Gonzalez FM, Gonzalez FDR. Is the near coming xenotransplantation era relieving us from needing to look for more non-living organ donors? World J Transplant 2022; 12(12): 388-393 [PMID: 36570406 DOI: 10.5500/wjt.v12.i12.388]
Corresponding Author of This Article
Fernando M Gonzalez, MD, Full Professor, Department of Nephrology, Faculty of Medicine, Universidad de Chile, Av. Salvador 486, Providencia, Santiago 7500922, Chile. fgonzalf@uc.cl
Research Domain of This Article
Transplantation
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Dec 18, 2022; 12(12): 388-393 Published online Dec 18, 2022. doi: 10.5500/wjt.v12.i12.388
Is the near coming xenotransplantation era relieving us from needing to look for more non-living organ donors?
Fernando M Gonzalez, Francisca del Rocío Gonzalez
Fernando M Gonzalez, Department of Nephrology, Faculty of Medicine, Universidad de Chile, Santiago 7500922, Chile
Francisca del Rocío Gonzalez, Web Intelligence Centre, Faculty of Physics and Mathematical Sciences, Universidad de Chile, Santiago 8370397, Chile
Author contributions: Gonzalez FM and Gonzalez FDR contributed to this paper; Gonzalez FM designed the overall concept and outline of the manuscript; Gonzalez FDR contributed to the discussion and design of the manuscript; both authors contributed to writing and editing the manuscript, and the literature review.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fernando M Gonzalez, MD, Full Professor, Department of Nephrology, Faculty of Medicine, Universidad de Chile, Av. Salvador 486, Providencia, Santiago 7500922, Chile. fgonzalf@uc.cl
Received: August 25, 2022 Peer-review started: August 25, 2022 First decision: September 9, 2022 Revised: September 19, 2022 Accepted: November 30, 2022 Article in press: November 30, 2022 Published online: December 18, 2022 Processing time: 113 Days and 8.6 Hours
Abstract
Despite organ transplantation being the most successful treatment for end-stage organ dysfunction, the number of annual solid organ transplantations is much lower than that required to satisfy the demand of patients on waiting lists. The explanation for this phenomenon is the relative scarcity of non-living organ donors due to several factors, such as: (1) Late arrival of patients with a neurocritical condition to an emergency service; (2) lack of detection of those patients as possible organ donors by health professionals dedicated to procurement or by clinicians at emergency and intensive care units, for instance; (3) late transfer of the patient to an intensive care unit to try to recover their health and to provide hemodynamic, ventilatory, and metabolic support; (4) lack of confirmation of the physiological status of the possible donor; (5) late or incorrect positive diagnosis of the subject’s death, either due to brain or cardiac death; (6) difficulty in obtaining legal authorization, either by direct relatives or by the authority, for the extraction of organs; and (7) deficient retrieval surgery of the organs actually donated. The recent reports of relatively successful xenotransplants from genetically modified pigs open the possibility to fix this mismatch between supply and demand, but some technical (organ rejection and opportunistic infections), and economic issues, still remain before accepting a progressive replacement of the organ sources for transplantation. An approximate economic cost analysis suggests that the hypothetical acquisition cost of any genetically modified pig derived organ is high and would not even satisfy the solid organ demand of the wealthiest countries.
Core Tip: The recent promising xenotransplants derived from genetically modified pigs (heart and kidneys) will open a new discussion: to maintain and improve human non-living organ procurement or invest in the development of solid xenotransplant clinical services. Issues to be solved before reaching that point will be immunologic (preventing acute and chronic graft rejection), opportunistic infections from pigs (for example, porcine cytomegalovirus) and economic (how to finance and afford those technically complex organs for the population).
