Acta vet. scand. 2002, Suppl. 99, 75-79.

Xenotransplantation – The Donor Welfare Perspective

By Svein Aage Christoffersen

Faculty of Theology, University of Oslo, P.O.Box 1023 Blindern, NO-0315 Oslo, Norway. Tel: + 4722850320, E-mail: [email protected]

Introduction In this lecture xenotransplantation is considered swers just to get rid of ethical considerations. from the point of view of animal ethics. The When ethics is reduced to a simple yes or no, main point is to show that a specific cluster of then it is of no use and not worth taking into arguments commonly used in favour of xeno- consideration. So ethics is from this point of transplantation, simplifies the ethical questions view trapped in a "catch 22". If it can't deliver involved. This simplification may be favourable simple answers, it is of no use, and if it delivers for political reasons in a short time perspective, simple answers, it certainly is of no use. but may at the same time be disastrous from an Contrary to the demand for simplicity I there- ethical point of view in the long run. If the eth- fore want to say, using the words of the poet ical questions regarding xenotransplantation Søren Kierkegaard, "that in this day and age are reduced to a simple yes or no, this will over- when everybody is striving to make everything shadow more important questions of how xeno- more easy, my task is to make everything more transplantation may be implemented in an ethi- difficult", or at least as difficult as possible cally responsible way. Resisting this simpli- within twenty minutes. I am not doing this be- fication, we have to explore instead the neces- cause I love difficulties, but because I think we sary conditions under which xenotransplanta- have to consider more deeply what xenotrans- tion may be carried through or rejected. plantation is all about. Putting something into Ethics is often expected to deliver simple an- action, there is a world of difference between swers to complex questions. The bottom line of doing it with or without an extended conscious- an ethical argument is expected to say yes or no. ness of what we are actually doing. So let us This way of understanding ethical contributions look more closely into the matter of xenotrans- to the public and scientific discourse about plantation from the perspective of animal xenotransplantation, or any scientific and pub- ethics. lic discourse, is however not in accordance with the ethical point of view. People who expect Animal welfare and xenotransplantation simple and clear-cut answers to moral questions The main arguments in favour of breeding ge- do not - or at least not always – expect these un- netically modified pigs for xenotransplantation ambiguous answers because they want ethics to are summed up in the following statement from be of importance to the questions involved. the 1996 Nuffield Council Report (1) on the Very often they expect unambiguous answers ethics of xenotransplantation: for the opposite reason. They want clear-cut an-

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"While the pig is an animal of sufficient in- to choose between animal lives and human telligence and sociability to make welfare lives, human lives have the preference. considerations paramount, there is less evi- Secondly: From a biological point of view we dence that it shares capacities with human may prefer to use organs taken from primates beings to the extent that primates do. As for xenotransplantation. But from an ethical such, the adverse effects suffered by the pigs point of view primates are too close to human used to supply organs for xenotransplanta- beings. They may react and suffer much in the tion would not outweigh the potential bene- same way as human beings do. Restrictions put fits to human beings. It is also difficult to see on the use of human transplant may therefore how, in a society in which the breeding of apply also to the use of transplants taken from pigs for food and clothing is accepted, their non-human primates. Pigs, on the other hand, use for life-saving medical procedures such are different from human beings to an extent as xenotransplantation could be unaccept- that primates are not; hence, arguments stated able." against the use of primates for xenotransplanta- tion are not valid with regard to pigs. From this point of view xenotransplantation Thirdly: The use of animals is not at all ex- seems to be a clear-cut case. Of course, taken traordinary. The use of pigs for human benefits literally the Nuffield Council is not rejecting is established long ago by the breeding of pigs animal welfare considerations. On the contrary, for food and clothing. When this is so, the the statement says that animal welfare perspec- breeding of pigs for xenotransplantation may be tives are paramount. But put into practice it says just as, or even more, legitimate. that animal welfare perspectives may not be Let us consider these arguments more closely, given preference when at variance with human one by one, beginning with the second argu- interests. Or put more bluntly: we may put ment. What this argument says, is not just that weight on animal welfare, provided this does the arguments against the use of primates are not jeopardize human welfare. But considering not applicable to the use of pigs. It also implies animal welfare only when it is consistent with that the arguments against the use of primates human welfare is next to nothing. The problem are conclusive. This is why primates are not in is what we ought do when animal welfare is not use for xenotransplantation. But why are these consistent with human welfare. And in these arguments not conclusive as far as pigs are con- situations, the Council says, animal welfare has cerned? Of course there are differences be- to make way for human welfare. tween pigs and primates, but are these differ- Reading the statement more closely we may ences significant? Pigs may not possess the identify three main arguments for this point of same intelligence and sociability as primates; view. Firstly: Xenotransplantation has to do let us take that for granted, at least for the sake with the saving of human lives, and when hu- of argument. Does this imply by logic that pigs man life has to be weighted against animal life, do not have the same capacity for suffering, or then human life takes priority. Today people are that the suffering brought upon pigs does not dying because of the shortage of organs avail- count because they are not as smart and intelli- able for transplantation, so breeding and killing gent as primates are? Is the difference between animals for xenotransplantation will compen- primates and pigs lager than the difference be- sate for this shortage and therefore save the tween primates and human beings, regarding lives of human beings. In this situation, forced intelligence and sociability?

