November 15, 2023
Author: Juan Manuel Palomares Cantero
Introduction
In the constant search for medical solutions for patients with serious heart conditions, medicine has entered a new era with pig heart xenotransplants (PHX) in human patients. This promising technological advance opens a horizon of hope for those facing imminent death due to heart problems, offering the possibility of a second chance at life. However, behind this prospect, deep and complex ethical issues are raised that cannot be overlooked. We will explore the crucial importance of addressing the ethical considerations surrounding this innovative medical technology in development. PHX represents an ethical challenge that compels us to consider respect for human life, justice in the distribution of medical resources, patient autonomy, and a series of other fundamental ethical principles that will guide the way toward a more promising and ethically sound medical future.
RESPECT FOR PHYSICAL LIFE AND HUMAN DIGNITY
Respect for human life and dignity is fundamental in medical decision-making, including PHX in human patients. This principle recognizes the intrinsic value of each life and the dignity of each individual, regardless of their health. However, the use of animal organs poses ethical challenges in relation to this principle. To ensure respect for the life and dignity of patients, it is crucial to fully inform patients about the risks and benefits of these transplants, allowing them to make informed decisions aligned with their values. The medical community and society at large must address these ethical issues seriously to ensure that these procedures are conducted ethically and respectfully toward human life and dignity.
JUSTICE AND EQUITABLE ACCESS
Justice and equitable access to PHX are essential. This implies that everyone, regardless of their economic or social situation, should have equal opportunities to access these innovative medical procedures. Although these transplants can offer hope to address organ shortages, it is crucial to approach risks and benefits with caution. Justice demands that these transplants be safe and accessible to all without discrimination. The medical community and society must work together to ensure equitable access to these procedures, avoiding unjust inequalities in healthcare access. To achieve this, fair selection criteria must be established, medical need prioritized on the waiting list, detailed information provided about risks and benefits, public education on these transplants, economic barriers eliminated, and regular reviews of protocols and criteria conducted, ensuring that equity becomes a reality.
PATIENT AUTONOMY
Patient autonomy is a key ethical principle in medical decision-making, especially in PHX. This implies the patient's right to make informed decisions about their medical care, including the choice to undergo such transplants. To ensure this, it is essential to provide comprehensive information about the procedures and offer alternatives so that patients can make decisions aligned with their values and preferences. Respecting patient autonomy is fundamental to ensuring that medical decisions are ethical and consistent with individual needs and desires.
PRINCIPLE OF SOLIDARITY AND SUPPORT FOR PATIENTS
The principle of solidarity emphasizes the importance of showing compassion and support to patients facing difficult medical decisions, such as considering PHX. These patients often opt for this option because they want to prolong their lives and spend more time with their loved ones, seeking a better quality of life. In this sense, the medical and scientific community has a responsibility to continue researching and developing medical alternatives that not only offer hope to patients but also improve their overall well-being. While exploring PHX as a viable option, it is essential to maintain a focus on ethical research that seeks to minimize the suffering of animals involved in these procedures. This ethical concern extends to the welfare of genetically modified pigs, and any progress in this field must be carried out with the highest level of consideration and respect for both human and animal life.
PRINCIPLE OF SUBSIDIARITY AND EVALUATION OF EFFECTIVENESS
The principle of subsidiarity, in the context of PHX, also relates to the personalistic vision of bioethics, especially in the perspective of Elio Sgreccia. From this viewpoint, personalistic bioethics focuses on the intrinsic value and dignity of each individual as a unique human being. The common good, according to this vision, is understood as a balance between individual well-being and collective well-being, achieved by respecting and promoting the dignity of each person. In the case of PHX, this means that any decision or action must take into account the individual benefit of the patient but must also consider how it contributes to the well-being of society as a whole.
From the personalistic perspective of bioethics, the principle of subsidiarity highlights the importance of addressing medical needs in an individualized manner and respecting the autonomy of each patient. The evaluation of the effectiveness and safety of PHX is carried out with the aim of ensuring that these interventions are beneficial to the patient and do not harm their dignity or integrity as a human being.
The principle of subsidiarity emphasizes the importance of making decisions for the individual patient's benefit and the common good of society while respecting the dignity and autonomy of each individual. The principle of subsidiarity, fundamental in the context of PHX, highlights the importance of making decisions and taking actions at the most appropriate and effective level to address specific needs. In the medical field, this implies that PHX must be evaluated in terms of their effectiveness in relation to the medical needs of patients. This means that before these procedures are performed on human patients, rigorous testing must be conducted on tissues and non-human animals to determine their safety and efficacy. This evaluation is essential to ensure that these transplants are applied ethically and based on solid scientific evidence, rather than being used prematurely or unnecessarily in the medical treatment of patients.
