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Medical-ethical principles on xenotransplantation.

The spectacular advances in the field of allogeneic organ transplantation achieved in the course of the last 30 years have made it possible to improve not only the life expectation but also the quality of life of a large number of patients. Unfortunately, transplantation surgery has become a victim of its own success: in all countries the increasing demand has led to a considerable shortage of donor organs and consequently to increasingly long waiting lists. As a result, a certain number of patients who could have been helped by an organ transplant are dying. Understandably, alternatives to allotransplantation are constantly being sought. One of these alternatives could be xenotransplantation, i.e. the transplantation of live cells, tissues or organs of one species into the organism of another species. Although in the years from 1990 to 1995 some scientists expected that within short time transplantations of animal organs into humans could be undertaken with real chances of success, today the majority are in fact more pessimistic. All the experimental organ xenografts that have been carried out up till now have proved unsuccessful in the short or medium term. In fact, this new biotechnology poses complex problems, in particular problems of an infectiological, immunological and physiological nature. There are as yet no answers to many of the questions that arise in this connection. It therefore seems to be appropriate for the Swiss Academy of Medical Sciences to define how one should approach this new biotechnology from the point of view of medical ethics. In this connection, respect for the human personality and the question of biological safety have to be given first priority: the risks to which not only the recipients but also those who come into contact with them are exposed have to be kept to the minimum. Man’s obligations towards animals also have to be taken into account. As a matter of fact, it is imperative to reflect on the following fundamental questions: – Bearing in mind our cultural and moral values, is the transplantation of animal organs, tissue or cells in humans desirable or acceptable? – What are the necessary ethical justifications for such a procedure? – What restrictions have to be established? – What priorities can a highly developed country such as ours reasonably set in the field of public health?