As we approach Future Surgery 2024, we look back at one of the standout presentations of last year’s show. The presentation explored one of our most innovative, and potentially most controversial, practices in modern surgery, xenotransplantation. Delivered by Daniel Rodger, a Senior Lecturer in Operating Department Practice for the Institute of Health and Social Care at London South Bank University, the presentation is available to watch in full below.

The presentation covered the current state of clinical xenotransplantation, including key concerns, efficacy, and future prospects.

Daniel Rodger
Senior Lecturer in Operating Department Practice, Institute of Health and Social Care, London South Bank University

Xenotransplantation, the process of transplanting animal organs into human recipients, is increasingly emerging as a promising solution to the global organ shortage crisis. Despite some prominent case studies in xenotransplantation resulting in organ failure and death (such as the 1984 case of Baby Fae), recent advancements have renewed interest in the practice.

With 107,000 people on the transplant waiting list in the USA and 7,500 in the UK, Roger and other supporters of this growing surgical innovation argue xenotransplantation could offer a near-unlimited supply of donor organs, potentially reducing wait times and improving transplant success rates. This is a particularly pertinent for in the UK, where last year over 415 people died while waiting for a transplant while waiting for a transplant.

Roger began his talk by introducing the fundamentals of xenotransplantation, explaining how genetic engineering techniques, particularly CRISPR, are employed to modify pig organs to make them more compatible with human immune systems. These genetic modifications reduce the risk of organ rejection, a significant barrier that has hindered the use of animal organs in humans. By altering specific genes in pigs, researchers have been able to eliminate certain proteins that trigger the human immune response, thus increasing the likelihood of successful transplants.

The presentation delved into the scientific breakthroughs that have made xenotransplantation a viable option. For example, one highlighted preclinical study on brain-dead patients and non-human primates, showed success with some kidney xenografts lasting up to two years in primates. Moreover, Roger highlighted prominent ongoing clinical trials with promising preliminary results, which demonstrated improved outcomes in patients who received pig kidney and heart transplants.

Roger noted that the findings of the recent studies and trials bring us closer to a future where xenotransplantation could routinely save lives. However, while public perception is generally positive if xenotransplant outcomes are comparable to traditional organ transplants, there are still many unanswered questions and ethical concerns, particularly regarding the risk of zoonotic diseases, public health implications, and regulatory frameworks.

With 75% of new diseases being zoonotic, Roger highlights the importance of stringent testing and a need for caution when looking at the risk of disease. For example, researchers worry about risk of novel pathogen transmission from xenograft to recipient. While some advocate cautious approach to xenograft research, others argue this is a relatively low risk and so isn't worth avoiding potential benefits. However, Roger notes that regulations to avoid the spread of disease in xenotransplantation are unclear.

In addition to the scientific and medical aspects, the presentation addressed the ethical and challenges inherent in xenotransplantation. Roger emphasised the importance of maintaining strict oversight not only in regard to the concerns around disease but also to ensure both animal welfare. He discussed the ethical considerations of using animals for organ harvesting and the need for transparent regulatory frameworks to guide this burgeoning field.

Almost a year on from Roger’s talk at Future Surgery, we have seen growing support for xenotransplantation across the globe. For example, at the latest meeting of the Polish Transplant Council this July, experts discussed the necessity of establishing a team to thoroughly analyse the viability of xenotransplantation.

“We want xenotransplantation to be one of the points in the National Program for the Development of Transplant Medicine,” the National Consultant for Clinical Transplantology, Prof. Grąt, recently stated.

However, 2024 has also seen unfortunate results for patients who received transplants from pigs. Most prominently, Richard Slaymanthe, first man to receive a genetically modified pig kidney transplant, died two months after the operation. Shortly following this, Lisa Pisano, the fourth xenotransplantation patient and second to receive a pig kidney also died, meaning all four patients who have received pig organs have now died. Evidently, as highlighted in Roger’s presentation, there is still a sizeable amount of research needed to improve the efficacy of this burgeoning practice.

To conclude, Roger argues that by leveraging advanced genetic engineering, this innovation could drastically reduce the waiting times for organ transplants, thereby saving countless lives. However, the successful integration of xenotransplantation into clinical practice will require continued research, ethical considerations, and robust regulatory measures.

Future Surgery 2023 showcased the dynamic interplay between technological innovation and human-centric care in the surgical field. Daniel Roger’s presentation on xenotransplantation exemplifies the show’s commitment to pioneering research that addresses critical medical challenges. As we look forward to our 2024 edition this October, we are excited to showcase new innovative practices and research that similarly paves the way for the future of surgery.