Will Xenotransplantation Mitigate or Intensify Ageism in the Transplant System?

Abstract: More than 6,000 people die each year in the United States due to a lack of organs available for transplantation. Older people are disproportionately affected – two thirds of people on the transplant waiting list are age 50 or over, and more than one quarter are age 65 or over. Age-related disparities in access persist at multiple points along the pathway to transplantation, reflecting overt and more latent manifestations of ageism and other health equity considerations that still preclude fair access to organ transplantation for many who would be good candidates. Xenotransplantation (XTx), the transplanting of animal organs into human recipients, has been hailed as a possible solution to the organ shortage, and innovations in XTx have accelerated rapidly over the past several years as the field approaches human clinical trials. Despite the potential for XTx to have a significant impact on the lives of older people with end-stage organ failure, very little, if any, efforts have been made to examine age-related ethical implications of XTx. This conceptual analysis generates new insights into equity considerations in XTx by examining the confluence of ageism and other ethical concerns related to XTx as an emerging, highly innovative treatment option. The analysis explores the potential for XTx to resolve the organ shortage, alongside possible harms to equity that XTx may incur. Findings provide essential context to ensure an equitable approach to XTx that supports the values and goals of older people and promotes fairness throughout the transplant trajectory.