-human tissues and animals” to ensure it is safe.
The Bennett transplant was not performed as part of a clinical trial, as is often necessary for experimental treatments. And the drugs they gave him have yet to be tested for use in non-human primates.
But surgeon Christine Lau of the University of Maryland School of Medicine, who was involved in planning Bennett’s procedure, said no shortcuts were taken in preparing for the operation.
“We’ve done this for decades in the laboratory, in primates, trying to get to the point where we think it is safe to offer this to a human recipient“he told the BBC.
Bennett’s treatment also reignited a debate about the use of pigs for human transplants, to which many animal rights groups oppose.
One of them, People for the Ethical Treatment of Animals (PETA), condemned Bennett’s pig heart transplant as “unethical, dangerous and a tremendous waste of resources”.
“Animals are not warehouses of assault tools, but complex and intelligent beings,” PETA said.
Activists they say it is wrong to modify the genes of animals to make them more human-like. The scientists altered 10 genes in the pig whose heart was used for Bennett’s transplant so that it would not be rejected by his body.
The pig’s heart was removed the morning of the operation.
A spokesperson for Animal Aid, a UK-based animal rights group, told the BBC that it opposes animal gene modification or xenotransplantation “under any circumstances.”
“Animals have the right to live their lives, without being genetically manipulated with all the pain and trauma that this entails, only to be killed and their organs removed,” the organization said.
Some activists are concerned about the unknown long-term effects of genetic modification on the health of pigs.
Katrien Devolder, a bioethics fellow at the University of Oxford, says we should only use gene-edited pigs for organs if we can “make sure they don’t suffer unnecessary harm.”
“Using pigs to produce meat is much more problematic than using them to save lives, but of course that’s no reason to ignore animal welfare on this as well, “he said.
Another dilemma could arise around those whose faith could mean that it is difficult for them to receive an animal organ.
Pigs are chosen because the relevant organs are similar in size to humans, and because pigs are relatively easy to raise in captivity.
But how does this choice affect Jewish or Muslim patients, whose religions have strict rules about the animal?
Although Jewish law prohibits Jews from raising or eating pigs, receiving a pork heart “is in no way a violation of Jewish dietary laws”said Moshe Freedman, a London rabbi who is part of the Moral and Ethical Advisory Group at the UK Department of Health.
“Since the main concern in Jewish law is the preservation of human life, a Jewish patient would be required to accept an animal transplant if this offered him the best chance of survival and the best quality of life in the future, “Freedman told the BBC.
For Islam, there is a similar conclusion that the use of animal material allowed if it saves a person’s life.
Dar al-Ifta of Egypt, the country’s central authority for issuing religious sentences, said in a fatwa that pig heart valves are allowed if “there is fear for the life of the patient, the loss of one of his organs, the exacerbation or the continuation of the disease, or an overwhelming deterioration of the body “.
Savulescu argued that even if someone rejects an animal transplant for religious or ethical reasons, they should not necessarily be given lower priority on the waiting lists for human organ donors.
“Some people might say that once you’ve had a chance to get an organ, you should go down the list; others would say that you should have as much right as anyone else,” he said.
“Those are just positions that we are going to have to reconcile.”