Theological‐ethical legitimization of xenotransplantation and challenges regarding the hospital chaplaincy including the pastoral psychological companionship
Authors: Sautermeister Jochen 
Published: April 2014

Background

In contrast to allotransplantation, xenotransplantation has thus far attracted lit‐tle interest within the field of theological ethics [6]. This can essentially be attributed to the fear of considerable problems regarding the medical feasibility due to possible immune reac‐tions and the risk of infection [10,11]. Consequently, at the beginning of the 21st century a recommendation was issued to stop all relevant research; this also led to a retardation of theo‐logical‐ethical reflections on xenotransplantation.

Ethical questions: Irrespective of technical feasibility, the question whether xenotransplanta‐tion is ethically justifiable or not can systematically be divided into three areas [10]: (i) Ethics regarding animals and nature are concerned with the significance of non‐human rights; (ii) ethics in the areas of medicine, biomedicine and research deal with the importance of human rights; (iii) within the frame of a social‐ethical perspective, these rights need to be debated within the context of distributive justice. The prevalent ethical discussions regarding xeno‐transplantation focus on the following issues [2, 10]: protection of animals, risks of infection and informed consent. These have been the main reasons for the reluctance regarding human experiments [3, 5, 8]. Another range of concerns centers on the creation of human/animal chimeras by Xenotransplantation and the psychosocial and sociocultural acceptance of such procedures. These reservations are especially strong where the heart is concerned, since it has a special value in terms of personal and cultural identity, and a strong symbolic meaning. The morality of breeding transgenic pigs as donor animals has also recently been questioned, rais‐ing the question of whether it is legitimate to transgress the human‐animal boundary [1].

Since chimerism raises questions regarding its psychosocial and sociocultural acceptance, the basic levels of the bioethical discourse that underlie the specific normative regulations are addressed. This concerns the anthropological question of human self‐conception and ques‐tions regarding fundamental interpretations of life and essential beliefs regarding the meaning of life. To the extent that the last mentioned levels are inevitably incorporated into the norma‐tive judgments of applied ethics and relate to the psychosocial and sociocultural acceptance of the xenotransplantation of the heart, it is necessary to bear in mind the fundamental anthropo‐logical and ideological implications [4, 9]. These implications are reflected by theological ethics. From a perspective of theological ethics the question of identity also has to be debated within a theological anthropological framework.

Most ethical perspectives on xenotransplantation refer explicitly or implicitly to the question of the psychosocial and sociocultural acceptance of Xenotransplantation. As a consequence, the question of personal [7], social and cultural identity as well as the pivotal question con‐cerning the significance of the acceptance category for the ethical argumentation and ethical legitimization of standards are addressed. According to the ethical standards definition, validi‐ty of a standard is also characterized by an opportunity to achieve social recognition and ac‐ceptance.

Research areas: The relationship between psychosocial and sociocultural acceptance and ethical legitimization shall be discussed within the context of xenotransplantation, and the relevance of public opinion shall be mapped out with the goal of achieving social acceptance and thereby facilitating the success of xenotransplantation. With reference to the psychosocial conditions for acceptance and success, the relevance as well as the tasks of pastoral compan‐ionship and pastoral‐psychological support for potential organ recipients shall be debated and guidelines shall be drafted. In light of the identity‐related challenges, an ethical and theologi‐cal request for psychosocial counseling and pastoral companionship. Furthermore, special focus shall be given to the particular importance of the spiritual dimension of counseling.

This project is funded by DFG (TR CRC 127 “Biology of xenogeneic cell, tissue and organ transplantation – from bench to bedside”).

References

[1] Beckmann JP. Menschliche Identität und die Transplantation von Zellen, Geweben und Organen tierischer Herkunft. In: Jahrbuch für Wissenschaft und Ethik 2000: 5: 169–182.

[2] Beckmann JP, Brem G, Eigler FW et al. Xenotransplantation von Zellen, Ge‐weben und Organen: Wissenschaftliche Entwicklungen und ethisch‐rechtliche Impli‐kationen. Berlin, Heidelberg: Springer, 2000.

[3] Chadwick R. Xenotransplantation. An ethical overview. In: Chadwick R, Galloux J‐Ch, Nys H, Simon JW, Paslack, R, Weisenfeld U. Xenotransplantation: Ethical, le‐gal, economic, social, cultural and scientific background Vol. 2. München: Akademische Verlagsgemeinschaft, 2008.

[4] Kirchenamt der Evangelischen Kirche in Deutschland, Sekre‐Tariat der Deutschen Bischofskonferenz. Xenotransplantation: Eine Hilfe zur ethischen Urteilsbildung (Gemeinsame Texte 13). Bonn, Hannover, 1998.

[5] Grimm H, ed. Xenotransplantation: Grundlagen – Chancen – Risiken. Stuttgart, New York: Schattauer, 2002.

[6] Halter H. Xenotransplantation aus ethischer Sicht. In: Münk H, ed. Organtrans‐plantation: Der Stand der ethischen Diskussion im interdisziplinären Kontext. Fri‐bourg: Paulinus, 2002.

[7] Illhardt FJ. Probleme in der Biographie: Identität und Organstransplantation?. In: Illhardt FJ, ed. Die Medizin und der Körper des Menschen. Bern, Göttingen, Toront, Seattle: Huber, 2001: 183–192.

[8] Mclean S, Williamson L, eds. Xenotransplantation: Law and Ethics. Hants, Burlington: Ashgate, 2005.

[9] Pontifical Academy of Life. Prospects for Xenotransplantation: Scientific Aspects and ethical Considerations. Vatican City, 2001 (http://www.academiavita.org/_pdf/documents/pav/prospects_for_xenotransplantation.pdf)

[10] Quante M. Ethische Aspekte der Xenotransplantation. In: Quante M, Vieth, A, eds. Xenotransplantation. Ethische und rechtliche Probleme. Paderborn: mentis, 2001: 15–66.

[11] Schicktanz S. Organlieferant Tier?: Medizin‐ und tierethische Probleme der Xe‐notransplantation. Frankfurt, New York: Campus, 2002.