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Current controversy
Ethical analysis of the first porcine cardiac xenotransplantation
  1. Christopher Gyngell1,2,
  2. Megan Munsie3,4,
  3. Misao Fujita5,6,
  4. Carrie Thiessen7,
  5. Julian Savulescu2,8,9,
  6. Igor E Konstantinov1,10,11
  1. 1 Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
  2. 2 Biomedical Ethics Research Group, MCRI, Parkville, Victoria, Australia
  3. 3 Stem Cell Ethics & Policy Group, MCRI, Parkville, Victoria, Australia
  4. 4 Melbourne Medical School, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
  5. 5 Uehiro Research Division for iPS Cell Ethics, Kyoto University Center for iPS Cell Research and Application, Kyoto, Japan
  6. 6 Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan
  7. 7 Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  8. 8 Faculty of Philosophy, University of Oxford, Oxford, UK
  9. 9 Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  10. 10 The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  11. 11 Heart Group, MCRI, Parkville, Victoria, Australia
  1. Correspondence to Dr Christopher Gyngell, Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia; christopher.gyngell{at}mcri.edu.au

Abstract

In this article, we provide an ethical analysis of the first porcine cardiac xenotransplant, performed in Maryland, USA in early 2022. David Bennett was offered the experimental procedure after he was deemed ineligible for human heart transplantation and mechanical circulatory support, based on a history of non-compliance. It was reported that Mr Bennett’s previous instances of non-compliance were for medically non-life-threatening conditions years earlier, where the risks of non-compliance were not as high. We argue that, in Mr Bennett’s case, a history of non-compliance in a different context, should not necessarily rule him ineligible for a potentially life-saving treatment now. Furthermore, using previous non-compliance to exclude individuals from donor organs may have the unintended effect of placing the burden of testing xenotransplantation on those who are already disadvantaged. We then argue that it is not enough to rely on patient consent to ethically justify xenotransplantation research. Taking a broad ethical perspective is crucial when mapping a clinical pathway for xenotransplantation.

  • Ethics
  • Informed Consent
  • Tissue and Organ Procurement
  • Animal Experimentation

Data availability statement

There are no data in this work.

https://doi.org/10.1136/jme-2022-108685

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    Data availability statement

    There are no data in this work.

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    Footnotes

    • Contributors CG, MM, IK and JS conceived the project. CG wrote the first draft. MF, CT, MM, IK and JS reviewed the manuscript and made significant suggestions and edits. CG agrees to act as guarantor and be held accountable for all aspects of the work.

    • Funding This study was funded by Uehiro Foundation on Ethics and Education; Novo Nordisk Foundation Center for Stem Cell Medicine (Grant number: NNF21CC0073729); Victorian State Government- Operational Infrastructure Support (OIS) Programme.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.