Christine Clavien: “The objective was to check that the pig organ was not rejected, no need for a living patient for that”

He was convicted and ineligible for a human heart transplant. David Bennett, 57, has consented to receive a heart transplant from a pig. It was on January 7 after the US Federal Drug Administration had given permission to doctors at Baltimore Hospital to try the experiment. The patient had to undergo several major operations due to complications during the transplant. He survived two months, bedridden in his room at the hospital, in a rather stable state for about forty days before his condition deteriorated. The pig’s heart in his chest did not show the classic signs of rejection, according to clinicians and the latest scans released on Wednesday. But a series of problems – which should have been avoided – complicated the situation and probably led to the failure of the transplanted organ. Christine Clavien, philosopher of science and morality at the University of Geneva, comes back with an ethical point of view on this unprecedented medical and scientific enterprise.

Read also: A turning point in xenotransplantation research

Le Temps: Was this experience of the first xenotransplantation of a pig’s heart carried out correctly?

Christine Clavien: I am surprised that the authorization was given by the American agency. Of course, there is always a spectacular side to these first attempts, but you have to have very good reasons to meet a scientific challenge at the cost of a patient’s suffering. I think that the reasons were not sufficient in this case. The patient, even though he was convicted anyway, signed the consent because he wanted to live and not because he wanted to serve science. I’m not sure he understood all the issues. He was exposed to intense daily suffering, he lost 20 kilos in two months, and was fed by tube before ending his days tied to a machine. How can one die under these conditions? Was this suffering necessary? To my knowledge, the challenge posed was to be able to transplant a pig’s organ without it being rejected by the recipient’s body, but you don’t need a living patient for that. Refining the technique with brain-dead patients avoids this suffering, as was done with pig kidneys recently.

Unexpected problems compromised the experiment, such as the detection of a porcine virus in the blood of the transplant patient, when the animal was not supposed to be infected. Did the FDA, the American drug agency, give its authorization too quickly?

If a risky operation is performed, the research team must at least make sure to use what is safest and most effective for the patient. But they did not use pigs purged of retroviruses (viruses called PERV which are integrated into the pig genome, editor’s note) while there are lines of animals without the most well-known viruses. And the donor animal has not been tested enough to check for the presence of other pathogens like porcine CMV. All of this should have been better prepared, even if it was an urgent situation where a quick decision had to be made. Obviously, even the small risk that a porcine retrovirus could cross over into humans and generate a new pandemic has not been taken seriously by researchers and the FDA, and that concerns me greatly.

Is the breeding of genetically modified animals as organ donors an ethical problem?

The animal is considered as a product that provides an organ for the human so yes, one can wonder. These animals are taken from their mothers at birth and raised in sanitized spaces. They cannot grow outdoors. But on the other hand, in our societies, we kill millions of pigs every year for food, raised under similar conditions for the most part with significant animal suffering – apart from a few farms where animal welfare is taken into account. Respect for animals is a basic question that we must ask ourselves in our society.

Is xenotransplantation a serious option to address the shortage of organ donations?

The lack of organ donation is a recurring problem worldwide regardless of the policy applied. If one day xenotransplantation is fully mastered – which is not the case today – then I imagine that this technique would become economically interesting. The costs of a human organ transplant are significant because of the logistics that accompany organ retrieval and transportation. So xenotransplantation could even end up replacing human donation. It still has to be accepted by the population.

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