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Xenotransplantation: How do we balance human well-being and animal welfare?

Updated: Aug 8


Do the lives of humans and nonhuman animals hold the same value? With the ongoing improvements in the potential solution of xenotransplantation, the transplantation of animal organs into human recipients, we must ask ourselves this question. As we strive to address the critical organ donor shortage and save human lives, we are compelled to examine the ethical implications of such advancements and consider whether the benefits to humans outweigh the moral costs to animals. This question challenges our perception of fairness and nonmaleficence, urging us to confront the complex balance of medical progress and ethical responsibility in an ever-evolving world.


Table of Contents

  • Abstract

  • Introduction

  • Scientific Background

  • Regulations and Ratifications of The Food and Drug Administration

    • Skin Xenotransplants

    • Heart Xenotransplants

    • Kidney Xenotransplants

  • Animal Sentience

    • Awareness of Surroundings

    • Stress and Isolation

    • Memory

    • Pain

    • Emotions/Fear

  • Ethics in Utilitarian Spirit - Fairness

  • Ethics in Utilitarian Spirit - Nonmaleficence

  • Conclusion

  • Individual Opinion


Introduction

In 2003, my aunt received a diagnosis of nephrotic syndrome, a kidney disorder that excretes excess protein in the urine. Her condition deteriorated over the last three years, requiring a transplant. The prolonged dialysis and waiting period for a kidney provided me with a comprehensive understanding of the transplant process. This experience urged my family and I to explore alternative avenues to improve the quality of life for my aunt — one where she would not have to attach herself to a peritoneal dialysis device in constant four hour increments. Eventually, after three years of dialysis, my aunt was fortunate to undergo a kidney transplant, a relatively short time frame compared to the average wait of 3-5 years. 


In the United States alone, there are currently over 100,000 individuals like my aunt, awaiting organ transplants. Approximately 17 of them die each day while on the waiting list (“Organ Donation Statistics” 1-2). For this reason, many researchers and transplant surgeons have been looking towards the development of xenotransplantation to address this issue.

Xenotransplantation, the donation of tissues and organs from an animal to a human recipient, holds the potential to significantly expand the pool of available organs and possibly offer more financially accessible, life-saving alternatives for those facing critical medical conditions. Industrially breeding animals, such as pigs, solely for the purpose of harvesting their organs challenges the value of fairness. The notion of fairness is commonly associated with delivering impartial treatment, but the implementation of xenotransplantation raises complex ethical questions about the treatment of animals versus humans. Should the value of a human’s life hold greater significance than the value of an animal’s life? Additionally, when there is harm being done to animals to benefit humans, a complex dilemma is created on determining whether or not nonmaleficence, the duty to do no harm, is truly being practiced. This paper will focus on the ethics of navigating the balance between enhancing organ accessibility for those who are in need of a transplant and animal welfare in the ongoing development of xenotransplantation. How do we maintain the wellbeing of animals while aiming for the goal of minimizing the population on the organ donation waiting list in the case of xenotransplantation? 


When exploring this question, I will employ methods that prioritize the quality of life for both humans and animals. My approach will focus on maximizing the benefits received by stakeholders throughout their lifetimes using the framework of utilitarianism. By doing so, I aim to provide a comprehensive analysis that seeks to achieve the greatest good for the greatest number, while also upholding ethical standards that protect both humans and animals involved in xenotransplantation.


Scientific Background

In order to fully grapple with the advanced use of animal organs to sustain human recipients, we must first understand the science behind it. Pigs have been identified to have similar physiological components when compared to humans, making them the ideal candidates for alternative organ/tissue options. Using CRISPR-cas9 technology, scientists are able to introduce human complement regulatory proteins into pig cells to reduce the binding of human serum antibodies. Additionally, they have added human thrombomodulin, a thrombin receptor that acts like a natural anticoagulant, and an endothelial cell protein C receptor to control blood clotting. Scientists have also introduced anti-inflammatory proteins and included human CD47, a protein that is fundamental in cellular functions like apoptosis, to further aid in organ compatibility and minimizing rejection risks that can occur during transplantation.  To put it simply, scientists are able to now edit roughly ten or more genes to suppress immune responses, prevent blood from coagulating, reduce inflammation, and enhance organ compatibility. This presents the first chance in organ transplantation to alter the donor instead of solely addressing the recipient. 


