Xenotransplantation involves the transplantation of cells, tissues, and whole organs from one species to another. Interest in animal-to-human xenotransplants has been spurred by the continuing shortage of donated human organs and by advances in knowledge concerning the biology of organ and tissue rejection. The scientific advances and promise, however, raise complex questions that must be addressed.
This book considers the scientific and medical feasibility of xenotransplantation and explores the ethical and public policy issues surrounding the possibility of renewed clinical trials. The volume focuses on the science base of xenotransplantation, public health risks of infectious disease transmission, and ethical and public policy issues, including the views of patients and their families.
- Xenotransplantation
- Copyright
- Contents
- Executive Summary
- RECOMMENDATION 1
- RECOMMENDATION 2
- RECOMMENDATION 3
- RECOMMENDATION 4
- RECOMMENDATION 5
- A NECESSARY CAVEAT
- 1 Setting the Stage
- INTRODUCTION
- STUDY PROCESS AND REPORT ORGANIZATION
- APPROACHING QUESTIONS OF OPPORTUNITIES AND RISKS
- The Potential Benefits of Xenotransplantation
- Providing Adequate Organ Supply
- Providing Cells and Tissues to Treat Disease
- Risk: Precedent and Uncertainty
- 2 Assessing the Science Base
- INTRODUCTION
- STAGES OF THE IMMUNE RESPONSE
- Progress in Molecular and Cellular Biology
- Mechanisms of Hyperacute Rejection
- Mechanisms of T-Cell-Mediated Rejection
- NOVEL THERAPEUTIC APPROACHES
- Limitations of Immunosuppression in Xenotransplantation
- Modification of the Source Animal
- Antibody Masking
- Transgenic Modification
- Gene Knockout
- Antisense RNA
- Modification of the Host
- Bone Marrow Chimerism
- Microchimerism
- Modification of the Graft: Encapsulation
- 3 Infectious Disease Risk to Public Health Posed by Xenografting
- ANIMAL INFECTIONS AND XENOTRANSPLANTATION
- BASIS FOR PUBLIC HEALTH CONCERN
- METHODS OF RISK EVALUATION
- DETECTION METHODS
- NEED FOR A REGISTRY
- SUMMARY
- 4 Ethics and Public Policy
- PATIENTS, ETHICS, AND SOCIETY
- Patients' Perspectives
- Informed Consent
- Justice and Fairness Issues: Organ Allocation and Research
- Social Acceptance of Xenotransplants
- Social Acceptance of Infectious Disease Risk
- VALUE AND USE OF ANIMALS
- Ethical Theory
- History of Social Responses to Xenotransplantation
- A Moderate Ethical Perspective of Xenotransplantation
- Application to Xenotransplantation
- ECONOMIC ISSUES REGARDING XENOTRANSPLANTS
- Aggregate Expenditures for Organ Transplantation
- Transplant Procedure Expenses
- Ethics and Public Policy
- Expenditures for Xenotransplantation
- Insurance Coverage
- Impact of Managed Care
- Justice, Fairness, and the Ability to Pay
- REVIEWING AND MONITORING XENOTRANSPLANTATION
- FDA Regulation of Xenotransplantation
- Current Regulatory Framework
- 5 Conclusions and Recommendations
- References
- A Workshop Agenda
- XENOGRAFT TRANSPLANTATION: SCIENCE, ETHICS, AND PUBLIC POLICY
- SPEAKERS AND PANELISTS
- B List of Participants
- WORKSHOP ON XENOGRAFT TRANSPLANTATION: SCIENCE, ETHICS, AND PUBLIC POLICY
- C Immunosuppression in Allotransplantation
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