Xenotransplantation: opportunities and dilemmas

Transplant surgeon Ian Alwayn (LUMC) is chair of the Dutch Xenotransplantation Working Group under the Dutch Transplantation Society (NTV). He explains where we stand now and provides a look into the future.

Pig heart transplantation

Ian Alwayn: ‘In 2022, a pig heart was transplanted into a living patient for the first time in America. The genetically modified heart prevented hyper-acute rejection, but the patient died after 2 months from a viral infection from the donor heart. In 2023, another patient lived for 6 weeks with a pig heart, until it was rejected.’

Research and progress

‘We see similar results with pig kidneys and livers. Although these are not major successes, they do show progress. By breeding pigs to be pathogen-free and developing better anti-rejection medication, we can improve the results. Internationally, clinical trials are being prepared for further studies into pig hearts and kidneys.’

Ethical dilemmas

‘In the Netherlands, research into xenotransplantation is currently prohibited. But in 2023, the House of Representatives passed a motion to review this. This takes time, but it shows that there is movement. Public debates, including those via the Rathenau Institute, conclude that the concept of xenotransplantation is not rejected for the time being. The condition, however, is that there is sufficient attention for, among other things, animal welfare. Ethical objections remain, however, such as genetic modification and unnatural housing of animals.’

Ultimate goal: saving human lives

‘In the Dutch Xenotransplantation Working Group, we work together with doctors, researchers, and ethicists. The working group explores themes surrounding this subject and contributes scientifically, including through analyses of international trials. If xenotransplantation succeeds, it could save countless human lives by drastically reducing the shortage of donor organs. That remains our ultimate goal.’