Dr. Megan Sykes, Director of the Columbia Center for Translational Immunology claims: 

You can quality control your donor. You don’t have to wait for somebody to pass away for an organ to be available. This is in the future, but you can start to think about transplanting people at an earlier stage of their disease, when they haven't developed all the complications of their heart failure, for example. And so their liver and their kidneys are still in good shape, and you obtain a much better outcome, better quality of life. So that’s the golden future of xenotransplantation. (Chang 4)

Regulations and Ratifications of The Food and Drug Administration


When evaluating the use and developmental stage of xenotransplantation, it is crucial to examine the role of the Food and Drug Administration (FDA). First, the FDA exercises regulatory control over all xenotransplantation products, which includes live organs, tissues, or cells sourced from nonhuman animals. This also encompasses materials related to xenotransplantation products, whether used in encapsulated form or involving ex vivo contact between nonhuman live organs, tissues, or cells and human body fluids, cells, tissues, or organs intended for human recipients. If xenotransplantation products are undergoing clinical testing, it is crucial to ensure that a thorough investigational application is in place. There are several recent examples of FDA approvals for xenotransplantation products and procedures.


  1. Skin Xenotransplants

A notable example is XenoTherapeutics, a foundation whose mission is to solve the global shortage of organs and tissues for transplants. In 2018, they were approved and cleared by the FDA for clinical studies on realSKIN, the temporary coverage mechanism for patients with severe burn wounds. Due to the extreme prices of cadaveric skin, the short supply, and the high risk of organ failure and mortality for patients with sever burns, realSKIN was developed to promote autologous skin regeneration of burns that affect different layers of the skin. The FDA has classified realSKIN as an orphan drug and marked it as the first live cell xenotransplant product to be recognized as a regenerative medicine advanced therapy. So far, XenoTherapeutics has completed the Phase I/II of their clinical trial studying 25 patients and are moving onto Phase III, where they will include double the number of participants (XenoTherapeutics, Inc.).  


  1. Heart Xenotransplant

Another demonstration of the capabilities and requirements for the FDA’s approval is the case of David Bennett Sr. He was a 57 year-old patient with a life-threatening arrhythmia and did not qualify for a traditional heart transplant due to his past history of attempted murder. However, the Food and Drug Administration (FDA) gave emergency authorization for him to receive a genetically modified pig heart at the University of Maryland School of Medicine on New Year’s Eve since it was his last chance at survival. As mentioned earlier, the pig carried 10 genetic modifications – four genes were initially inactivated, including one that encodes a molecule that causes an aggressive human rejection response. Then, another gene was inactivated to prevent the pig’s heart from continuing to grow after it was implanted. In addition, five to six human genes were inserted into the genome of the pig. David Bennett lived for an extra two months due to the porcine organ and the failure was because of factors other than rejection, more specifically, immunocompromisation from his poor health before the transplant and an unprecedented porcine cytomegalovirus that could have initiated an inflammatory response.

 

  1. Kidney Xenotransplants

Transitioning to even more recent developments, on March 16th, 2024, a 62-year-old male, Richard ‘Rick’ Slayman, received the first ever successful porcine kidney transplant. He had end-stage kidney disease (ESKD) from Type 2 Diabetes and hypertension so the procedure was performed under a single FDA Expanded Access Protocol (EAP). This protocol allows a single patient or group of patients with serious, life-threatening illnesses to attempt experimental treatments when no alternative treatment options or therapies exist. The porcine kidney was provided by eGenesis of Cambridge, Mass., from a pig that had 69 genomic edits using CRISPR-Cas9 technology. Learning from David Bennett’s case, scientists developed methods to deactivate porcine endogenous retroviruses (PERVs) within pig donors, effectively eliminating the risk of PERV transmission to humans during xenotransplantation procedures. This modified organ showed success in studies revolving around monkeys, as the monkeys remained alive for an additional two years. 


