Editorial
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
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.

Keywords: Organ donation; Xenotransplantation; Procurement; Kidney transplantation; Costs

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).