The Ethics of Xenotransplantation
A Televised Forum Hosted by
Dr. Margaret Somerville, McGill Centre for Medicine, Ethics & Law, Montréal, Québec
Alastair Gordon, The Islet Foundation
NETWORK STATION: GLOBAL
TIME: 12:00 REFERENCE: 244B1-4 LENGTH: 22 MIN.
DATE: 05 Mar 99
ARLENE BYNON: Xenotransplantation. The use of animal organs in human transplants could help with Canada's low rate of organ donation. Now the Commons health committee is holding public hearings right now to examine ways to improve the rate of donation. They've heard from a host of medical and ethical people with reservations on organ transplants. Today the case for and against the use of animal organs. We're joined by Alastair Gordon of Islet Foundation and from Ottawa, Dr. Margaret Somerville from McGill University Centre for Medicine, Ethics and Law. Welcome Dr. Somerville.
Dr. MARGARET SOMERVILLE / McGILL UNIVERSITY: Thank you.
BYNON: I know there has been bad weather so you're stuck there in Ottawa. Let me ask you first of all, what reservations, what should we be asking ourselves before we move more forward with this kind of transplantation?
SOMERVILLE: Well there's all of the usual reservations that we have about medical research which you know, are good reservations. They're to make sure when we do medical research we do it ethically. All of those apply to xenotransplantation. But there's two other reservations. One of them I find serious but not insurmountable. That is what we do to animals in order to make them suitable as donors of these organs. 'Cause these animals have a pretty terrible life. I think we have -- pigs are intelligent animals. It seems as though that's what we'll use. And so I think we have to be very sensitive to the issues surrounding that. Some people think we shouldn't use those animals at all in that way. The other set of issues relates to us. You see most medical research really only creates serious risks to the people who are the research subjects. But there is a possibility and we don't know whether this will occur or not, that you could transfer an infective agent from the pig into the person who gets the organ and that person could then spread it first of all to their sexual partners, maybe to their family and ultimately possibly to everybody in the population. That's what we're worried about.
BYNON: Okay. Let's just stop on that point because is there new information that humans and animals transfer more diseases than we know because you know, as many people say we have been using some aspects of animals' bodies like insulin or whatever for years. So what's different about it?
SOMERVILLE: Well because I mean, we don't know. That's the point. Look, I'm not an expert. I'm an expert to the extent that I'm an expert on anything is that once I'm given the scientific facts, I can manage to do an ethical and legal analysis of those. What we know here is a lot of very reputable scientists, eminent scientists say that we've got no idea what we might transfer when we say let's say a heart out of a pig and put the it into a human. There could be all sorts of unknown things. We know about some of the things that we could transfer and we could watch out for those. But the other thing that people were talking about this morning in the committee of the House of Commons was that it could even be that for instance a virus that's in the pig which might not hurt us could combine with a virus that's in us which possibly doesn't hurt us at the moment and then you could have something new and very dangerous. And so there's all sorts of unknowns that we're dealing with here.
BYNON: Now isn't that the case -- I mean, that's how people believe HIV. I mean it was prevalent in a monkey. It didn't affect the monkey. Somehow it got into a human --
SOMERVILLE: Yes. Well we've only be able to establish that authoritatively in the last few weeks. And also the other one that we're concerned about is mad cow disease. Now that's a kind of an unusual transfer between a sheep and cow. But that's two different species where that -- I mean they've lived together for as long as humans have lived with animals. There was never that transfer until we did something unusual feed the cows food that was made from the sheep. And so we're doing something here -- we're doing what we call crossing the species and immunological barrier. And that's very different from simply living with another animal.
BYNON: Okay. Okay. I'd like to turn over to Alastair Gordon with the Islet Foundation. You've just heard some of this. I mean, are you, you believe that this is a good thing as Martha Stewart would say. Do you not have any reservations about xenotransplantation?
ALASTAIR GORDON / ISLET FOUNDATION: Any reservations I would have about xenotransplantation would have to be driven by actual scientifically compelling information. In other words, I think it's fairly immoral to allow death and suffering to continue in the face of a completely unarticulated fear. A fear that has never once been demonstrated, never proven.
BYNON: But it happened with HIV in monkeys. Isn't that...I mean it has happened.
GORDON: Well if we take look at the examples of HIV in monkeys, there was a transfer of disease from an animal to a human. It did not occur as a result of xenotransplantation.
BYNON: I know but I think the example is clear that if you know, if it happened by accident, couldn't it happen when we do things on purpose?