Originally, Slayman received a traditional human kidney. However, it failed after five years. His extensive time undergoing dialysis treatments, frequent hospital visits due to blood clot complications, and other vascular issues led to his participation in pioneering studies in xenotransplantation, specifically focusing on transplanting porcine kidneys into human recipients. There were some bumps on the road. On the eighth day after the procedure, doctors discovered that his white blood cells began to infiltrate the organ inducing signs of cellular rejection. Slayman’s medical team initiated medications, and his body started responding positively to the treatment. As a precaution against potential rejection episodes in the future, they also increased the immunosuppressive treatment he will continue for the future. Unfortunately, Slayman died on May 11th, around two months after the surgery was performed. The cause of his death is still being uncovered by pathologists and the hospital has stated that the transplant “no indication that it was the result of his recent transplant” (Hughes 1). 


The final case I’ll discuss is of a 54 year-old woman, Lisa Pisano. She suffered from both end-stage kidney disease and heart failure which led to her experiencing frequent episodes of cardiac arrest, requiring resuscitation each time. She described feeling “miserable” (The Associated Press 5), which motivated her to consider undergoing this experimental surgery. Her heart failure made her unsuitable for a conventional kidney transplant because her chances of survival were deemed too low even with the transplant. However, while on dialysis, she also didn’t meet the criteria for a heart pump, known as a left ventricular assist device (LVAD). Therefore, the FDA approved her to undergo the two procedures together: a xenotransplant and a heart pump, once again, under the FDA Expanded Access Protocol, similar to Richard Slayman’s case. She received the LVAD on April 4th and then the pig kidney transplant on April 12th. 


“I feel fantastic” said Lisa Pisano on a Zoom meeting with the press (Mullin 1). To date, she has not exhibited any signs of rejection, and doctors are hopeful that she will be able to return home and spend quality time with her family.


These recent developments underscore the imminent reality of xenotransplantation and emphasizes the promising strides being made in medical science toward overcoming organ shortage challenges. These initial steps mark the beginning of a journey aimed at making xenotransplantation a widely accepted procedure. However, amid these advancements, it is crucial to pause and reflect on the ethical implications of this innovation. Considering the perspectives of all stakeholders, what are the ethical considerations that society must not ignore?


Animal Sentience - Specifically amongst pigs

Sentience can be defined in different ways by different theorists. In terms of this paper, sentience will be regarded as conscious experiences. For pigs, this is broken down into five categories of studies: Awareness of surroundings, stress and isolation, memory, pain, and emotions. 


  1. Awareness of surroundings

Two studies have shown that pigs are able to recognize the pigs that they are surrounded by. The first study involved 12 litters of piglets and aimed to investigate social recognition in pigs. In the familiarization process, piglets from different litters were given the opportunity to interact through netting-separated pens. After this process, some litters remained in their original pens, while others were moved to new pens. Testing revealed that piglets spent more time investigating unfamiliar piglets than those they had met before, indicating recognition. (“Pig sentience.” 6)  The second study, conducted by de Groot in 2001, explored the impact of introducing pigs to unfamiliar companions. Pigs were either paired with unfamiliar pigs or with littermates. Pigs mixed with unfamiliar counterparts exhibited a reduced immune response to a disease they had been vaccinated against, along with more clinical signs of infection. Male pigs paired with unfamiliar pigs displayed increased fighting behavior and higher stress-related hormone levels. These findings suggest that introducing pigs to unfamiliar companions induces stress, as evidenced by compromised immune responses and behavioral changes (7). 


  1. Stress and isolation

Researchers conducted a study that examined the impact of isolation-induced stress on piglets and how their individual personalities influenced their responses to being alone. Female piglets, aged 2-4 days, were categorized into two personality types based on their reactions when placed on their backs. “Reactive” piglets made two or fewer attempts to escape, while “proactive” piglets made five or more attempts. These personality types reflect different coping styles in response to threats. Reactive piglets exhibited a more passive response, while proactive piglets were more active and inclined to escape or fight (7). Researchers then observed the stress responses of piglets that were separated from their litters at different ages. They discovered that all piglets, irrespective of their personality types, exhibited signs of stress when isolated. This was characterized by elevated cortisol levels and a drop in body temperature. The piglets also displayed increased exploratory behaviors and vocalizations, indicating distress and a search for their missing companions.

