Pediatric Cardiac Xenotransplantation: Recommendations for the Ethical Design of Clinical Trials.

For children with complex congenital heart problems, cardiac allotransplantation is sometimes the best therapeutic option. However, availability of hearts for pediatric patients is limited, resulting in a long and growing waitlist, and a high mortality rate while waiting. Cardiac xenotransplantation has been proposed as one therapeutic alternative for neonates and infants, either in lieu of allotransplantation or as a bridge until an allograft becomes available. Scientific and clinical developments in xenotransplantation appear likely to permit cardiac xenotransplantation clinical trials in adults in the coming years. The ethical issues around xenotransplantation of the heart and other organs and tissues have recently been examined, but to date, only limited literature is available on the ethical issues that are attendant with pediatric heart xenotransplantation. Here, we summarize the ethical issues, focusing on (1) whether cardiac xenotransplantation should proceed in adults or children first, (2) pediatric recipient selection for initial xenotransplantation trials, (3) special problems regarding informed consent in this context, and (4) related psychosocial and public perception considerations. We conclude with specific recommendations regarding ethically informed design of pediatric heart xenotransplantation trials.
Competing Interests: D.J.H. and L.P. are members and paid consultants to a working group on xenotransplantation ethics at New York University. D.J.H. is a member of the International Xenotransplantation Association (IXA) Ethics Committee. R.N.P. is the chair of the IXA Ethics Committee and has received research funding and material support from multiple companies involved in xenotransplantation. D.K.C.C. is a consultant to eGenesis Bio, Cambridge, MA, but the opinions expressed in the article are those of the author’s and do not necessarily reflect those of eGenesis. The other authors declare no conflicts of interest.
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