In the realm of human imagination, the boundaries between fiction and reality have often blurred, giving rise to remarkable technological leaps.
From the futuristic visions of video calls in Star Trek becoming the cornerstone of modern communication, to the notion of voice-activated assistants akin to science fiction's digital companions, our world has consistently drawn inspiration from the creative musings of storytellers.
Take, for example, HAL 9000, the iconic AI from Stanley Kubrick's 2001: A Space Odyssey, known for its cold, calculating demeanor and unnerving calmness. And how could we forget its murderous intentions?
Contrast that with Holly, the quirky and eccentric ship's computer in the British sci-fi comedy Red Dwarf, with their witty banter and endearing personality.
These contrasting personalities have left an interesting mark on our perception of AI and voice-activated systems in the real world, shaping our expectations and aspirations for the technology.
Science fiction has envisaged concepts from space travel to artificial intelligence long before they materialized.
These intersections between science fiction and reality continue to shape the future, with each innovative step forging a connection between the fantastic and the factual.
British author Malorie Blackman explored the idea of xenotransplantation in her book Pig Heart Boy. Xenotransplantation involves grafting or transplanting organs, tissues, or cells from one species into another. The story follows Cameron, a boy with heart failure who receives a transplant from a genetically modified pig.
While Blackman's book imagined a futuristic concept, it eerily foreshadowed the real-life work scientists are doing today with animal-to-human organ donation.
Pig hearts: the future of organ transplantation?
In groundbreaking new research, doctors have successfully transplanted pig kidneys into human participants. These pioneering procedures were once only imagined in science fiction stories.
Yet the concept of using animal organs to save human lives has now become a reality.
The recent achievements in xenotransplantation show how quickly fictional concepts can leap from the page to the lab.
While research into using primate organs for humans began in the 1960s, immunological rejection posed a major barrier. Pigs have become the focus for their anatomical similarity to humans and ability to be bred specifically for donation. Still, differences between pig and human tissues can lead to rejection.
Scientists are using gene editing to remove sugars on the surface of pig cells that trigger this immune response in humans. Other approaches involve knocking out genes for pig proteins that can activate clotting and inflammation. Pharmaceuticals and genetic modifications help control the recipient's immune system to prevent it from attacking the foreign organ.
These efforts paid off in several recent milestones.
In September 2021, NYU Langone Health researchers accomplished a successful kidney transplant from a genetically engineered pig to a brain-dead human patient, with no rejection issues.
In 2022, surgeons at NYU Langone Health successfully transplanted pig hearts into two brain-dead people, followed by another xenotransplantation trial in 2023 that transplanted pig kidneys into two brain-dead recipients.
After running this recent study, co-author Dr Jayme E. Locke, professor of surgery at the University of Alabama at Birmingham Heersink School of Medicine, explained to IFLScience that this research “allowed us to demonstrate the life-sustaining renal function of genetically edited pig kidneys in an adult human.”
Dr Locke pointed out that the biggest hurdle to xenotransplantation evolving in the future is the regulatory approvals needed to move to clinical trials, however, the development “has the potential to completely solve the organ shortage crisis.”
While xenotransplantation provides hope for saving lives with animal organs, it also raises ethical questions.
Is xenotransplantation ethical – for humans and animals?
Evan Thornburg, a bioethicist who explains ethical concepts under the username @gaygtownbae on TikTok, pointed out that we must consider the ethical treatment of both animals and human recipients.
The ethical considerations surrounding the use of animals in transplantation and related research can be categorized into two key areas.
First, there are concerns related to animal ethics, encompassing aspects such as their treatment, rearing, living conditions, sentience, and potential harm, with implications for communities like vegans, vegetarians, or Buddhists.
Second, there are ethical dimensions related to the human recipient, including beliefs about the process of using animals for transplantation, sustaining one's life through another's tissue, access to treatment, sustainability of treatments, and the manner in which informed and enthusiastic consent is obtained.
These ethical considerations are vital in shaping the discourse surrounding animal-based transplantation and research. Broader preemptive public education is crucial, particularly on medical and scientific concepts, as most people encounter these topics only during a medical crisis.
With limited health literacy, it is important to integrate health science information into education systems early to enable informed consent during critical healthcare decisions.
Thornburg noted to IFLScience that “a huge component of bioethics as it pertains to clinical care and treatment involves thinking critically (and respectfully) about belief systems and religious doctrine that followers utilize as their moral and decision guidance.”
“With existing new medical research, scientists that make up research teams do not always consider this element, and how necessary to respect it is,” Thornburg said.
“Coming up with viable alternatives or more accessible care options, especially for the ongoing crisis that is transplant and tissue-related medical care, is absolutely necessary because of how much life is lost due to unmet supply and demand.”
It’s important to note, however, that ‘fixing’ the organ shortage issue via a method such as xenotransplantation may result in growing disparity between populations who agree to treatment and those who oppose or cannot consent due to their beliefs.
Thornburg highlights that we should focus on promoting healthcare options aligned with these beliefs and engage in education and dialogue with religious communities, potentially influencing religious leaders to incorporate these treatments into their principles.
Dr Cat Henstridge, a veterinary surgeon and star of CBBC’s The Pet Factor, told IFLScience that while we still have a journey ahead before xenotransplants become a standard choice for recipients, this research presents encouraging findings and may signify a significant advancement for patients dealing with organ failure.
Dr Henstridge also commented on the ethical considerations, emphasizing that as a veterinarian, her stance on this matter aligns with the treatment of any other animal employed for human benefit.
If they have lived a life meeting their welfare requirements, allowing them to exhibit natural behaviors, and ensuring they have been free from pain, discomfort, and distress, followed by surgery and euthanasia carried out in a gentle, compassionate, and painless manner, then there may be limited reservations about utilizing them as organ donors for human recipients.
Addressing the fear of animal-to-human transplants
Experts agree that there must be a wider public debate, if animal-to-human transplants are to be accepted more widely.
For example, concerns regarding the transmission of diseases from animals to humans must be addressed. Ensuring the safety of xenotransplants is essential to prevent potential public health crises and garner public support.
The ethical questions surrounding the treatment of animals and the potential exploitation of animal donors that must be addressed through rigorous regulations and ethical frameworks.
There are economic and logistical challenges associated with xenotransplants, including the cost of breeding and maintaining donor animals.
Further research will be crucial to foster transparency, establish ethical guidelines and pave the way for a more widespread acceptance.
Thornburg said that “one of the issues that affects consent is foundational knowledge/understanding of medicine and science, with most people being introduced to a medical concept, treatment, or possibility only when they are enduring a medical crisis that requires decision-making.”
“Between the emotional duress of a diagnosis and prognosis along with the average (American) health literacy level being around a 6th grade reading level (this is even lower is places with high poverty, high youth populations) enthusiastic, informed consent really requires having some general or starting familiarity with health sciences and treatment possibilities.”
Thornburg also highlighted how the scientific community “does the general population a large disservice by not embedding this kind of information into our educational systems early.”
“Especially since at any time, any day, at any point in a person's life they could end up in care or in need of an aggressive or complicated treatment that they don't understand and deeply fear.”
The recent milestones in xenotransplantation showcase how science fiction concepts can translate into real innovations.
Writers and artists have long been trailblazers envisioning possibilities that drive science and technology forward. As researchers continue making strides in cross-species organ transplantation, they turn the imagination of authors like Malorie Blackman into life-saving medical therapy.
Xenotransplantation is an example of the important relationship between creativity and discovery. And it leaves us wondering – what other futuristic ideas from today's great science fiction will become tomorrow's reality?