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Alternatives to Xenotransplantation

Proponents of xenotransplantation insist that using animals for spare parts is the only solution to the perceived human organ and tissue shortage. But there are safer, more cost-effective, and humane alternatives to xenotransplantation that are not being adequately explored. Below are some of them.

  • Prevention
    Ironically, it is precisely because we eat too much bacon and pork chops, and have unhealthy lifestyles, that pig organ transplants are being considered. Top nutritional and health experts now agree that a diet rich in saturated fat from animal products (meat, dairy, butter, etc.) is one of the major causes of heart disease, cancer, stroke, noninsulin dependent diabetes, and obesity.1 In 1997, researchers suggested that 100,000 first-time heart attacks could be averted by the year 2005 if Americans simply reduced their average saturated fat intake by one to three percentage points.2 Lifestyle changes have proven capable of reversing and controlling many chronic diseases.3 Diabetes, for example, is the most common condition found in patients who need kidney transplants. A 1999 study revealed that a strict vegetarian diet and regular exercise can control type 2 diabetes.4 Several researchers, including Hans-Michael Dosch, an immunologist at Toronto's Hospital for Sick Children, and Outi Vaarala of the National Public Health Institute in Finland, have linked Type 1 diabetes with early intake of cow's milk.5 Alcohol-related cirrhosis and alcoholic hepatitis are the most common forms of fatal liver disease in the US, which could be prevented through avoidance of alcohol. Similarly, about 5,000 intravenous drug users develop a chronic and potentially fatal form of hepatitis C every year which could be prevented through avoidance of drugs or needle sharing.6 If implemented on a grand scale, population based prevention programs could drastically curtail chronic disease rates. Preventing disease before it begins would shrink the number of people on transplant waiting lists, reduce the demand for human organs (and surgical procedures of all kinds), save money, and eliminate the prospect of dangerous cross-species transplants.

  • Improving Success Rates of Human-to-Human Transplants
    Chronic rejection remains a major problem in human-to-human transplants. Roughly 50% of transplanted human organs are rejected and fail within five years.7 Before embarking on dangerous and more complex cross-species transplantation technologies, it would be wise to try to perfect existing allotransplantation techniques.

  • Improving Organ Delivery System
    A General Accounting Office report on organ donation (April 1998) found that the U.S. Health Care Finance Administration (HCFA), which sets performance standards for organ procurement organizations, has not accurately determined the number of usable organs in the U.S., and that number may be much higher than previously thought.8 Improving the organization and performance of organ procurement agencies, instituting nationally standardized hospital procedures to ensure that all potential donors are identified, that every family is approached about the possibility of organ donation, and that the request is properly structured,9 and launching public education campaigns to increase public awareness about organ donation would help considerably. For example, Illinois spends $1 million annually on organ donor TV ads, and has more residents on its organ donor registry (4.5 million) than any other state.10

  • Increasing Cadaveric Organ Donation
    In 1998, Yong W. Cho, et al. reported in the New England Journal of Medicine, that cadaveric organ donation — using kidneys from newly deceased people whose hearts have stopped beating (as opposed to organs from brain-dead donors with beating hearts) — could increase the supply of kidneys two-to-five fold.11

  • Kidney Transplantation From Living Donors
    Kidney transplantation from living donors has been successfully performed in the U.S., and is associated with an 85% increase in rate of organ donations from living donors. In Norway, between 45–50% of transplanted kidneys come from living donors.12 Liver transplantation from living donors has also been performed successfully. Livers can regenerate to almost their normal size in a matter of weeks.13

  • Expanding Donor Criteria
    Coleman-Musser, et al., found that kidneys and livers can be transplanted from older donors with positive outcomes.14

  • Split Organ Transplants
    Split organ transplants of livers from cadaveric donors have been successfully performed in Israel and elsewhere. These transplants could save two lives instead of one and reduce the number of people on transplant waiting lists.15

  • Financial Incentives
    Lloyd Cohen, Professor of law at George Mason University in Virginia, claims that, the U.S. organ shortage could be alleviated by creating financial incentives or rewards for donors and/or their beneficiaries.16 For example, Congressman James Greenwood of Pennsylvania has introduced legislation to use federally-financed life insurance programs as an incentive for people to donate their organs.17 Some estimate that such financial incentives could produce up to 80,000 organ donations each year.