Interestingly, although reactive piglets initially exhibited a more pronounced stress response, proactive piglets seemed to find extended isolation more challenging, as they displayed sustained elevated cortisol levels (6-7). This study highlights how pigs are able to feel stressed, regardless of their individual personality traits.


  1. Memory

Investigations have shown how pigs are capable of learning where food is hidden and even after a period of time, remember its location. Eight male pigs were put into a trial to search for hidden food. Once the pigs located the food, they were placed into the arena, again, to search for food that was hidden in the same place. The pigs steered clear of empty locations they recalled and quickly relocated the food (8). In addition, the researchers introduced uninformed pigs (those unaware of the food’s location) into groups with informed pigs. The uninformed pigs rapidly learned to follow the informed ones and grasped the pathway to the food. Subsequently, they demonstrated that they had memorized the location and could replicate the path initially shown by the informed pigs (8-9).


  1. Pain 

Numerous scientific studies have conclusively shown that pigs experience pain during castration. This is supported by the presence of pain receptors (nociceptors) in their testes, which enable them to sense and transmit pain signals. Administration of local anesthesia during castration has been found to significantly reduce pain responses in pigs, akin to anesthesia's pain-relieving effects in humans. Observations of pig behavior post-castration reveal a range of indicators such as abnormal movements, postures, reduced feeding, and vocalizations like squealing, all pointing to distress and discomfort. Importantly, these signs of pain are consistent across pigs of varying ages, indicating that castration induces pain regardless of developmental stage (14-15). This evidence emphasizes the need for ethical considerations and pain management strategies in pig organ harvesting.


  1. Emotions/Fear 

Pigs are capable of experiencing negative emotions such as fear, as evidenced by their behavior when confronted with new and potentially dangerous stimuli. Explorations have shown that pigs exhibit signs of fear, such as being slow to approach and explore unfamiliar objects, as well as actively avoiding them. Administering an anxiolytic drug, which reduces anxiety and fear, has been found to mitigate these fear-related behaviors in pigs, confirming their experience of fear in certain situations. To assess fearfulness, researchers conducted a novel object test where pigs encountered new objects, sounds, and smells. Pigs not treated with the anxiolytic drug displayed avoidance behaviors, spent less time near the novel stimuli, and oriented more towards the exit, indicating fearfulness. In contrast, pigs treated with the anxiolytic drug showed increased feeding behavior, spent more time near the stimuli, and faced the feeding area, suggesting reduced fear and anxiety (15). These findings demonstrate that pigs can experience fear and that anxiolytic drugs can effectively alleviate fear and anxiety in pigs, much like their effects in humans.


Collectively, these sentient characteristics of pigs underlines the need for considerations towards their welfare and treatment in the xenotransplantation process. The depth of the pigs’ cognitive, emotional, and social capacities play a significant role when analyzing the ethical implications of using pigs for organ transplants, thereby emphasizing the importance of humane treatment and strict ethical standards.


Ethics in Utilitarian Spirit - Fairness

Currently, for human donors, an established system for organ allocation has been developed by NOTA (National Organ Transplant Act) and is in place to minimize the inequalities and underscore fairness in organ distribution and allocation. The dictionary definition of fairness is delivering impartial/just treatment. Hence, this system relies on voluntary actions and compliance of the transplant community, proving essential for ensuring that treatment decisions are made without bias or favoritism and thereby upholding the value of fairness. However, since pigs lack the ability to volunteer themselves in xenotransplantation, does this change the notion of fairness? 



One perspective to this question is that the fairness should be maintained under the definition. To maintain fairness in xenotransplantation procedures, both the animal donor and human recipient should receive “equal benefits”. Please note that “equal benefits” will be measured and defined by quality of life of both the animal and human. This perspective aligns with the biocentric view, which holds that all forms of life should receive equal consideration and extends inherent value to all living beings. Proposed by David Wendler and mentioned in the Kennedy Institute of Ethics Journal, a way to instill “equal benefits” can be through compensating for the harm inflicted upon animals. In this case, compensation does not refer to regular cash compensation but rather compensation with lavish living conditions such as opulent treatment, space, handling, and ensuring that animals are faced with the least amount of stress possible (Wendler 2). As a result, the pigs’ overall quality of life increases. Still, this raises the question of whether lavish treatment for animals holds the same value as the life of a human. 


