Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, PA, USA.
Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, AL, USA.
Xenotransplantation. 2020 Sep;27(5):e12623. doi: 10.1111/xen.12623. Epub 2020 Jun 28.
Many patients who would undergo organ transplantation cannot proceed due to the inability of human organ donation to satisfy medical needs. Xenotransplantation has the potential to offer unlimited availability of pig organs for transplantation, and pig-to-non-human primate models have demonstrated outcomes that may soon justify clinical trials. However, one of the unique ethical challenges faced by xenotransplantation is that the risk of introducing potential zoonotic disease into the community must be weighed along with the benefit to the patient. While most experts believe that zoonosis is manageable, apprehension over disease transmission from animal donors to human recipients remains a frequent concern of many who are undecided or opposed to clinical xenotransplantation. The COVID-19 pandemic represents a scenario (rapid worldwide spread of a highly contagious novel zoonotic disease with no natural defense in humans) that would seem to justify apprehension, especially in the United States, which has largely avoided previous pandemic outbreaks. However, there are many differences between zoonosis found in the wild or after xenotransplantation that favor the safety of the latter. Still, these differences, as well as the benefits of xenotransplantation, are not widely understood outside of the field. We must therefore ask what impact the COVID-19 pandemic will have on attitudes toward xenotransplantation.
许多需要进行器官移植的患者由于人类器官捐赠无法满足医疗需求而无法进行手术。异种移植有可能为移植提供无限量的猪器官,并且猪到非人类灵长类动物模型已经证明了结果,这些结果可能很快就会证明临床试验是合理的。然而,异种移植面临的一个独特的伦理挑战是,必须权衡将潜在的人畜共患病引入社区的风险与患者的受益。虽然大多数专家认为人畜共患病是可以控制的,但动物供体向人体受者传播疾病的担忧仍然是许多犹豫不决或反对临床异种移植的人的常见关注点。COVID-19 大流行代表了一种情景(一种具有高度传染性的新型人畜共患病在人类中没有自然防御能力,在全球范围内迅速传播),这似乎让人感到担忧,尤其是在美国,美国在很大程度上避免了以前的大流行爆发。然而,在野外或异种移植后发现的人畜共患病有许多差异,有利于后者的安全性。尽管如此,这些差异以及异种移植的好处在该领域之外并没有得到广泛理解。因此,我们必须询问 COVID-19 大流行将对异种移植的态度产生什么影响。