Xenotransplantation, or the use of animal organs for transplant into human beings, is an issue that appears intermittently in the news. As I write, an American surgeon claims to have transplanted the heart of a pig into a human patient. The claim is that the operation has been 'successful' although it is early days.
I was a member of our government's advisory group on the ethics of the procedure. The advisory group consisted of scientists, a transplant surgeon, an animal welfare officer and a journalist. It was chaired by Sir Ian Kennedy, at that time professor of law and ethics at King's College, London. The advisory group reported in 1997 but our discussions are still relevant to the contemporary case. I shall refer to some of the considerations which arose in our discussions but introduce others. In any case, the views expressed are my own and not those of the advisory group.
Before discussing the concerns of the advisory group, it is interesting to examine a common consideration. It is commonly said in discussions of the rights and wrongs of xenotransplantation that most people accept without much thought that a pig's right to life is outweighed by the benefits its carcass will bring to human beings as food. So why do the same considerations not apply to transplanting its organs?
A possible answer to this common argument uses the ambiguous and often dismissed terms 'natural' and 'unnatural'. Certainly, it can be argued that while the eating of animal flesh may or may not be ethically right, it is 'natural' in the sense that many other animal species do it. Indeed, it has been claimed by some biologists that the human animal species is essentially carnivorous or at least omnivorous. So, if eating pork comes naturally, what can be wrong with using it for a medical benefit?
The 'doing what comes naturally' argument is relevant to the food context and requires a reply from vegetarians and vegans. I will not take up that issue here, but if the 'doing what comes naturally' claim is extended to support xenotransplantation, then it can be queried. For the transplanting of animal tissue into human beings is by no means doing what comes naturally. It can be regarded as 'unnatural' in the sense that it is a human artefact, a procedure planned in a laboratory well away from normal human-animal interaction.
This does not mean that it is morally wrong. Perhaps every medical intervention is in that sense 'unnatural'. It does, however, suggest that the reassuring analogy between eating animals and using them for transplantation is misleading.
The consideration (hardly an 'argument') that xenotransplantation is 'unnatural' is difficult to assess. Those who are impressed with the use of the terms 'natural' or 'unnatural' may go on to say that the scientists/doctors are 'playing God'. The same has been said of many life-saving therapies, and perhaps the use of the word 'unnatural' in this context simply reflects an understandable fear of the unknown.
But it is also possible to be too sophisticated here and too much impressed by science. What is being proposed is (a) inserting human genes into another species and (b) transplanting the organs of the species so treated into the human species. Such a process seems profoundly different from the usual medical interventions, so the term 'unnatural' springs to mind. But whether or not the terms 'natural' and 'unnatural' are persuasive either way, they do not mean the same as 'morally wrong'. And it was the ethics that the advisory group was charged to examine.
A preliminary question concerns the sense of 'ethics' involved. For some philosophers and most theologians, the ethical question is easy. They would claim that human beings have a 'higher moral status' than animals so animal suffering counts for much less than human suffering. I am not sure what the glib phrase 'higher moral status' means. If I survey human history with its religious persecutions, holocausts and illegal wars, I don't feel very comfortable with our 'higher moral status'. I remember a
New Yorker cartoon which showed an older dog reassuring a puppy by saying: 'Sure dogs go to heaven. It's not us that screwed up'.
There is a variant and cruder version of the higher moral status position. Some enthusiasts for xeno simply say: 'Animals are commodities – forget ethics, we can do this so we will'. This cruder position is at least not smug and self-congratulatory.
For other commentators in 1997 (perhaps still) 'ethics' is to be distinguished from what they would call 'practicalities'. Once we have settled the question of animal suffering, or indeed before we have done so, their argument runs: the problems of xenotransplantation are practical/technical rather than ethical. That suggests that the risk that the process might unleash dangerous pathogens which could kill thousands of people is just a practical problem!
Nowadays, knowing what we do about the possible origins of Covid and other pandemics, the unknown unknowns suggest that this is very much more than a 'practical' problem. Anyway, the advisory group took the view that the 'ethics' involved an 'all-things-considered-judgement' on the 'practicalities', which included the science, and the economics, as well as the extent to which it might relieve the shortage of donor organs. In short, as a matter of public policy, we had to go down the utilitarian route of weighing up the harms and benefits of the procedure.
The harms include first the cost. The cost is considerable in view of the process of producing a sterile transgenic pig for every recipient and the subsequent monitoring of the patients. What other treatments are we to cut back on in order to pay for this procedure for a small number of patients?
Second, the cost in terms of animal suffering is considerable. There is a view, as I said above, that animals are disposable commodities. The existence of the veal and meat industries exemplifies widespread acceptance of that position. If we go down that route, the cost in terms of animal suffering can be discounted. On the other hand, it is also possible to think of animals as possessing inalienable rights. The advisory group took a middle position, that animal suffering must be weighed against benefits to humans and that in this respect at least xenotransplantation is justifiable.
I disagree with the advisory group on that issue. I do not endorse the view that animals have inalienable rights, but it seems to me that the amount of animal suffering involved in the process of creating transgenic pigs is unacceptably large weighed against the alleged benefits to some human beings. It should also be stressed that while our advisory group ruled out the use of primates (chimpanzees, etc) as source animals for organs, the group accepted the use of primates for experimental procedures and trials. I do not know the US position on this but I hardly think it is stricter than our own. The idea that we can use a primate for experimental purposes I find totally unacceptable.
As our meetings progressed and we learned more about the procedure, most of the group at the lunch break moved to the vegetarian sandwiches.
There are other considerations which the advisory group did not consider but which I believe are relevant to any cost/benefit analysis of a policy of xenotransplantation. We are familiar with the idea that medical developments liberate us from the bondage of disease. The idea is widely accepted because it is to a great extent true. On the other hand, it is at least arguable that the main determinants of ill-health are social. It is well-known that obesity, lack of exercise, pollution and so on are major contributory factors to heart disease and many other diseases. And a major cause of these and many similar contributory factors is poverty or the underlying lack of equity in the distribution of the resources which make life worthwhile. But a good diet and exercise, not to mention higher taxation, are not sexy whereas the gee-whizzers of surgical skills are.
Indeed, for those who prefer the route of surgical skills and science, their aim should be to increase the number of human donors, and to work on the possibilities of mechanical and other means to improve heart function.
It must also be remembered that while medical skills and technology may be among the factors which free us from the bondage of disease, they can also enslave by keeping us alive with a poor quality of life. There is an ambivalence within the liberating power of medical technology. In my book,
Quality of Life, I have discussed the delusion that quality of life is a medical preserve and can be measured on a scale 1-10.
Robin Downie is Emeritus Professor of Moral Philosophy at the University of Glasgow
