Xenotransplantation--ethical considerations based on human and societal perspectives.

Xenotransplantation marks a qualitatively new challenge in medical technology assessment. The reasons for this claim are twofold: (i) in contrast to more traditional medical interventions, xenotransplantation involves risks not only to the patient, but also to larger segments of society, thus to public health in general. (ii) while most medical technologies demand assessment and risk-management at the time when the technology is sufficiently developed to be put into practice, xenotransplantation demands pro-active action at a very early stage of development. A particular challenge for any assessment of xenotransplantation is the inclusion of a satisfactory approach to the ethical issues involved. In itself this is, of course, not particular/unique to xenotransplantation, as most medical interventions need a good consideration of ethics. But seen in connection with the two characteristics mentioned above, this amounts to a truly formidable task. Given that discussions about xenotransplantation are rather recent, and given that a real scientific development is – luckily I am inclined to say – still pending and assumedly not to be expected for several years to come, it is not surprising that the debate about the ethics involved is still very tentative. Several academic papers and several government reports from a variety of countries do indeed deal with the ethical issues of xenotransplantation. But it is, as far as I can see, still too early to say that a general consensus has been reached about what precisely the ethical issues are, and, more importantly, how best to deal with them. What is important, though, is that the discussion about ethics in xenotransplantation has started, and that it follows the medical-scientific advances very closely. This is in itself a consoling reminder that ethical awareness in modern societies is coming more and more to the fore front of public debate, and that ethics is put on the agenda, including the political agenda, like never before. In this paper I shall leave out a number of ethical issues that need to be dealt with if the ethical assessment is to be comprehensive. These are e.g. issues concerning animal welfare and ethics, issues concerning standard medical ethics about how to prepare patients for serious medical interventions, or issues concerning what could be considered a equitable distribution of scarce organ resources. With the exception of animal ethics, none of these seem to be specific to xenotransplantation. Rather, I shall concentrate on three salient issues that I deem to be decisive for any acceptable treatment of ethical issues with regard to xenotransplantation. The first issue is the often heard "playing Acta vet. scand. 2002, Suppl. 99, 65-73.