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Alternatives to Xenotransplantation

Organs should be donated by humans, not stolen from animals

Companies trying to develop pig organs for human transplant, such as Cambridge-based Imutran Ltd. , have claimed that pig organs are the only way to meet the growing demand for organ transplants. Indeed, the lengthy waiting list for organs is cited as the reason for developing xenotransplantation in the first place. However, a closer examination of alternative approaches to xenotransplantation reveals that there is huge scope for improving the supply of human organs.

Strategies to improve the supply of human organs include:

  • Increasing the numbers of people carrying donor cards. Opinion polls consistently demonstrate that about three-quarters of the British public are willing to donate their organs in the event of their death. However, only a fifth of the population actually carry organ donor cards. (Call Freephone 0800 555 777 for copies of NHS Organ Donor Register leaflet and donor dard.)
  • Improving the management of the organ retrieval system. A well-funded decentralised network of transplant co-ordinators in Spain has resulted in an ìimpressiveî increase in Spainís transplant rates, which almost doubled over a six year period (1989-1995). The improvement is that much more impressive because it occurred despite a decrease in the number of road traffic deaths. [1]
  • Clarifying the currently muddled legal situation regarding organ donation, which is currently governed by the outdated Human Tissue Act 1961.
  • Reassessing the criteria for suitable organ donation. At present cadaveric human organs are harvested only from "heart beating" donors in intensive care facilities, but recent evidence shows that usable organs can be obtained from "non-heart beating" donors, and preliminary results suggest similar medium term success rates to "heart-beating" organs.Translated into national policy, this finding could dramatically increase the supply of organs. [2]
  • Changing the law. A review of the laws governing consent will increase the supply of organs. Options such as required request (legally obliging doctors to request organs) and presumed consent (the assumption of willingness to donate organs unless otherwise directed), among others, have been employed in other countries with considerable success. [3] In Belgium the introduction of a presumed consent system doubled the number of donors and transplants. A Manual of Kidney Transplantation (1994) estimates demand for kidneys, the organ for which the waiting list is the greatest, at 50 per million population (pmp) and states "it can be estimated that for most developed countries there exist up to 50 cadaver donors (or 100 cadaver kidneys) pmp per year if all potential donors are identified, managed appropriately and if consent is granted." [4]
  • Live Donation. The organ for which the shortfall is the greatest is the kidney, but this organ can, of course, be obtained from living donors. 20 year follow-up of living donors shows no evidence of statistically significant increase in prevalence of renal disease and recipients have better long term survival than those receiving cadaveric transplants. [5] In this country under 10% of organs are obtained from this source, but in theory it could answer the entire demand for kidneys.

Extrapolating from a U.S. Government study, every year up to 31,000 deceased people in the UK could contribute to the supply of organs,[6] easily coping with the current waiting list of between six and seven thousand patients. What particularly worries Uncaged Campaigns is that hype about the prospects for pig organ transplants may further discourage the public from carrying donor cards and registering as donor cards. That would be a tragedy for patients waiting for organs as human organs will always be a far better option than an organ from another animal. This concern has also been expressed by bioethics reports such as the British Kennedy Report, and a Dutch Committee:

"The [Health Council of the Netherlands:] Committee [on Xenotransplantation], however, believes that... by far the best way of resolving the shortage in organs for transplantation is to increase the supply of human donor organs."
Xenotransplantation, Health Council of the Netherlands: Committee on Xenotransplantation, 1998

Prevention

The best way to tackle ill health is to prevent it in the first place. Lifestyle and environmental factors contribute to many instances of organ failure. Greater investment in the prevention of illnesses which may lead to organ failure will, in the long term, reduce the demand for organs. A seriously increased commitment to the reduction of smoking and alcohol consumption along with general improvement in diet could lead to a significant reduction in pulmonary and cardiac disease, hepatic failure and diabetes, which is a significant factor in the prevalence of renal failure.

Conclusion

The imbalance between supply of and demand for human organs can be reduced significantly, or possibly even eliminated by changes in policy. argument in favour of xenotransplantation ineffective. Although many of these changes are not without their own ethical implications they carry neither the dangers nor the cruelty intrinsic to xenotransplantation. Furthermore, the potential negative impact on human organ donation of any public perception of successful xenotransplantation could significantly affect allotransplantation, which must remain the treatment of choice.

Notes and references

[1] "Animal Tissue into Humans", Advisory Group on the Ethics of Xenotransplantation (AGEX), Department of Health, 1997, pp. 92-93.
[2] Nicholson M (1996) Kidney Transplantation from asystolic donors British Journal of Hospital Medicine vol 55 p51-52.
[3] Allen & Chapman, A Manual of Renal Transplantation (1994), p.22
[4] The Times 21/1/97
[5] Najarian et al (1992) The Lancet vol 340 88 p23-25
[6] From a report by the U.S. General Accounting Office (April 1998) on the state of organ procurement in the U.S.. The study suggests that were up to 147,000 (6% of deaths) potential donors in the U.S. in 1994, after adjusting for age and cause of death. The UKís population is approximately 20% of the U.S. population, hence the UK figure of 31,000

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Uncaged 1993-2012: This is the archived website of Uncaged. All information correct at the time of archiving - November 2012.