This viewpoint can be considered as utilitarianism for animals and deontology for humans. Utilitarianism, a form of consequentialism, focuses solely on minimizing the harms that pigs receive. By compensating for the harm, death, and suffering caused by the experimental procedures, utilitarianism aims to justify these actions based on the overall welfare outcomes. In contrast, deontology for humans evaluates the inherent nature of actions and their adherence to moral rules, regardless of the consequences. By saving the lives of humans, whether or not it comes at the expense of pigs, the nature of this action falls accordingly with Kant’s deontological philosophy. This is attributed to Kant’s perspective that all human life is sacred and that no one should be killed under any circumstances (Yaganak 1). 


One may see these two moral frameworks of utilitarianism for animals and deontology for humans as mutually exclusive and incompatible. It may seem to contradict the biocentric argument that humans and animals should receive equal consideration. However, by incorporating Peter Singer’s principle of equal consideration of interests, this apparent contradiction can be reconciled. Singer’s principle suggests that the interests of all beings, human or non-human, should be given equal weight, but this does not mean that all beings are treated the same. Instead, it calls for the fair consideration of the welfare and interests of each party (Francione 3). Therefore, maintaining the definition of fairness in xenotransplantation requires a nuanced approach that respects both the utilitarian concern for animal welfare and the deontological respect for human life, ensuring that the interests of both animals and humans are fairly and thoughtfully balanced.


Another way an individual may be inclined to evaluate fairness between the animal donor and human recipient is through the anthropocentric belief that describes a human-centered approach, meaning that human life holds greater significance when compared to other non-human beings. Abrahamic monotheistic faiths such as Christianity, Judaism, and Islam are religions that are considered to use this perspective. The overlapping moral frameworks of these religions claim that the creations made by God are under the dominion humans.

Christianity, Judaism, and Islam all teach that man was created under God’s image and instructed to “rule over the fish of the sea and over the birds of the sky and over the cattle and over all the earth, and over every creeping thing that creeps on the earth” (Genesis 1:26). Following that, in Genesis 1:27, it states “God created man in his own image. . .”

These concepts are foundational to both religions, as seen in Hebrew words like “bara” (create) and “yatsar” (form) used in the creation story. The book of Genesis also holds that humans are deliberately created to perfect themselves and the world, viewing humanity as central to creation and given stewardship over the Earth. This responsibility is evident in Genesis 2:15, mentioning that we’re placed “in the garden to work it and to guard it.” The language used strongly suggests that we, as humans, hold a higher status than nonhuman beings and bear the moral responsibility to take ownership of and care for them.


Moreover, humans are depicted as the only beings capable of communicating with God through speech and prayer, reflecting a special relationship and dependence on divine communion. Humans also possess free will, creative thought, and cultural development capacities, highlighting their unique gifts and abilities. The Bible also assigns humans a high purpose and calling “for Him,” indicating a distinct role and significance not shared by animals. Furthermore, humans are portrayed as eternal beings, with existence beyond bodily death, reinforcing their eternal nature and importance in Christian and Jewish beliefs. Overall, these beliefs underscore the idea that humans have a unique and elevated role in the natural order, with a responsibility to use and manage the Earth’s resources in accordance with divine will.


For individuals who may not be religiously affiliated with Abrahamic faiths, many people believe that animals are “violable in the service of greater good” whereas humans are “fully inviolable” (Wendler 1).  This can be attributed to a multitude of reasons. One common view is that humans possess a more advanced mental capacity than animals. Humans are capable of complex communication, autonomous decision-making, and utilizing animals to achieve our objectives, leading some to believe that we carry a heavier moral weight. According to Kant’s moral theory, which emphasizes the importance of autonomous moral agency, only individuals who possess rationality and the capacity for moral reasoning are granted “full” moral status (“Kant’s Moral Theory” 1). Based on this reasoning, animals may not be considered to have “full” moral status, creating an imbalance between the moral status of animals and humans.


