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Research opportunities and ethical considerations for heart and lung xenotransplantation research: A report from the National Heart, Lung, and Blood Institute workshop. 2024
Kiran K Khush, and
James L Bernat, and
Richard N Pierson, and
Henry J Silverman, and
Brendan Parent, and
Alexandra K Glazier, and
Andrew B Adams, and
Jay A Fishman, and
Michael Gusmano, and
Wayne J Hawthorne, and
Mary E Homan, and
Daniel J Hurst, and
Stephen Latham, and
Chung-Gyu Park, and
Karen J Maschke, and
Muhammad M Mohiuddin, and
Robert A Montgomery, and
Jonah Odim, and
Rebecca D Pentz, and
Bruno Reichart, and
Julian Savulescu, and
Paul Root Wolpe, and
Renee P Wong, and
Kathleen N Fenton
Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA. Electronic address: kiran@stanford.edu.
Xenotransplantation offers the potential to meet the critical need for heart and lung transplantation presently constrained by the current human donor organ supply. Much was learned over the past decades regarding gene editing to prevent the immune activation and inflammation that cause early organ injury, and strategies for maintenance of immunosuppression to promote longer-term xenograft survival. However, many scientific questions remain regarding further requirements for genetic modification of donor organs, appropriate contexts for xenotransplantation research (including nonhuman primates, recently deceased humans, and living human recipients), and risk of xenozoonotic disease transmission. Related ethical questions include the appropriate selection of clinical trial participants, challenges with obtaining informed consent, animal rights and welfare considerations, and cost. Research involving recently deceased humans has also emerged as a potentially novel way to understand how xeno-organs will impact the human body. Clinical xenotransplantation and research involving decedents also raise ethical questions and will require consensus regarding regulatory oversight and protocol review. These considerations and the related opportunities for xenotransplantation research were discussed in a workshop sponsored by the National Heart, Lung, and Blood Institute, and are summarized in this meeting report.
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