ETHICAL CONSIDERATIONS IN ANIMAL GENETIC MODIFICATION
Genetic modification in pigs for the purpose of making their organs more compatible with humans raises important ethical considerations. This involves the genetic manipulation of animals, especially pigs, to reduce the risk of organ rejection by the human immune system. Despite the noble intention of saving human lives, this practice generates ethical concerns regarding the welfare of the animals involved. There is debate about the ethics of genetically altering animals to meet human needs and how animals used in research and medicine should be treated. Additionally, it is questioned whether it is ethical to sacrifice these animals, called sentient beings, a recent concept introduced in the legal world, to obtain organs compatible with humans, emphasizing the importance of considering respect for the welfare of animals throughout the process.
RELIGIOUS CONSIDERATIONS
Religious beliefs play a fundamental role in decision-making about PHX and present complex ethical issues in medicine. In Judaism, although dietary restrictions prohibit pigs, the preservation of human life is considered a higher imperative, which could allow for these transplants, but this varies according to individual interpretation. In Islam, the use of animal material to save lives is allowed. However, balancing these religious beliefs with the fair distribution of human organs poses ethical challenges, especially regarding waiting lists and equal access. Religious considerations in PHX require a balance between individual beliefs and the quest to save human lives, demanding careful attention in ethical decision-making in medicine.
CONCLUSIONS
Xenotransplantations represent a hopeful medical innovation for patients with serious heart conditions, offering a second chance at life. However, these interventions raise profound ethical considerations that must be addressed seriously.
Respect for human life and dignity must be a priority, ensuring that patients are fully informed about the risks and benefits.
Justice and equitable access to these procedures are fundamental, avoiding any form of discrimination.
Patient autonomy must be respected, providing them with complete information and alternative options. Solidarity should guide research to improve the quality of life for patients and minimize the suffering of the animals involved.
Subsidiarity dictates that xenotransplantations must be rigorously evaluated before their application in humans.
Finally, religious considerations add ethical complexity and must be carefully balanced with the preservation of human life and equal access.
Ultimately, the path to a more promising and ethically sound medical future requires a comprehensive and reflective approach to these ethical issues.
Juan Manuel Palomares Cantero is a lawyer, teacher, and doctor in Bioethics from the Anáhuac University, Mexico. He was the director of Human Capital, director, and general coordinator at the Faculty of Bioethics. Currently, he works as a researcher in the Academic Directorate of Integral Training at the same University. He is a member of the National Mexican Academy of Bioethics and the Latin American and Caribbean Federation of Bioethics Institutions.
The opinions shared in this blog are the sole responsibility of their respective authors and do not necessarily represent a unanimous opinion of the seminars, nor do they reflect an official position by CADEBI. We value and encourage any comments, responses, or constructive criticism you may wish to share.
i Sgreccia, E. (2013). Persona humana y personalismo. Cuadernos de bioética, 24(1), 115-123.
ii Bedregal Mendoza, T. (2023). Cultura de donación en Trasplante, Essalud Repositorio Digital
iii Mascaro, J. (2022). Trasplante cardíaco: estado actual. Revista Médica Clínica Las Condes, 33(3), 263-274.
iv Pérez Villares, J. M. (2020). Bioética en donación y trasplante de órganos. Revista de Bioética y Derecho, (48), 95-109.
v Bustos, A. R. E. (2020). Antropología y Salud: El trasplante de órganos desde una perspectiva antropológica. Revista de la Facultad de Ciencias Médicas (Quito), 45(1), 5-14.
vi Gómez, M. A. T. (2020). 20 años de Vida y Ética: la propuesta del personalismo ontológico, más vigente que nunca. Vida y Ética, 21(2), 165-178.
vii Peña, R. M., Núñez, G. E. C., González, M. G., & Urquiza, D. E. P. (2019). Principios terapéutico y de subsidiariedad. Un acercamiento al carácter humanizador de la Sociedad Ecuatoriana de Bioética. Medisur, 17(5), 615-621.
viii Peña, R. M., Núñez, G. E. C., González, M. G., & Urquiza, D. E. P. (2019). Principios terapéutico y de subsidiariedad. Un acercamiento al carácter humanizador de la Sociedad Ecuatoriana de Bioética. Medisur, 17(5), 615-621.
ix Morán Zafrilla, S., Marqués Martínez, M., & Bayón González, Y. (2022). Modificación genética en cerdos destinados a xenotrasplante. Ambiociencias, (20), 33-44.
x Téllez Ballesteros, E., & Vanda Cantón, B. (2020). Cuestionamientos éticos a la generación de conocimiento en la investigación biomédica con animales no humanos. Revista de Bioética y Derecho, (49), 173-189.
xi Ferreiro, E. C., Pérez, D. N., Arias, L. C., & González, E. D. C. (2019). Polémicas actuales sobre donación y el trasplante de órganos desde una perspectiva bioética. Revista Información Científica, 98(6), 815-827.
More information:
Centro Anáhuac de Desarrollo Estratégico en Bioética (CADEBI)
Dr. David Cerdio Domínguez
david.cerdio@anahuac.mx