SOMERVILLE: Could I just also interrupt here and just sort of say what we're looking at here in terms of ethics? You see I disagree with you that we've got to know about the risk. You see what we're saying is we should take what's called a precautionary ethic. We should be reticent to do this until we know it's reasonably safe and ethical to do it. Whereas what you're saying is let's do it until we found out it's unsafe. We've had so many bad experiences in the past when we've done that. I mean even if you look at our whole --
BYNON: Can you hang on Dr. Somerville? Let Alastair Gordon answer.
GORDON:: I think, Dr. Somerville, what I'm saying is we have a massive body of evidence that shows that there is not disease transfer between pigs and human beings despite about a 75 year history in which we provided innumerable pathways for that to occur.
BYNON: Do you mean the insulin?
GORDON:: For example, people with diabetes have injected insulin from pigs for the past 77 years. For about the first two decades that was a non sterile product. People with burns have been treated with living pig skin. People working in slaughterhouses have certainly been exposed to pig tissue getting into open wounds and those are people that have in many cases severely compromised immune systems at the turn of the century, including tuberculosis.
SOMERVILLE: Look I accept that. I'm not the expert in the transfer of these organisms or these infected agents. But if that's -- and I accept what you say is true -- but all of the people I listen to when I'm at these scientific meetings are world experts on immunology. And they know all of that and they're raising these concerns. And in fact the concerns are so great in Europe that it's very likely that Europe's going to put a moratorium on this.
BYNON: Okay. I just want to ask Alastair, do you think there should be control over it? Anything that would make -- you know, put your mind at rest about transferring these kind of diseases? Is there any kind of controls that we are doing?
GORDON:: Yes, there most definitely needs to be controls.
BYNON: And what are we doing now? Do we check things?
GORDON:: We're drafting xenotransplantation guidelines which will make sure that we are using purpose-bred pigs whose sole raison d'être is to be a tissue donor. And --
BYNON: What are these pigs like?
GORDON:: They are are kept under very sterile, very humane conditions. Just touching on Dr. Somerville's point of the ethics of using animals in this way, human beings have a long history of using pigs for suede, paint brushes and bacon. To use a pig to save a child from the horrors of diabetes or somebody from dying from liver disease is certainly to me a lot more ethically palatable than eating them and wearing them.
BYNON: Dr. Somerville, not a bad point there.
SOMERVILLE: No, no it's a different argument. You see, what you're mixing up the kind of life that the pig has with what you do with the pig after you killed it. I mean I agree with you that if we use pigs for other purposes then that helps to justify using them for this purpose. But those pigs could be for instance pigs that live anywhere and have a good life. You kill them and you use them for what you want to. These pigs are going to have a totally artificial, confined, terrible life. We know that but we still may be justified in doing it as I believe but not everybody agrees with that. You got to be careful with these arguments that you're very accurate about this points you're taking up. Comment
BYNON: Okay. Now Alastair, considering all -- let's talk about the justification of doing it in the first place. How low is our organ donation in Canada?
GORDON:: Well I think that we shouldn't really confuse xenotransplantation with a quick fix for low --
BYNON: I want to know what the problem is.
GORDON:: Well in part it is. I would say pigs do not represent a replacement for human organs for probably at least 10 years. Simply because there are major technological hurdles to transplanting a whole organ from a pig to a person, for example a kidney, a liver or heart.
BYNON: When it comes to organ donations, I mean that's the reason the Commons committee is taking a look at this. How long are the waiting lists?
GORDON:: Well I believe around there are three thousand people a year die who are on the list who have qualified for organs. So it's a very serious problem. But I don't want -- again, I don't want to be putting forward xenotransplantation as something that's going to remedy that in the next 10 years.
BYNON: But there are some scientists who believe that.
GORDON:: And they're absolutely correct. But they're not saying we'll do it tomorrow. Pig tissue as opposed to organs today could hold a very high degree of promise for curing diseases that were not normally cured through transplantation. For example, curing certain forms of liver disease, curing diabetes, curing Parkinson's and other neurological diseases. So we're not talking whole organ transplants, we're talking about transplanting very small masses of tissue.
BYNON: Okay. We're going to return. We will be back in a moment. We're going to continue with our look at human problems and animal organs. We'll be right back.
(ADS) (GRAPHIC): In October 1984, the living heart of a seven- month-old female baboon was transplanted into an infant who was nicknamed "Baby Fae" by the press, in the first introduction of xenotransplantation to the public.
BYNON: Let's go back to Ottawa. Dr. Somerville, I'm wondering about the psychological. Did anything come up at the Commons committee about the psychological damage of all this both for the donor and the families? I mean is there work being done in that area?