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The question of suffering is a utilitarian one. to say that these experiments have caused ex- But utilitarianism is not the only perspective tensive animal suffering, and that they are likely relevant in this case. It is also possible or even to cause animal suffering in the future, too. But necessary to apply a deontological perspective this is not the main point in my argument, be- and ask whether a pig has any right to lead a cause the point is that these experiments are not pig's way of life. A pig is not just an isolated or- within the limits of what a farmer is allowed to ganism capable of responding to external stim- do to his animals. There is a basic difference be- uli. To be a pig is also to lead a pig's way of life. tween a farmer and a researcher, and if we take The word "rights" is, as you all know, contro- into consideration how the researcher is al- versial in animal ethics. My point of view may lowed to treat an animal, this is an exception to be phrased like this: Regardless of suffering I ordinary requirements regarding farm animals. think we have good reasons for saying that pigs So the ordinary use of pigs for food and cloth- have a right to lead a pig's way of life. But if the ing is not sufficient to make animal experimen- word "right" is offending you, I may just as well tation acceptable. say that we have a certain obligation to permit The second reason is that the use of pigs for pigs to lead a pig's way of life. This is not con- xenotransplantation requires transgenic pigs troversial with regard to primates, so why and hence genetic transformation of the pigs in should it be controversial with regard to pigs? use. But when we breed pigs for food and cloth- If we are not convinced by the reasons for treat- ing, genetic engineering is not permitted. This ing pigs and primates differently, conclusions has of course partly to do with food safety, but may be drawn in two different directions. We that is not all there is to it. The prohibition of may either lower the primates down to the pig's genetically modified farm animals is also meant level, permitting the use of primates for xeno- to protect animals against infringement and in- transplantation too, or we may raise the pigs to justice. So breeding pigs for food and clothing a higher level and say that pigs are to be pro- does not make genetic engineering legitimate. tected against xenotransplantation to the same The third reason is that the way of breeding pigs extent that primates are. for xenotransplantation is not in concordance The third argument says, as we have heard al- with rules normally applied to the keeping and ready, that the use of pigs for xenotransplanta- confinement of farm animals. Especially be- tion is made legitimate by the extensive use of cause of the danger of infection, pigs in use for pigs for food and clothing. But this argument xenotransplantation may be kept isolated to an does not hold water either. There are several im- extent far above what is normally accepted for portant differences between the breeding of farm animals. pigs for xenotransplantation and the breeding These and similar reasons taken together ex- of pigs for food and clothing, and because of plain why the use of pigs for food and clothing these differences it is impossible to make xeno- does not make the use of pigs for xenotrans- transplantation acceptable by just pointing to plantation acceptable. This does not mean of our use of animals for food and clothing. Let course that xenotransplantation is to be re- me mention very briefly just three of these rea- jected. The point is that eating pork and wear- sons. ing a fur coat are as such not sufficient to legit- The first reason is that the use of pigs for xeno- imate xenotransplantation. transplantation requires extensive use of animal These lines of argument lead to the conclusion experimentation. It is not controversial, I think, that just playing human life off against animal