Consider the prevalent example of the subordinate roles animals play in animal testing for pediatric neuroblastomas. Before mice even begin their life, researchers use technology to genetically engineer these mice to develop this mutation for studies. Then, throughout their life, they are consistently given new drugs to test for human use. Ultimately, they either face death by tumor or death by experimental treatment. Conversely, human clinical trials on neuroblastomas operate under a more cautious protocol. Patients are extensively briefed about every facet of the trial, allowing them the autonomy to decide whether to participate. They also retain the right to withdraw at any point and are meticulously monitored for potential adverse effects. 


This comparison can be described as consequentialism for animals, deontology for humans. Consequentialism for animals means that there is not an upper limit placed on the harms that animals may permissibly receive. This places primary importance on the outcomes. The meaning for deontology for humans remains the same. When one follows these frameworks for analyzing the ethicality of xenotransplantation, they illustrate the perspective that humans hold greater significance than animals. Consequently, the notion of fairness should be recalibrated to tip the scales in favor of humans, prioritizing human life and wellbeing while recognizing the utility and instrumental value of animals in achieving these outcomes. This dual approach underscores the belief in the hierarchical value of life forms, where the ethical considerations for humans inherently outweigh those for animals.


Overall, addressing fairness in xenotransplantation requires considering the quality and value of life for both animal donors and human recipients, potentially through compensation for animals’ suffering. Having explored this ethical concept and its implications for xenotransplantation, it is crucial to examine another foundational ethical principle: nonmaleficence.


Ethics in Utilitarian Spirit - Nonmaleficence

Nonmaleficence is the bioethics principle of “doing no harm”. It is characterized by refraining from inflicting pain, suffering, and robbing others out of the fruits of life. Knowing this, should nonmaleficence even apply to a case like xenotransplantation when there is explicit harm imposed on animals for human benefit?


North Dakota National Guard
North Dakota National Guard

One perspective is that nonmaleficence does apply and xenotransplantation violates this principle by inevitably resulting in the killing of pigs for organ harvesting. Based solely on the dictionary definition of harm – “evil (physical or otherwise) as done to or suffered by some person or thing; hurt, injury, damage, mischief” (“Oxford English Dictionary”) – one may contend that killing constitutes as harm as it falls under this definition. Like aforementioned, pigs are sentient beings. They possess the feelings of stress, pain, and positive and negative emotions. Furthermore, they are capable of being aware of their surroundings and remembering the past. Recognizing pigs as sentient beings, their inclusion in xenotransplantation raises ethical concerns regarding the considerable risk of mental and physical strain, as it involves causing harm and suffering to these animals. Inflicting harm on sentient beings inherently contradicts the ethical obligation to avoid causing unnecessary suffering (although there may be cases where harm could be deemed necessary but should be approached with caution and justification). Killing pigs at the peak of their life for human benefit does not only harm the pig but also denies the inherent value of their life. If pigs are sentient beings capable of experiencing well-being, prematurely ending their lives for human purposes disregards their intrinsic worth, violating the nonmaleficence principle.


An additional harm that the process of xenotransplantation entails includes industrial-scale pig breeding. Taking a closer look, the intensified breeding practices required for a large-scale organ supply may subject pigs to overcrowded environments, limited space, and inadequate living conditions. In the meat consumption industry, pregnant sows are confined in tiny gestation crates, measuring a mere 0.6 meters wide and 2.1 meters long, where they cannot even turn around. Approximately 80% of sows endure this confinement during their four-month pregnancies, leading to severe physical and psychological distress. Despite the well-documented harm caused by gestation crates, their use persists in the U.S. pork industry, with some sows spending nearly their entire lives in these cramped and restrictive enclosures. This widespread practice reflects a concerning disregard for animal welfare, as acknowledged by various animal rights organizations and industry reports. Moreover, sows are transferred to equally confining farrowing crates shortly before giving birth, where they can only stand up or lie down but cannot move freely. This continuous cycle of confinement and restriction contributes to immense suffering for these animals, who are denied the opportunity to engage in natural behaviors. Pigs raised for meat also face distressing conditions, including mutilations like castration and tail docking performed without any pain relief. They are confined in crowded pens for up to six months until they reach market weight, enduring extreme weather conditions during transport to slaughter. Even regulations intended to protect animals, such as the Humane Methods of Slaughter Act, fall short in practice. Reports reveal that some animals remain conscious during slaughter, highlighting systemic failures in ensuring humane treatment (“An HSUS Report: The Welfare of Animals in the Meat, Egg, and Dairy Industries” 2-3). These statistics paint a picture of the pervasive harms and exploitation within the agricultural industry, shedding light on possible concerns surrounding animal welfare in the xenotransplantation industry. 