SOMERVILLE: Well the donor's the pig. I guess we didn't ask the piglets. (Laughs)
BYNON: Yeah, I mean the person receiving.
SOMERVILLE: The recipient. What would happen to people --
BYNON: Is there a human psychological kind of a factor here?
SOMERVILLE: I've only heard that briefly mentioned at some of the conferences I've been at on this. It wasn't discussed this morning at the committee. And I don't know very much about it. We do know that transplant recipients can sometimes need to have adjustment to the fact that they've got someone else's organ. And I suppose that would be at least as serious with an animal organ. I don't know. Maybe less. You might think it wasn't somebody else who was a walking around, thinking, you know acting person. Maybe it's less problematic. I've got no idea about that. Comment
BYNON: Okay. Alastair, is there any psychological factor? Have you talked to people who have had transplants or had you know, some connection?
GORDON:: Well I've talked to people who have had transplants and I've talked to people who stand to have their lives extended and their suffering minimized by receiving organ tissue from from pigs. And I've not really heard any issue whatsoever, any more than I've heard an issue from somebody I know who has received a pig heart valve. He's just very happy to be alive.
BYNON: I would imagine though that these people you know, when they're in that condition, when they're waiting that they would have a very grateful. The human being wants to stay alive doesn't it?
GORDON:: I think the psychological adjustment when compared to the prospect of a life without the procedure, there's just no comparison between the two.
BYNON: Okay. I want to ask you is there a way to know whether an infectious agent is in of these -- these tissues or organs before it's transplanted? 'Cause we hear there is?
GORDON:: Yes there are sensitive assays that can test down to one viral fragment. There are thousands of people in the world today who have received, who are living, who have received living pig tissue. And the --
BYNON: Does the operation stop if any of that is present?
GORDON:: Well the operation takes place and then over the next year or two they are tested for infection.
BYNON: But I'm talking before it happens. If there's an infectious agent, is there a way of testing before the transplant happens?
BYNON: Would the operation stop? Would the transplant go ahead?
BYNON: The tissue would not be used from any kind of infected animal.
SOMERVILLE: Well we can only test for infected agents. It's unknown ones we're worried about. I mean, this was exactly the problem -- for example we've got a problem in this respect at the moment. The CJD which is (unclear) disease and what's called new variant CJD which came from mad cow disease. I mean we're concerned still that that could be transmitted by blood transfusions. We've got no way to test for that. That's the problem.
BYNON: The dilemma is people don't know whether we stop and whether we're causing a big problem or whether we're holding back science. Is that the problem here?
SOMERVILLE: In one way I think what we can do is we can talk about science time and medical time and we can talk about ethics time. And the problem is they're not all on the same scale. When you look at science -- and this is totally understandable. The people who are doing it are really, they're enthralled with what. They're doing they want to do it as fast as possible. That's right. They want to discover. You talk about medical time and again, the people that you look at the individual and you think gosh, you know anything I could do to help that person and save their life of course we should do it. At the individual level that's right. Then you talk about ethics time and you say wait a minute, what if what we're doing in all good faith to help this individual and let science go ahead actually gets us into some really serious situation for a very large number of people in the future because of what we've done? That's what we're worried about.
BYNON: Okay. Alastair, what is your response to that? Is there such a thing as ethics time and have we taken it?
GORDON:: I think there are those different time scales involved in any new science. But I think any ethical principles we apply to this must be consistent with ethical principles that we apply elsewhere. Using Dr. Somerville's reasoning, if a patient with AIDS required surgery, there is a very real risk that the surgeon will pick up the HIV virus and will pass it on to his intimate contacts. This is not some theoretical unproven risk.
BYNON: But we can protect ourselves.
GORDON:: Not to anything near the extent you need to.
SOMERVILLE: That's not true.
GORDON:: Dr. Somerville, let me finish please. And yet we make the decision that that risk is worth taking even though it's a very real and demonstrated risk. In this case we are talking about a risk which has never manifested itself. Not once. And it is very prejudicial to say that one particular group will be denied medical care, the best available, because some people harbour fears of the unknown.
BYNON: Okay. Dr. Somerville?
SOMERVILLE: Well I don't think the HIV is a good example. First of all, we can test for HIV. Secondly, we know what the conditions for transmission and risks are. And thirdly, we can take steps even if someone does get infected to protect other people from it. And that's precisely -- none of those things can we do with the risks that we're worried about now. If we could do those things --
GORDON:: Dr. Somerville, we can apply those controls to the handful of people that will receive pig tissue during early clinical trials. It's a far more controllable situation than the one you're describing.
