American Scientist

XENO: The Promise of Transplanting Animal Organs Into Humans. David K. C. Cooper and Robert P. Lanza. 304 pp. Oxford University Press, $30.

David K. C. Cooper and Robert P. Lanza's XENO begins like a novel, drawing the reader into the real world of organ transplantation, then to a futuristic world of xenotransplantation—the insertion of cells, tissues and organs from pigs and other animals into human beings. Their study describes patients suffering from diabetes, liver failure, Parkinson's disease and other conditions, and it indicates how these could eventually be treated. Although this book is about xenotransplantation, its subjects are so encompassing that it can serve as a fascinating primer about developments in contemporary medical research.

The solidly researched topics of XENO are placed into the overarching form of an epic narrative that soon turns into a history for stout-of-heart readers: sheep-blood transfusions and dog-bone grafts in the 17th century, ape-testicle grafts in impotent men in the 1920s, chimpanzee and baboon heart and liver transplants from the 1970s through the 1990s. We hear of the failures and successes of ingenious and dedicated scientists and of the necessity of "bold surgeons and brave patients" to face future challenges. The narrative ends with the vision that xenotransplantation will "almost certainly be only a transitory therapeutic option" that is eventually replaced by successful cloning and stem-cell research.

The authors expertly explore the many issues surrounding xenotransplantation. They deal with the complexities of human and animal immune systems and organ rejection, immunological suppression and future paths to achieving immunological tolerance, cross-species physiology, infectious-disease transmission and the cloning and genetic engineering of animal species. Their expertise is all the more impressive because of their clear explanations and use of ordinary language. Cooper and Lanza also forthrightly grapple with the profound ethical questions surrounding xenotransplantion. These include balancing concerns over the present grave shortage of transplantable organs with the possibility of a pandemic outbreak of disease, the value and status of animals, justice in allocating health-care funds, potential legal problems, the ethics of human-subject research and how medical research should be regulated.

Without saying it, XENO demonstrates that the scientific, medical, social and ethical dimensions of xenotransplantation surpass those of every other major medical research initiative. This deserves to be read by a wide audience. The text does not lose itself in medical jargon, and rather than focusing exclusively on developments in the U.S., it regularly relates its topics to the U.K., continental European nations, Russia, Japan and other regions and nations.

XENO is so expertly researched and well written that criticisms of its form and content should be viewed as responses to, rather than detractions from, its manifest merits. From the perspective of the humanities, the book's epic form and its attention to fascinating bodies of information mask some of the human dimensions of new and powerful medical innovation. Cooper and Lanza speak candidly and frequently about the "unfortunate" deaths of the human subjects of xenotransplants and of the likely deaths to come. They bring readers inside the world of the poignant and trying decisions of surgeons, and speak through the voices of knowledgeable, curious and determined surgeons and scientists. They do this to make the strongest case possible for a vast, promising and controversial field of medical innovation. The epic features of their text can thereby be regarded as both natural and even necessary. Their book exemplifies how expertise, heroism and hope instill and maintain a passionate commitment to medical progress.

It is therefore not surprising that, with rare exceptions, the actual experiences of patients and research subjects are left to the imagination—imagination enlivened by descriptions of medical cases that can be interpreted as virtually pleading for efficacious xenotransplantation therapies. Would the past and present human stories and voices of patients faced with organ dysfunction, dire suffering and inescapable necessity detract from or strengthen the case for xenotransplantion research? Against the grain of pro-research writing, one can argue that these stories and voices would strengthen the case all the more, because our deepest levels of empathy and commitment are enlivened by those whom we come to know and know well.

It is unfortunate that the author's discussion of a number of the critical ethical issues surrounding xenotransplantation occurs in a chapter with the title "Animal Rights and Human Wrongs." In fact, this chapter's subtitle, "Ethical Concerns," captures its content, which encompasses brief but highly informative sections on animal rights, public-opinion polls, profit motives and conflicts of interest, informed consent, patient confidentiality and when re-initiated clinical trials will be justified.

The need to inform the public about the many issues surrounding xenotransplantation has emerged as a recurrent theme at national and international meetings. To its great credit, XENO can strongly contribute to this frequently and at times fervently voiced concern. XENO merits the attention of numerous researchers, news reporters, educators, government personnel and concerned citizens. It should also be viewed as required reading for anyone who supports or lobbies for bans on further xenotransplantation research. Until they have mastered the topics discussed by Cooper and Lanza, opponents of xenotransplantation should remain silent.