A counterargument to this perspective is that nonmaleficence does not apply because xenotransplantation does not truly violate this principle. This is because the dictionary definition of nonmaleficence is that a physician has a duty to ‘do no harm’ to a patient/human. It’s obvious that in this case, pigs are not patients nor are they humans.

Hence, one might contend that this principle does not apply to pigs. Furthermore, some bioethicists would make the distinguishment between sentience and sapience - the ability to be self-aware. They would argue that in order for killing to undeniably be deemed “harm”, the individual has to actually possess the desire not to be killed. Any animal that does not possess the cognitive ability to comprehend its own identity and existence over time, and thus lacks any desire or awareness of a continued existence, might not be considered harmed by being deprived of life. This argument posits that, in the absence of such cognitive awareness, the animal may not suffer from being killed, particularly if the death is administered painlessly.


However one may define and view the harms imposed on pigs during xenotransplantation, many people would still make the argument that the potential benefits to human health and medical advancements outweigh these ethical concerns. The contention is that by utilizing pig organs for transplantation, we can address the shortage of human organs, potentially saving numerous human lives.  As mentioned earlier, xenotransplantation holds the potential to significantly alleviate human suffering by providing an alternative source for organ transplants. A single human donor has the capacity to save up to eight lives through the donation of vital organs such as the heart, lungs, liver, kidneys, pancreas, and intestines. Pigs possess similar organs, suggesting the possibility of saving a comparable number of lives through xenotransplantation. To add on, xenotransplantation offers several other advantages that may tip the balance in favor of its benefits outweighing the harms. These include the prospect of reduced wait times for organ recipients, increased accessibility to transplantation procedures, and the potential to advance medical research and technology.

To reiterate the significance of addressing transplantation issues, the average time frame for a viable kidney spans from three to five years and the number of people who were on the patient waiting list in the U.S. for kidneys as of September 2023 was 88,551. The amount of transplants performed was a little over one sixth of that, at 15,927 (“Organ Donation Statistics” 1-2). 


A further positive aspect to consider is the potential integration of the meat consumption industry with the xenotransplantation sector. As previously discussed, pigs in the meat industry often endure cruel conditions. By implementing compensatory living conditions for pigs used in xenotransplantation, we can extend these improved standards to pigs in the meat industry. This would significantly enhance their welfare as they would have better living conditions than the statistics show. On top of that, integrating these two sectors could lead to a more efficient and ethical use of animal life. Instead of having separate groups of pigs for organ harvesting and meat production, we could use a single group for both purposes. This approach would not only reduce waste but also ensure that the entire animal is utilized, simultaneously providing life-saving organs and nourishment. By maximizing the use of each pig, we can make the process more sustainable animal life. This not only addresses ethical concerns but also meets human needs more effectively.


Nevertheless, it is important to note that porcine organs cannot be equivalent to human organs. Despite the fact that pigs intended for xenotransplantation are rigorously screened to be clinically and medically pathogen-free, recent research findings indicate that there is a prevalent misguided perception of pigs as “dirty” -  also regarded as the “ick factor”. This shows that xenotransplantation has the potential to create a hierarchy among organ donors, where some individuals might receive highly sought-after human organs while others may end up with less desired porcine organs. Nonetheless, this paper will not delve into the intricacies of distributive justice within the transplant system in the context of xenotransplantation. This includes considerations towards the beliefs of individuals who adhere to religions that prioritize the sanctity of certain animals’ lives.


A further rebuttal to this argument is that although xenotransplantation can extend human life, does the lifelong need for immunosuppressants, which lead to heavy financial burdens, and the potential of other risks, such as failure, zoonotic diseases, and infection, diminish the maximization of benefits in this procedure? It seems as if we are prioritizing quantity of life over quality.


