The view of the three monotheistic religions toward xenotransplantation.

Publisher: Munksgaard Country of Publication: Denmark NLM ID: 8710240 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1399-0012 (Electronic) Linking ISSN: 09020063 NLM ISO Abbreviation: Clin Transplant Subsets: MEDLINE

Original Publication: Copenhagen : Munksgaard,

Religion*; Animals ; Humans ; Transplantation, Heterologous

Xenotransplantation, transplanting animal organs into humans, may offer a solution to the shortage of organs for transplantation. This would increase the chances for scheduled, elective transplantation, even for patients currently ineligible for receiving a human organ. However, xenotransplantation raises specific ethical and philosophical issues, that is, a personal identification of the body parts with the soul and spirit, the relationships between humans and animals, and challenges related to issues of medical and social ethics. The three monotheistic religions have laws and perspectives pertaining to xenotransplantation. This scholarly review examines the theology and viewpoints of the three monotheistic religions and their concerns regarding xenotransplantation (interspecies) in terms of religious-legal rulings, the ethical considerations related to the procedure, through religious scriptures and rulings of scholars of the three faith communities. This review should be viewed as a continuation of an extensive investigation of these issues, as the field of transplantation advances toward clinical trials. It was found that there are no fundamental religious reasons presented by any of the three religions to prohibit the use of animal organs as a means of treating severe and life-threatening conditions. However, there are certain limitations prescribed by each religion relating to the treatment of the animals and the choice of organs to be transplanted.
(© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Cooper DKC, Ekser B, Tector AJ. A brief history of clinical xenotransplantation. Int J Surg. 2015;23(Pt B):205-210. doi:10.1016/j.ijsu.2015.06.060.
Wang W, He W, Ruan Y, Geng Q. First pig-to-human heart transplantation. Innovation (Camb). 2022;3(2):100223. doi:10.1016/j.xinn.2022.100223.
Porrett PM, Orandi BJ, Kumar V, et al. First clinical-grade porcine kidney xenotransplant using a human decedent model. Am J Transplant. 2022;22(4):1037-1053. doi:10.1111/ajt.16930.
Montgomery RA, Stern JM, Lonze BE, et al. Results of two cases of pig-to-human kidney xenotransplantation. N Engl J Med. 2022;386(20):1889-1898. doi:10.1056/NEJMoa2120238.
Locke JE, Kumar V, Anderson D, Porrett PM. Normal graft function after pig-to-human kidney xenotransplant. JAMA Surg. 2023;158(10):1106-1108. doi:10.1001/jamasurg.2023.2774.
Sharifova RA, Al Breizat AKS, Kaabak MM, Maslikova UV, Yaremin BI. Ethical issues of xenotransplantation in the aspect of religious views. Bulletin Medical Institute “REAVIZ” Reaviz Medical University. 2022;12(1):117-130. doi:10.20340/vmi-rvz.2022.1.TX.1.
Paris W, Seidler RJH, FitzGerald K, Padela AI, Cozzi E, Jewish CooperDKC. Christian and Muslim theological perspectives about xenotransplantation. Xenotranspl. 2018;25(3):e12400. doi:10.1111/xen.12400.
Steinberg A. What is it to do good medical ethics? An orthodox Jewish physician and ethicist's perspective. J Med Ethics. 2015;41:125-128.