  • Presumed Consent
    Many nations, including Austria, Spain, Belgium, and Singapore, have seen organ donation rates soar after the passage of "presumed consent" laws which assume that citizens will donate their organs after death unless they "opt out."18 Dr. Phil Berry, an organ transplant recipient and past President of the Texas Medical Association, the British Medical Association, and Ronald Davis, the North American editor of the British Medical Journal, have published views in favor of "presumed consent." Very little research has been done to determine the feasibility of such legislation in the U.S. "Mandated choice" laws require citizens to declare whether they want to donate their organs or not. Such laws produced 600,000 new donors in Sweden and 150,000 in Denmark.19 One U.S. survey suggested that 90% of Americans would support a "mandated choice law" and over 60% would support a "presumed consent" law.20 Public debate is needed to discuss the merits of these laws in the U.S.

  • Innovative Research

    1. Because human embryonic stem (ES) cells have the capacity to develop into any type of tissue in the body, including internal organs, researchers and bioethicists say that the cells could be cultured to grow unlimited supplies of human tissue for transplant and, eventually, whole human organs.21 The cells can be obtained from cadavers and in vitro fertilization clinics which destroy huge numbers of fertilized embryos each year.22

    2. Scientists at the Medical College of Virginia in Richmond froze liver cells from donated organs that were unsuitable for transplantation, and infused them into patients with liver damage. Seven out of 12 patients survived long enough to have a whole organ transplant and one patient made a full recovery with the cells alone.23

    3. A consortium of seven Seattle-area research centers have formed the Seattle Human Islet Transplantation Project, to transplant human (as opposed to porcine) pancreatic islet cells into human diabetics in an attempt to treat the disease.24

    4. Dr. Jayanta Roy Chowdhury and colleagues at the Albert Einstein College of Medicine in New York say that an injection of liver cells may preclude the need for whole organ transplantation.25

    5. Reuters reported that about 75% of heart disease patients who undergo a procedure called ventricular remodeling — in which a section of heart muscle is removed and reshaped — can be taken off the transplant waiting list.26

  • Cloning Human Organs
    Some have suggested that, cloning human tissues and organs from a patient's own cells, would eliminate the prospect of cross-species transplants, as well as the problem of hyperacute rejection, theoretically doing away with toxic immunosuppressive medications.27

Dr. Jonathan Hughes, professor of political thought at the University of Manchester, U.K., writes that, "a moratorium should be imposed upon xenotransplantation procedures at least until possible avenues for increasing the supply of human organs have been exhausted and until a more reassuring judgement can be reached on the prospects for preventing and containing transmitted infections."28


References

1 R.J. Deckelbaum, et al., "Summary of a Scientific Conference on Preventive Nutrition . . .," Circulation: The Journal of the American Heart Association, Vol. 100 (July 27, 1999): 450-6; Wayne R. Bidlack, "Interrelationships of Food, Nutrition, Diet and Health . . .," Journal of the American College of Nutrition, Vol. 15, No. 5 (1996): 422-33.

2 Gerry Oster, David Thompson, "Estimated Effects of Reducing Dietary Saturated Fat Intake . . .," Journal of the American Dietetic Association, Vol. 96, No. 2 (February 1996): 127-31.

3 See Dean Ornish, et al., "Intensive Lifestyle Changes for Reversal of Coronary Heart Disease," Journal of the American Medical Association, Vol. 280, No. 23 (December 16, 1998: 2001-7.

4 A. Nicholson, et al., "Toward Improved Management of NIDDM . . .," Preventive Medicine, Vol. 29, No. 2 (August 1999): 87-91.

