April 5, 2024, by Brigitte Nerlich
Xenotransplantation
About 25 years ago, I first encountered something called Science and Technology Studies (STS) – a field that examines interactions between science and society (culture, policy etc.). One of the first articles I read, published in 1999, was by Nik Brown on xenotransplantation: “Xenotransplantation: Normalizing disgust”.
Using ideas and concepts from STS stalwarts like Mary Douglas (contamination) and Bruno Latour (hybrids), the article looked at “how disgust is represented in popular media coverage of the technology” and what measures have been “deployed to normalize disgust”.
Now, 25 years later, xenotransplantation, that is, the transplantation of organs, tissues, or cells from one species to another, especially to humans, has been in the news again. According to a press release from 21 March, 2024, the world’s first genetically-edited pig kidney transplant into a living recipient* was performed at Massachusetts General Hospital in the United States. I wondered: Is this technology still seen as disgusting or has it become normalised?
Xenotransplantation – a short history
How did we get to this recent announcement? Xenotransplantation has actually a really long history. At least as early as 1902 Alexis Carrel at the Rockefeller Institute in New York described how blood vessels could be reconnected in transplanted organs. He received the Nobel prize for this work in 1912 (see this timeline).
Lots of things happened after that, especially in the 1960s when the first chimpanzee or baboon liver or kidney to human transplantations were carried out. The word ‘xenotransplantation’ was used for the first time in 1969, according to the Oxford English Dictionary. 1969 was also the year that “Sir Peter Medawar, the British scientist who won the Nobel Prize for medicine in 1960 and is considered the father of transplant immunology, stated, ‘We should solve the problem [of organ transplantation] by using heterografts [xenografts] one day if we try hard enough, and maybe in less than 15 years.’”….. Not quite, but in 1984 the word was first used in English newspapers…
Things began to speed up in the 1990s, as, for example, in 1995, David White in Cambridge created transgenic pigs that had a human protein to prevent their tissues and organs being rejected by the immune system (see timeline). A year later, in 1996, the Nuffield Council on Bioethics published a report entitled “Animal-to-Human Transplants: the Ethics of Xenotransplantation”. And in 1999 Nik’s article appeared.
Xenotransplantation, biorisks and society
In the late 1990s biological and bioethical advances in xenotransplantation collided with a host of other emerging science and policy issues, especially with regard to cloning and Dolly the sheep, BSE or mad cow disease, the genetic modification of foods and crops, and also the MMR vaccine scandal.
This was the time when we established the Institute for the Study of Genetics, Biorisks and Society, which later became the Institute for Science and Society. We studied all these issues, apart from xenotransplantation which became, in a way, the domain of Nik and his colleagues (here they studied, for example, focus group data on xenotransplantation).
Xenotransplantation and public attitudes
A lot has happened since the late 1990s, most importantly genetic modification has been modified itself, through the invention of CRISPR, a new way of editing genes that has, on the main, avoided the yuck factor, as it is framed as clean and precise. The heat has also gone out of the cloning debate, as fears of armies of little Hitlers have receded into the background.
In the case of this year’s pig to human kidney transplant, CRISPR played an important role, as 69 rejection-preventing gene edits were carried out. This is important, as one of the main obstacles to successful transplantation has been organ rejection. CRISPR was also used to silence retroviruses that could lead to infections.
All this might explain why despite still existing risks, recent attitudes to xenotransplantation seem to be favourable – but this assessment comes with a lot of caveats.
Media reactions to a previous breakthrough in 2023 were also mainly positive, as reported by the Hastings Centre last December. As the authors said: “The realized promise of xenotransplantation seems to be quickly approaching, following the medical breakthrough of a pig kidney functioning for a record two months in a deceased [brain dead!] human body. This milestone has received overwhelmingly positive media attention despite the complexity of the technical and ethical hurdles to overcome.”
The Hastings report is worth reading, as it grapples with serious ethical and animal welfare questions which had also been asked by the Nuffield Council on Bioethics in 1996 (and many more).
Xenotransplantation and the media
What about media reactions to the most recent announcement? Somebody has to undertake a really thorough investigation of both traditional and social media reporting. However, at first glance the word ‘hope’ seems to be used more often than in the 1990s and the word ‘fear’ is used less.
It seems that disgust has not been normalised over time, although ‘Frankenstein’ still lurks in the tabloids. Overall though, reporting seems to be relatively neutral, sticking to the press release or highlighting the hope that this advance might improve the lives of many people waiting for organ transplants, as, currently demand for human organs for clinical transplantation far exceeds supply… So there seems to be normalisation of xenotransplantation rather than normalisation of disgust.
*Addendum. The patient has sadly died two months later
Image: Kidney transplant by Tareq Salahuddin, Flickr
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