Shiwani MH. The use of porcine mesh implants in the repair of abdominal wall hernia: an Islamic perspective for an informed consent. JBIMA. 2020;4(2):30-37. Accessed December 5, 2021. https://www.jbima.com/wp-content/uploads/2020/04/4.pdf.
Sautermeister J, Mathieu R, Bogner V. Xenotransplantation-theological-ethical considerations in an interdisciplinary symposium. Xenotranspl. 2015;22(3):174-182. doi:10.1111/xen.12163.
Teo B. Organ donation and transplantation: a Christian viewpoint. Transplant Proc. 1992;24(5):2114-2115.
Shah A, Goerlich CE, Pasrija C, et al. Anatomical differences between human and pig hearts and their relevance for Cardiac Xenotransplantation Surgical Technique. JACC Case Rep. 2022;4(16):1049-1052. doi:10.1016/j.jaccas.2022.06.011.
Tisato V, Cozzi E. Xenotransplantation: an overview of the field. In: Costa C, Máñez R, eds. Xenotransplantation. Methods in Molecular Biology (Methods and Protocols). Humana Press; 2012.
Wachholtz AB. Bioethics of xenotransplantation: three religious perspectives. Journal of Faith and Science Exchange. Accessed February 12, 2018. https://hdl.handle.net/2144/3989.
Mathieu R. Jewish ethics and xenotransplantation. Xenotranspl. 2016;23:258-268.
Sautermeister J. Xenotransplantation from the perspective of moral theology. Xenotranspl. 2015;22:183-191. doi:10.1111/xen.12157.
Stadlbauer V, Stiegler P, Muller S, et al. Attitude toward xenotransplantation of patients prior and after human organ transplantation. Clin Transplant. 2011;23:495-503.
Jang K, Paris W, Bargainer R, et al. Student opinions in xenotransplantation (abstract). Transplant. 2016;100:S869.
Abalovich A, Matsumoto S, Wechsler CJ, et al. Level of acceptance of islet cell and kidney xenotransplants by personnel of hospitals with and without experience in clinical xenotransplantation. Xenotranspl. 2017;24(4). doi:10.1111/xen.12315.
Paris W, Jang K, Bargainer R, et al. Psychosocial challenges of xenotransplantation: the need for a multi-disciplinary; religion; and cultural dialogue. Xenotranspl. 2016;23:335-337.
Leviticus 11:7-8 (King James Version). https://www.bible.com/bible/1/LEV.11.7-8.KJV.
Gold ER, Adams WA. Reconciling private benefit and public risks in biotechnology: xenotransplantation as a case study in consent. Health Law J. 2002;10:31-75.
Deshmukh A. Visual Capitalist. Mapped: the world's major religions. Accessed February 11, 2022. https://www.visualcapitalist.com/mapped-major-religions-of-the-world/.
Midrash Rabbah 10:7, Tanchumah, Sifre. https://www.sefaria.org.il/Bereshit_Rabbah.10.7?lang=he&with=Midrash%20Tanchuma&lang2=he.
There is a Babylonian Talmud and a Jerusalem Talmud; the Babylonian is regarded as more authoritative. Rubenstein, JL. The culture of the Babylonian Talmud. Baltimore MD:Johns Hopkins University Press; 2004.
Karo Y. Shulkhan Arukh (16th Century) and Yechiel Epstein Arukh HaShulkhan (19th Century).
Feinstein M. Igrot Moshe (20th Century) and Reform Responsa for the Twenty-First Century (21st Century).
Alster, Baruch. “R. Moshe Feinstein on Milhemet Mitzvah.” The Gift of the Land and the Fate of the Canaanites in Jewish Thought (2014): 429. In: Feldheim, Artscroll. KTAV. Jewish Publication Society and Jewish Lights.
Exodus 21:19; Deuteronomy 4:15, 22:2-3.
Karo Y. Shulkhan Arukh, Yoreh Deah 336:1. Laws pertaining to physicians ad healing. [Hebrew] Accessed October 15, 2022. https://www.sefaria.org.il/Arukh_HaShulchan%2C_Yoreh_De'ah.336?lang=he.