Conclusion

This paper emphasizes the tension between human interests and animal well-being in xenotransplantation, prompting an examination of whether the medical industry should resort to animal solutions during times of shortage. As the dimensions surrounding fairness and nonmaleficence unfold, the discussion delves into the complex question of whether the potential benefits, such as addressing critical organ shortages and saving lives, justify the harm inflicted on sentient beings. Ultimately, this challenges the pursuit of medical advancements, such as xenotransplantation, by highlighting the need to navigate the delicate balance between addressing human health needs and ensuring the welfare of animals.


Considering the ethical dimensions of fairness in xenotransplantation, two distinct perspectives emerge. The first, advocates for fairness between animals and humans through a biocentric lens, proposing compensatory measures for potential harm to animals, aligning with utilitarianism for animals and deontology for humans. This compensation involves providing good living conditions to enhance the overall quality of life for pigs involved in xenotransplantation. The second perspective, rooted in anthropocentrism, prioritizes the significance of human life, often justifying how the scales should tip in human favor to make things fair. This is tied with a result-oriented approach for animals and a deontological stance for humans. The tension between anthropocentrism and the call for equal benefits prompts a critical examination of the ethical considerations in balancing human interests with the well-being of animals and whether animals lives should be sought for in times of crisis.


Under evaluation through the lens of the bioethics principle of nonmaleficence, xenotransplantation raises concerns about causing harm to sentient pigs. The killing of these animals for organ harvesting is seen as contradicting the principle, disregarding the intrinsic value of their lives. Industrial-scale pig breeding for this purpose intensifies these concerns, subjecting animals to overcrowded and inadequate conditions. Proponents, however, argue that the potential benefits of xenotransplantation, such as addressing organ shortages and saving lives, outweigh these considerations. Based of the utilitarian perspective, xenotransplantation maximizes the advantages, including reduced wait times for organ recipients, saving up to eight lives, and advancements in medical research. The examination of xenotransplantation involves weighing its potential benefits against the harm inflicted on sentient beings.


Individual Opinion

Utilitarianism is an ethical philosophy that advocates for maximizing wellbeing and benefits for stakeholders – in this case, the focus is on the pig donors and human recipients. Using this lens, I support the idea of xenotransplantation, as its development has the potential to significantly reduce the organ donation waiting list. The prospect of a single pig potentially saving up to eight lives, along with improvements in quality of life through innovations like xeno-skin donations, is truly remarkable. Drawing from a personal connection, I envision a world where my aunt has the opportunity to undergo a kidney transplant whenever and wherever she requires it. This kidney wouldn’t just serve the purpose of extending her life; rather, it would optimize her lifespan to the fullest extent possible, due to the genetic advancements enabled by CRISPR-Cas9 technology. In contrast to the present reality, where she endured a three-year wait and received a kidney from a death row inmate, the ideal scenario would involve her receiving a kidney meticulously tailored to her biological components.


That being said, I firmly believe in the importance of upholding animal welfare standards through measures that include providing animals with favorable living conditions. While some may argue that such compensation does not equate to the inherent value of an animal’s life, it’s crucial to acknowledge that it is a step in the right direction. I advocate for prioritizing the quality of life for these animals, recognizing that they are unable to prioritize quantity if they were to be used for organ transplantation.  By ensuring that animals are treated well and given environments that allow them to express natural behaviors and thrive, we can make meaningful strides in honoring their lives and well-being.


I would also recommend implementing limitations on the breeding population. Recognizing the profound implications of animal sentience, it’s imperative to prioritize animal welfare and ensure humane treatment to prevent them from bearing unnecessary human-induced burdens. By controlling the breeding population, we can reduce the surplus of animal use and alleviate the mental and physical strain on animals. Providing ample space for them to roam and live relatively freely can mitigate feelings of stress and fear, contributing to their overall well-being. Lastly, if this is proven to be possible, I would advocate for the intersection between the meat consumption industry and the xenotransplantation sector, as pigs are already utilized in agriculture. This way, waste and excessive pig usage can be avoided.


Works Cited

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