Introduction

The term 'xenotransplantation' derives from the Greek word xenos, meaning foreign, and all the issues surrounding this procedure spring from the notion of associating something 'foreign' with a human body.

In recent years the transplantation of human cells, tissues and organs (allotransplantation) has dramatically improved the survival and health prospects for people suffering from life-threatening illnesses. Xenotransplantation involves transplanting living cells, tissues or organs between species, and in particular, from animals to humans. It is being considered because worldwide the demand for human cell, tissue and organ donation far exceeds the supply. This would be true even if everyone agreed to donate their cells, tissues or organs when they die. Furthermore, the world's population is ageing, which will place increasing demand on donation as more people suffer from chronic degenerative diseases. Currently there just are not enough human donors to go round, and as a result people on waiting lists are dying.

The body's immune response is serious enough with donated human organs and tissues, but it is so severe with animal organs and tissues that xenotransplantation has not been seen as a viable option. However, interest in xenotransplantation has been rekindled as a result of recent advances in the genetic modification of animals to make their tissues less likely to be rejected. The development of increasingly sophisticated anti-immune drugs and the accelerating need for cells, tissues and organs have also contributed to an intensification of research into the possibilities of xenotransplantation.

Along with the promise of a potentially unlimited supply of organs and tissues there are risks in xenotransplantation, especially from the transfer of diseases across species - as is thought to have happened with HIV. There are also questions as to whether we should be performing these procedures on animals and humans, with respect to the effects on animals' lives and the 'mixing' of different species. The Government wants these issues to be publicly debated and the full implications of xenotransplantation to be clarified before decisions are made about its use in New Zealand.

Toi te Taiao: the Bioethics Council is engaging in a dialogue with New Zealanders to find out what they think about xenotransplantation, and this document is aimed at informing this dialogue. This is not intended as a technical document. The Council's concern is specifically with the cultural, ethical and spiritual aspects of xenotransplantation. We are not directly concerned with assessing the safety and effectiveness of xenotransplantation, the extent of the public health risk it causes, the best ways of dealing with the risk, or the extent of the demand for xenotransplantation treatments. These matters are being considered elsewhere by the Government. However, we do not want to exclude these topics from our dialogue because obviously they give rise to many of the cultural, ethical and spiritual concerns about xenotransplantation.

For example, someone who believes there is something wrong with mixing material from different species may be willing to tolerate this procedure if it would do a great deal of good - such as saving a child's life. Clearly such a decision depends on an assessment of the safety and effectiveness of xenotransplantation. This discussion document briefly covers these topics, and we expect and welcome discussion on these and any other matters relating to the cultural, ethical and spiritual judgements about xenotransplantation.

The document is divided into two parts. In Part One we begin by looking at what xenotransplantation is, taking some care to define the different types and their uses, given that we may decide that there are both justifiable and unjustifiable applications of the technology. Chapter 2 asks why xenotransplantation should be seriously considered, followed by a chapter on how well the procedure actually works. Whether a procedure works or not will also be judged in terms of the risks involved, and these are addressed in Chapter 4.

Having established the technical groundwork, in Part Two we directly address the cultural, ethical and spiritual issues relating to xenotransplantation. Chapter 5 looks at spirituality, culture and need. Chapter 6 then considers Maori and xenotransplantation. This is followed by an overview of the ethics of using animals for human benefit, and a chapter that looks at how we might balance individual benefits with public risks, especially in terms of infringing on human rights. The final chapter outlines the legislative situation in New Zealand and the decisions to be made. How other countries are handling these issues is covered in the appendix.

There are obviously other questions that need to be addressed about the use of xenotransplantation, not least being the question of cost: what resources would be required to raise the animals, perform the procedures and monitor the recipients afterwards? How do these compare with the costs of alternative procedures? Would such an allocation of resources move funding from other areas of greater need, including research? And if the operations were not government funded, would there be equity issues of who receives this new treatment? These are important questions if xenotransplantation is to be considered in New Zealand, but they are beyond the scope of this document.

Face-to-face dialogue

The Bioethics Council has been charged with promoting 'dialogue'. Often 'dialogue' is used in the sense of government consulting with the public along traditional channels of input into policy decisions (e.g., submissions to government and regulatory authorities, select committee hearings, consultation on proposals). However, the Council is determined to engage in dialogue that genuinely seeks to build understanding, rather than persuading people to adopt a position.

This kind of dialogue works on the assumption that agreement on a way forward often requires not simply more information, or tighter arguments, but a deeper understanding of how others understand a situation.

Dialogue provides a 'space' in which participants can, without fear of ridicule or personal attack, examine their own and others' deeply held convictions in such a way that all parties respect the nature of those values and try to understand what shapes and gives meaning to other people's lives.

The value to government of dialogue about biotechnology is that:

• the public has an opportunity to better articulate and understand the values and beliefs they and other citizens think should underlie government policy
• government can get a better understanding of what is at stake for the public, the factors that shape public responses to developments in policy and technology, and the values the public wish to see expressed in political and economic decisions.

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