Acta vet. scand. Suppl. 99 - 2002 78 S. Aa. Christoffersen life is a superficial simplification. Giving hu- pigs and humans. Blurring this difference man life a preference over and against animal means making xenotransplantation more dubi- life does not imply a carte blanche to treat ani- ous. I think we have a real dilemma here. On the mals according to our own convenience only. one hand pigs may be used for xenotransplanta- Moreover, just playing human life off against tion because they have a biological resemblance animal life implies that we have no other alter- to human beings. On the other hand pigs may be native. Is that true? If we resign from xeno- used for xenotransplantation just because they transplantation does that imply that we have to are not human beings, or not even primates. The resign from transplantation all together? Of closer pigs are connected to human beings from course it doesn't mean that. The shortage of hu- an ethical point of view, the more dubious xeno- man organs may also be compensated for by transplantation becomes. So to promote xeno- our efforts to increase the availability of human transplantation we have to stick to the differ- organs. One may of course be pessimistic re- ence and probably extend it, and at the same garding the possibility of satisfying the demand time make the most of the similarities. for organs by these efforts, but xenotransplanta- Our way of thinking is not always changed by tion is no secure road to success either. And the use of arguments. We may want this to be then we have the use of stem cells. In the end the case, but the fact is that our way of thinking the situation may very well be that xenotrans- is often changed as a result of new technology. plantation appears to be a sidetrack. This may By changing our ways of life, technology also take some years of course, but there are never- conveys new ideas and new ways of thinking. theless reasons to believe, that the main track to For this reason it is not far fetched to imagine organ supplement would be stem cell research. that an extensive use of xenotransplantation The question of xenotransplantation is there- may change our understanding of what a pig ac- fore not a question of saving human lives or not, tually is. Through genetic engineering we may but a question of different roads to the saving of not just change the animals, but implicitly human lives. change our understanding of animals too. Ani- mals have already, from a genetic point of view, The relationship between humans and pigs become inconstant or contingent in a way never Another important question is how, or to what seen before. The genetic engineering we apply extent, xenotransplantation may affect our un- to the pigs today is of a minor kind. So it is still derstanding of the relationship between animals obvious to speak of a genetically altered pig as and human beings. Usually this question has a pig. But these restrictions put on our genetic been discussed with regard to the human self- engineering are in no way necessary; they are esteem, self-consciousness and self-under- minor just for the time being. So I think we standing. My perspective is however, the donor must prepare ourselves for questions more far perspective, so my question is if or to what ex- reaching than the questions we confront today. tent xenotransplantation may change our under- Questions I have in mind are questions such as: standing of animals. when is a genetically modified heart of a pig not Some have argued that xenotransplantation will a pig's heart any more? And when is a geneti- pave the way to a more inclusive understanding cally altered pig not a pig any more? And if it of animals. But this is just wishful thinking. As isn't a pig, then what is it? Let us imagine that mentioned already, using pigs for xenotrans- the demand for modified pig's hearts suddenly plantation presupposes the difference between is satisfied. Is it possible to sell the surplus as

Acta vet. scand. Suppl. 99 - 2002 NKVet Proceedings 2002 79 pork, or is it cannibalism to eat hearts from plantation. I am not saying that xenotransplan- these pigs? Is the consequence of xenotrans- tation is to be abandoned. What I am saying is, plantation the establishment of a new category that if we are to put xenotransplantation in ac- of living creatures, labelled replacement parts? tion, we have to pay serious attention to the And what about the human understanding of source animal welfare perspective. This may what it is to be a human being. Will this under- not be the most important perspective, but it is standing be changed if we transform animals to nevertheless one of several important perspec- an assembly of replacement parts? tives. If we can't afford time and money to take These questions may seem a bit gothic or even this perspective into account, xenotransplanta- bizarre, but the point is that they uncover possi- tion may not be the way to human flourishing ble consequences implied in the use of this kind that we expect today. of new technology. Abhorring from these ques- tions will not do us any good. References 1. Animal-to-human transplants: The ethics of xeno- Final considerations transplantation. Nuffield Council of Bioethics, UK, 1996. Questions and arguments raised in this lecture are not conclusive with regard to xenotrans-

Acta vet. scand. Suppl. 99 - 2002