5 See O. Vaarala, et al., Diabetes, Vol. 48, No. 7 (July 1999): 1389-94.

6 A. Fano, et al., Of Pigs, Primates and Plagues: A Layperson's Guide to the Problems With Animal-to-Human Organ Transplants, (Medical Research Modernization Committee, 1997).

7 David Stipp, "Replaceable You," Fortune, November 25, 1996, pp.131-138.

8 General Accounting Office, Organ Donation: Assessing Performance of Organ Procurement Organizations, (GAO, Washington, DC, April 8, 1998).

9 W. DeLong, "Options for Increasing Organ Donation: the Potential Role of Financial Incentives, Standardized Hospital Procedures, and Public Education to Promote Family Discussion," Milbank Q, Vol. 73, No. 3 (1995): 463-79.

10 Jim Ritter, "What Will Make You Be An Organ Donor?" Chicago Sun Times, November 5, 1999, p.6.

11 Y.W. Cho, et al., "Transplantation of kidneys from donors whose hearts have stopped beating," New England Journal of Medicine, Vol. 338, No. 4 (January 22, 1998):221-5; Associated Press, "Study Supports Expanding Supply of Kidney Transplants from Cadavers," January 21, 1998.

12 Anon, "Renal Transplantation From Living Donors," British Medical Journal, (3 February 1999): 409-10; Anon, "Drive to Increase Live Kidney Donors," BBC News Online, January 27, 2000.

13 Richard Saltus, "2 Donors Give Part of Their Livers," The Boston Globe, December 12, 1998, p.B1.

14 Coleman-Musser, et al., "Discard Rates and Transplant Outcomes in Organs Recovered From Older Donors," J. Transpl. Coord, Vol. 7, No. 4 (December 1997): 190-4; M.L. Jordan, et al., "High-Risk Donors: Expanding Donor Criteria," Transplantation Proceedings, Vol. 31 (1999): 1401-3.

15 Iris Krauz, "Donated Liver Split for Two Patients," The Ha-aretz, Israel, April 22, 1999.

16 See Lloyd Cohen, Increasing the Supply of Transplant Organs: The Virtues of an Options Market (Texas: R. G. Landes, 1995.

17 Patricia M. La Hay, "Organ-Donation Bill Would Pay for Life Insurance," The Philadelphia Inquirer, November 22, 1999, p.B1.

18 Ian Kennedy, et al., "The Case for Presumed Consent in Organ Donation," The Lancet, Vol. 351, (May 30 1998): 1650-2.

19 Moussa Awounda, "Swedish Organ-Donation Drive Set for Success," The Lancet, Vol. 347 (May 18, 1996): 1401.

20 A. Spital, "Mandated Choice: The Preferred Solution to the Organ Shortage," Archives of Internal Medicine, Vol. 152, No. 12 (December 1992): 2421-4.

21 J. Gearhart, "New Potential for Human Embryonic Stem Cells," Science, Vol. 282 (6 November 1998): 1061-2; Anon, "Alternative Ways of Meeting Demand," Nature, Vol. 391 (22 January 1998): 325; Anon, "The Politics of Embryos," The Washington Post, Op-Ed, February 21, 2000; National Bioethics Advisory Commission, Ethical Issues in Human Stem Cell Research, (NBAC, Rockville, Maryland, September 1999).

22 Anon, "[Phoenix] Clinic Plans to Destroy Unclaimed Embryos," The New York Times, July 13, 1999, p.D10.

23 Anon, "The Frozen Cells That Heal Sick Livers," New Scientist, December 9, 1999, p.5.

24 Carol Smith, "A New Way to Attack Diabetes," Seattle Post-Intelligencer, August 16, 1999, p.A1.

25 Anon, "Cell Injection May Help Some Liver Diseases," Reuters, May 14, 1998.

26 Anon, "Surgery Staves Off Heart Transplant," Reuters, March 17, 1997.

27 See www.humancloning.org and Anon, "Yes to Cloned Tissue," New Scientist, December 12, 1998: 5.

28 Jonathan Hughes, "Xenografting: Ethical Issues," Journal of Medical Ethics, Vol. 24 (1998): 18-24.