Pigs: a new breed of organ donors

In January 2022, a heart transplant patient named David Bennett became world famous when it was reported that the 'donor' of the heart that had saved his life was – a pig (see BioNews 1128).

The use of pig hearts for organ transplants in humans is surely better than the alternative: that people die for lack of human hearts. However, from an ethical perspective, I suggest that there are grounds to feel concerned about the story of David Bennett and his new heart. The phenomenon of expanding consumption is one of these, and the emergency nature of the intervention is another.

Let us take first that word 'consumption'. Human beings have a rapacious capacity for consumption. We look at forests and see fuel; we look at animals and see meat.

Since we already consume pigs, there is nothing new here. The use of genetically modified pigs to produce hearts for humans who need a new one, is just an incremental step in our expanding consumption-sphere. Animal rights activists will oppose it, others will accept it with varying degrees of distaste. But the way in which this case was reported in many of the stories published in the newspapers helps us to avoid that distaste. In many cases, the patient was described as receiving a 'genetically modified heart' as though the organ was a free-floating entity that scientists modified in a laboratory. The individual, the living creature, the pig, is swept aside in the focus over the product it yielded.

But there will be other pigs, perhaps many more of them now. We are told that there are other companies developing lines of genetically-modified pigs. These are animals whose makeup is no longer determined by evolution, nor even selective breeding. They are creations – stranded in a metaphysical no-man's land between organism and artefact. Created for our consumption. Pigs were favoured over monkeys because they are easier to produce in bulk as they have larger litters, to transport and raise to adult size. Pigs can easily be reared by technology companies.

If porcine – human heart transplants indicate increased scope for the consumption of pigs, what do they indicate for humans themselves?

David Bennett surely has cause to be grateful, even if the pigs do not. If it were not for that pig's heart, he would be dead. But if this is the case, why was Bennett not eligible for a human heart? Here, there is an interesting discrepancy in the news reports. Some sources state that Bennett was refused a human heart because he had a history of not complying with medical advice. This could mean any number of things, but recent news stories about unvaccinated patients being refused transplants have shown the issue is emotive and maybe even politicised for many.

If this is indeed true, the circumstances in which the transplant took place assume a rather murky moral character. The urgency of Bennett's medical situation made him, to use the terminology of the doctors involved 'the right patient' for this experimental treatment.

But Bennett's 'rightness' for this experiment was constructed. It was because he was refused a human heart that he was running out of options. Facing imminent death, of course Bennett was likely to consent to this highly experimental procedure.

In such a situation, it is important to think about how much choice the patient really has in a life or death situation. Medics who make use of such patients for their research rightly face intense scrutiny. The slide from caring for patients towards using patients for research is insidious…

Of course, there are regulations in place. Nature reported that the Food and Drug Administration had initially rejected an application for a clinical trial. They had proposed more animal studies be done instead, but then provided permission for Bennett's transplant to go ahead as he faced 'certain death'. It is reported that the medics involved in this breakthrough transplant will do more emergency treatments if 'the right patients come along'. This inversion of the usual order of things is striking.

Instead of searching for the right treatment for their patients, the doctor develops a treatment and then looks around for the right subjects on whom to try it out. In this way, medical innovation turns humans into fodder for its ongoing progress.

However, some reports gave a different account of how this patient ended up with a pig's heart. This demonstrated that the exact circumstances under which the procedure was offered and consented to are unclear. BBC News stated that Bennett was 'too ill to qualify for a human heart'. There is something peculiar about being too ill for a human heart, but well enough for a pig's heart. Either way, it remains the case that Bennett's ineligibility for standard treatment made him the perfect host for this pig's heart.

Viewed in this way, the patient himself, as well as being a consumer of the pig's organ became in his own right, a product for consumption. In the march of biomedical progress, we are both the consumers and the consumed.