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A pig in a poke.

It was front-page news when medical science tried out yet another way to postpone our common and inevitable fate--TERMINALLY ILL MAN GETS BABOON'S LIVER IN UNTRIED OPERATION (New York Times, 29 June 1992).

The story about his death ten weeks later was much harder to find (see D14, Business Section). Besides raising ethical issues of xenografting, this episode represents another opportunity to survey the extent of human desperation to prolong life through organ transplantation.

Although xenografts have been attempted since 1905, the development of new transplant technologies has led some to proclaim a new "xenograft era" (American Medical News, 13 August 1992). Techniques in genetic engineering are now potentially employable not just to reduce the risk of rejection of xenografts; they may also be used to alter species that are genetically less similar to human beings than nonhuman primates. British scientists are developing a plan to insert parts of human genes into fertilized sow eggs to create "transgenic pigs." The idea is then to mate these designer pigs with normal pigs to create pigs with human-ready organs. Dr. Ian Fraser, a transplant physician at the Royal Melbourne Hospital, believes human beings with transgenic pigs' kidneys will be a likely possibility in the near future (Bioethics News, July 1992). With organ rejection minimized, he concludes, the problem of organ shortages would be solved.

Meanwhile, pressures on human organ procurement have led to some disturbing practices. Commercial organ traffic worldwide is increasing. Organ brokers in India are reportedly doing a brisk business, while in the United States one transplant physician has called for incentive payments to bereaved relatives for the removal of cadaveric organs (British Medical Journal, 4 July 1992). In Argentina, employees at a mental hospital are being investigated regarding allegations that patients were deliberately killed or preyed upon so that their organs could be sold (American Medical News, 18 May 1992). In Taiwan, executed prisoners are legally harvested for their organs (Canadian Medical Association Journal, 1 July 1992). And in China, this practice is coupled with collection of fees from organ recipients, according to the BBC2 production, "The Great Organ Bazaar." The idea of obtaining organs from prisoners on death row--with or without their consent--is under increasing consideration, including in the United States.

How might this activity indict our ethical failures and exercises in "courage"? The World Health Organization unequivocally rejects the use of the human body and its parts in commercial transactions as a violation of basic human values and the Universal Declaration of Human Rights (Human Organ Transplantation, 1991). Ethical considerations regarding use of executed prisoners or xenografting are less straightforward. As pressures for organ procurement grow, the ethical arguments in favor of such procedures turn increasingly to utilitarian considerations and issues of need. The danger lies in what such appeals and the technologies that drive them cover up. Many see a failure of altruism; others see simply ignorance. Perhaps it is a failure of a more basic kind of moral understanding about human mortality. The Times reporter noted that no transplant of a baboon organ to a human being had been successful, but he didn't say what would count as success.
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Title Annotation:In Brief; xenografts
Author:Hanson, Mark J.
Publication:The Hastings Center Report
Date:Nov 1, 1992
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