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News Archive
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donation, which is currently governed by the outdated Human Tissue Act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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