SOMERVILLE: Well what you have to be talking about then is that you would have these people agree to live in isolation and their sexual partners and their families to live in isolation with them. Is that what you're thinking of?
GORDON:: No, I am not thinking reducto ad absurdum. I am thinking of reasonable monitoring and controls.
SOMERVILLE: But the problem is we don't know that reasonable monitoring and controls will work. That's precisely the problem.
GORDON:: We don't know that that doctor operating on that patient with AIDS will not nick his finger and pick up the virus and pass it on. We don't know any of those things. We don't know that that doctor will comply with restraints not to be sexually active. We don't know any of those things. That is the world that we live in. And you cannot apply an unrealistically high standard which prejudices one group of people when those same standards are not applied across the board.
BYNON: Okay I would like to ask -- just a minute. Alastair Gordon, is there not, I mean a new -- do you have no fear of some of the new connections between human and animals transferring disease. I mean it's very real. We're learning from some kind of new mutations of viruses. It's not things that we've known before. There's a new frontier there. Does it concern you at all?
GORDON:: I would have reservations if we were talking about organ donors being primates, being monkey and baboons.
BYNON: But not pigs?
GORDON:: Not pigs because we have a long history of pig tissue in human beings. We have had hundreds of thousands of opportunities for infection to occur.
BYNON: But aren't there new animal human things happening though? That's the research that I've been doing stories on for a while. There's new connections between animals.
GORDON:: Well then perhaps we shouldn't coexist with chickens or cows or --
SOMERVILLE: We're worried about that. I mean somebody gave evidence this morning in the House of Commons about the fact that the human virus and a chicken virus started this -- was the cause of the Hong Kong flu, which was thought to be immensely threatening so that they wiped out the chicken population in Hong Kong just last year.
GORDON:: That's correct Dr. Somerville but to control that you would have to likewise bring a moratorium on eating chickens. And we don't do that. We recognize --
BYNON: They did kill off a lot of chickens. We are out of time, okay. I would like to thank you both for joining us. Joining us from Montreal is Dr. Margaret--
SOMERVILLE: No, from Ottawa.
BYNON: You're from Ottawa. You were supposed to be in Montreal and the weather kept you there. I hope you eventually get home to Montreal.
SOMERVILLE: So do I.
BYNON: You know, hang in there in Ottawa. The weather will heal. And Dr. -- and you're not a doctor -- Alastair Gordon with the Islet Foundation. Thank you so much.
GORDON:: Thank you.
BYNON: When we return we're going to talk about a romantic comedy called "Jack and Jill." Don't go way.
|Comment re Psychology of Xenotransplantation:
It is worth noting that Dr. Somerville was not always as indifferent to arguments of psychological damage resulting from xenotransplantation as she purports to be in this discussion. In her own abstract (below) presented at the National Forum on Xenotransplantation: Clinical, Ethical and Regulatory Issues (November 6-8, 1997 in Ottawa, Canada), her arguments are predominantly philosophical and psychological.
|Comment re Animal Care:
On several occasions, Dr. Somerville raises the specter of profound cruelty to animals in the practice of xenotransplantation -- in particular, "These pigs are going to have a totally artificial, confined, terrible life". This assertion is simply untrue. I have spoken to a veterinary caregiver at a SPF (Specific-Pathogen-Free) facility where pigs are raised for medical applications, and the level of care and supervision is greater than in any commercial hog farming operation. In fact the greatest difference between a commercial and an SPF facility, to quote this individual, is that "You will not find any SPF pigs coughing, scratching, or suffering from bloody diarrhea. They are disease free." They have the same degree of freedom, and the main difference is that their human handlers must shower and wear protective clothing before entering the facility. At this facility, the welfare of the animals is overseen by an Animal Care Committee (ACC), consisting of academic members from philosophy, zoology, veterinary medicine, and other faculties, members of the humane society, and concerned members of the public.
At the same xenotransplantation conference in November
1997 attended by Dr. Somerville, Dr. Dilly Griffin of the Canadian Council
on Animal Care described the standards for raising animals for medical
purposes in Canada:
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Other Xenotransplantation Links
The Xenotransplantation Debate - Science or Superstition?
National Forum on Xenotransplantation - Ottawa
The Xenotransplantation Debate Continues
Testimony to Committee on Health of the Canadian House of Commons on Xenotransplantation - February 4, 1999
OECD/NYAS International Xenotransplantation Workshop
Xenotransplantation is safe! CDC Report and Latest Xeno Events
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