Maimonides M. Commentary on Mishnah Nedarim 4:4. Cited in Shapiro, MB. Maimonides' Thirteen Principles: The Last Word in Jewish Theology?. The Torah U-Madda Jo 1993; 4:187-242.
Steinberg A. Encyclopedia of Jewish Medical Ethics. A Compilation Of Jewish Medical Law On All Topics Of Medical Interest. 2003;2:524. Accessed October 1, 2017. http://nleresources.com/kiruv-and-chinuch/online-books/halacha/793-2/#.WlOUujdG3IU.
Mackler A. Medical care in the end of life. In: Mackler A, ed. Life and Death Responsibilities in Jewish Biomedicalethics. G & H Soho; 2012:27.
Babylonian Talmud, Sahnedrin 74a. Soncino. Accessed August 2022. https://halakhah.com/rst/nezikin/34d%20-%20Sanhedrin%20-%2067a-92b.pdf?.
Asher M. Animal suffering: the Jewish view Animals and people are kindred spirits, but far from equals.Business Ethenter of Jerusalem. Accessed October 1, 2017. www.aish.com/jl/i/mn/Animal_Suffering_The_Jewish_View.
Rosner F. Pig organ transplants into humans. In: Rosner F, Shulman R, eds. Medicine and Jewish Law V3. Yashar Books; 2005:149-162.
Bokek-Cohen Y, Tarabeih M. The use of porcine-derived materials for medical purposes: what do Muslim and Jewish individuals know and opine about it. J Bioeth Inq. 2022;19(4):599-612. doi:10.1007/s11673-022-10203-w.
Nachmanides M. Commentary to Leviticus. Ramban on Leviticus. 19:19. https://www.sefaria.org.il/Ramban_on_Leviticus.19.19?lang=he.
Mathieu R. Jewish ethics and xenotransplantation. Xenotransplant. 2016;23(4):258-268. doi:10.1111/xen.12247.
Goren S. Letter to MK Savidor. (On organs for transplant). Assia. 1999; 65-66 [Hebrew].
Rosner F. Contemporary Biomedical Ethical Issues and Jewish Law. Book News; 2007:1-14.
Rabbinical Assembly. Committee of Jewish Law and Standards, Yoreh Deah; 2015:297. https://www.rabbinicalassembly.org/jewish-law/committee-jewish-law-and-standards.
Address of Pope Francis to participants in the conference of the Italian Society of Surgical Oncology on digestive surgery new trends and spending review. 2014; April 12. Accessed November 15, 2017. https://www.vatican.va/content/francesco/en/speeches/2014/april/documents/papa-francesco_20140412_congresso-chirurgia-oncologica.html.
Sautermeister J. Xenotransplantation Legitimation und Akzeptanz aus theologisch-ethischer Sicht. In: Zur Debatte. 2014;65:16-26. https://mthz.ub.uni-muenchen.de/MThZ/article/view/2014H1S16-26.
The Holy See. Address of Pope Francis to participants in the conference of the Italian Society of Surgical Oncology on digestive surgery new trends and spending review. 2014. https://www.vatican.va/content/francesco/en/speeches/2014/april/documents/papa-francesco_20140412_congresso-chirurgia-oncologica.html.
Pew Research Center. Pew-Templeton Global religious futures Project Phase VI. 2021. [Cited: 06 02]. [Online]. http://www.globalreligiousfutures.org/religions/muslims.
Padela AI, Duivenbode R. The ethics of organ donation, donation after circulatory determination of death, and xenotransplantation from an Islamic perspective. Xenotranspl. 2018;25:e12421. doi:10.1111/xen.12421.
Enoch S, Shaaban H, Dunn KW. Informed consent should be obtained from patients to use products (skin substitutes) and dressings containing biological material. J Med Ethics. 2005;31(1):2-6. doi:10.1136/jme.2003.005272.
Sura-Al-Anaam, Al-Qur'an [6:145].
Sura Al-Baqarah, Al-Qur'an [2:173].
Sura Al-Nahl, Al- Qur'an [16:115].
Sura Al Maeeda, Al-Qur'an [5:3].
