Pig-to-Human Kidney Transplant Offers Hope — and an Ethical Solution

With so many people on the organ transplant waiting list, the ethics of organ donation have begun to buckle.

• Euthanasia has been conjoined with organ harvesting in Canada, Belgium, Netherlands, and Spain.
• Efforts are under way to permit people to sell one kidney and parts of their liver to supplement philanthropic donations.
• A procedure is now in use by which, prior to organ procurement, a donor’s heart is restarted and blood flow to the brain is cut off — which would seem to suggest that doctors are causing brain death.
• China has a black market in organs supplied by the killing of Falun Gong prisoners and other political dissidents.
• Presumed consent proposals are being proffered, for example in Spain, that would require people to opt out of donation rather than opt in.
• Some have suggested taking organs from living but cognitively disabled people.
• There has even been advocacy in a bioethics journal to perform euthanasia by organ retrieval.

These proposals are not only unethical, in my opinion; in some cases they also treat donors as objects rather than subjects. Each and any of them could undermine the public’s already thin trust in the organ transplant system, which would be a catastrophe.

But an ethical way forward has also been researched assiduously, and it is beginning to bear fruit: xenotransplantation, that is, the use of pigs’ organs, genetically altered to be more compatible with humans.

Early experiments offer cause for optimism. Recently, a woman who was dying of kidney failure received a pig kidney, and she seems to be doing well. From the NPR story:

Looney donated one of her kidneys to her mother in 1999. A few years later, she developed chronic high blood pressure during a pregnancy and her remaining kidney failed in 2016. Since then, she’s been on dialysis for four hours a day, three days a week.

Her immune system would reject a human kidney. So the Food and Drug Administration made an exception to its usual clinical study requirements to let her get a pig kidney that’s been genetically modified to be accepted by her body.

Even though using pig organs remains highly experimental, it’s her only chance, her doctors say.

For the same reason, the FDA previously allowed doctors to transplant two other genetically modified pig kidneys into patients in New York and Boston, as well as engineered pig hearts into two men in Maryland. Those organs seemed to work well. But the patients were gravely ill with many health problems and only survived weeks or months.

Doctors are more optimistic this time because Looney is much healthier.

What are the objections? Animal-rights activists will howl because they believe that “a rat, is a pig, is a dog, is a boy,” that humans and animals are moral equals, and that therefore we should not use animals for any human purpose.

As the NPR story indicates, some bioethicists express an anti–human exceptionalism view:

“The gene edits are not made to benefit the pigs. The gene-editing is an attempt to fit a square peg into a round hole — to sand off the incompatible edges of a pig organ to force it to work in a human. But what does that do to the pig? How does it affect their health?” she [bioethicist L. Syd M Johnson] says. “The environments in which these pigs are raised for xenotransplantation necessarily deprives them of many of their basic social, psychological and physical needs.”

But humans do have a higher moral value than animals, and if we can eat bacon and pork chops, we can certainly use pig organs to save lives. Besides, pig heart valves are already being transplanted to humans, so what would the difference be if we used more of the pig?

The only serious ethical objection I see — assuming proper and careful informed consent — is the potential for a porcine virus to cross the species barrier. That’s a real safety issue that must be addressed in clinical trials.

So, let the xenotransplantation experiments continue. If researchers can successfully perfect the process, the urgent need for human organ donations will lessen, and the waiting list to receive the “gift of life” might one day be erased. That would be great for organ recipients and for the preservation of morality in medical ethics.