Omar A, Firas A, Hazim R. The use of porcine bioprosthetic valves: an Islamic perspective and a bio-ethical discussion. JBIMA. 2022;4(11). Accessed November 6, 2022. https://www.jbima.com/wp-content/uploads/2022/09/2-Ethics_5_Hazem_-Heart-Valves_.pdf.
Padela AI. Islamic bioethics: between sacred law, lived experiences, and state authority. Theor Med Bioeth. 2013;34:65-80. doi:10.1007/s11017-013-9249-1.
Shabana A. Bioethics in Islamic thought. Relig Compass. 2014;8:337-346. doi:10.1111/rec3.12137.
Fadel M. The true, the good, and the reasonable: the theological and ethical roots of public reason in Islamic Law. Can J Law Juris. 2008;21:5-69. doi:10.1017/S084182090000432X.
Ghaly M. Islam and Disability: Perspectives in Theology and Jurisprudence. Routledge Islamic Studies Series. Routledge. xiv; 2010:254.
Qureshi O, Padela AI. When must a patient seek healthcare? Bringing the perspectives of Islamic jurists and clinicians into dialogue. Zygon. 2016;51:592-625. doi:10.1111/zygo.12273.
Murthy R, Bajara P, Bhama J, Cooper DKC. Heart xenotransplantation: historical background, experimental progress, and clinical prospects. Annals Thor Surg. 2016;101:1605-1613. doi:10.1016/j.athoracsur.2015.10.017.
Fah̲rī M. Ethical Theories in Islam. Vol 8. Brill; 1991.
Isa NM. Darurah (Necessity) and its application in Islamic ethical assessment of medical applications: a review on Malaysian Fatwa. Sci Engin Ethics. 2016;22:1319-1332.
Ghannam O. Organ Donation and Islam. In: Ismail S, ed. Muslim Healthcare Student Network. 2019. Accessed October 7, 2019. https://dokumen.tips/documents/organ-donation-and-islam-islamic-medical-ethics-donation-from-anorgan-donation.html?.
Hussaini MO. Organ transplantation: classical Hanafite perspective. Accessed November 1, 2017. https://pureway.org/Writings/organ_transplant.pdf.
Kurniawan F, Nugroho A, Baskara RA, et al. Rapid analysis to distinguish porcine and bovine gelatin using PANI/NiO nanoparticles modified Quartz Crystal Microbalance (QCM) sensor. Heliyon. 2022;8(5).
Ali A. The Quran: Translation. Tahrike Tarsile Quran; 1999.
Ibn Mājah AMIY. Sunan Ibn Majah. Sunnah.com. Accessed November 2, 2017. https://sunnah.com/ibnmajah.
Manesh SB, Samani RO, Manesh SB. Ethical issues of transplanting organs from transgenic animals into human beings. Cell J. 2014;16:353-360.
Padela AI. Muslim perspectives on the American healthcare system: the discursive framing of “Islamic” bioethical discourse. Die Welt des Islams. 2015;55:413-447.
Ebrahim AFM. Organ Transplantation, Euthanasia, Cloning and Animal Experimentation: An Islamic View. The Islamic Foundation; 2001.
Cozzi E, Bosio E, Seveso M, et al. Xenotransplantation-current status and future perspectives. Brit Med Bull. 2005;75:99-114. doi:10.1093/bmb/ldh061.
Kamali MH. Qawa ‘id al-fiqh: the Legal Maxims of Islamic Law. The Association of Muslim Lawyers (UK). Accessed November 3, 2017. https://ia800306.us.archive.org/17/items/KamaliQawaidAlFiqh/Kamali_Qawaid_al-Fiqh.pdf.
Padela AI. Social responsibility and the state's duty to provide healthcare: an Islamic ethico-legal perspective. Develop World Bioeth. 2016;17:205-214.
Sattar SP, Ahmed MS, Madison J, et al. Patient and physician attitudes to using medications with religiously forbidden ingredients. Ann Pharmacother. 2004;38(11):1830-1835. doi:10.1345/aph.1e001.

Keywords: Christian; Jewish; Muslim; theological views; xenotransplantation

Date Created: 20231117 Date Completed: 20240131 Latest Revision: 20240418

20240418

10.1111/ctr.15192

37975531