Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Commentary

The xenotransplantation question: public consultation is an important part of the answer

Adrian J. Ivinson and Fritz H. Bach
CMAJ July 09, 2002 167 (1) 42-43;
Adrian J. Ivinson
Dr. Ivinson is Director of the Harvard Center for Neurodegeneration and Repair, Harvard Medical School, and Dr. Bach is with the Immunobiology Research Center, Harvard Medical School, Boston, Mass.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Fritz H. Bach
Dr. Ivinson is Director of the Harvard Center for Neurodegeneration and Repair, Harvard Medical School, and Dr. Bach is with the Immunobiology Research Center, Harvard Medical School, Boston, Mass.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

In his commentary in this issue (page 40),1 James Wright disagrees with the central conclusion of the recent Canadian Public Health Association (CPHA) report on its public consultation on xenotransplantation. Whereas we have some sympathy with some of the concerns he raises, both he and the CPHA are missing the point. They see the public consultation as a voting exercise, the result of which can be used to determine policy. And that is wrong.

The CPHA report summarized the findings of a “comprehensive consultation with Canadians on the complex issue of xenotransplantation” through citizen forums.2 Delivered to the federal minister of health, the report made 7 recommendations. It was the principal recommendation “That Canada not proceed with xenotransplantation involving humans at this time …” that bothered Wright the most.

Wright takes issue with the consultation process, arguing that on the whole it was poorly designed. And he raises some important concerns. For example, the central question that was repeatedly asked of the lay participants “Should Canada proceed with xenotransplantation and if so, under what conditions?” was indeed vague and difficult to answer simply. The great variation in responses from the different lay panels is also cause for concern, and the suitability of some of the expert witnesses put at the disposal of the lay panels was questionable. That said, judging by the description given in the official report, the public consultation exercise generally was well organized and comprehensive. But it is just that, a consultative exercise, not a vote or recommendation for a particular policy.

The benefits of new technological discoveries must always be weighed against their potential dangers. In the case of xenotransplantation, the medical and scientific communities are familiar with many of the risks3 (with infectious agents4 topping the list for most of us). Likewise, the typical stakeholders — industry, patient advocacy groups, animal rights advocates, the legal community and others — are also aware of the issues and know how to make their views heard. The public, in contrast, is rarely consulted, yet is expected to live with the consequences of these decisions. As such, the CPHA and others are to be congratulated on any effort to involve the public in this discussion.

Public consultation on complex biomedical issues (or indeed on any technological development) is not simple. As both the CPHA and Wright stress, there is little value in asking the opinion of an uninformed or misinformed constituency. Great efforts must therefore be made to explain the issues in such a way that the lay audience is given an accurate, comprehensive and objective picture that includes all the major views but is nondirective. In effect, we are aiming for a process similar to that required for fully informed consent in clinical practice.5

But the CPHA's public consultation exercise must not be mistaken for a referendum or a national poll. Determining whether most Canadians endorse xenotransplantation would certainly be interesting but is neither possible from this exercise in limited public consultation, nor, we believe, should it have been the aim. Rather, the value of this exercise lies in exploring with a lay group a variety of concerns and options and then feeding this understanding to those who ultimately are charged with setting policy.6 Those decision-makers are responsible for considering the positions of all the parties and arriving at a decision that is informed by all parties, including the public.

At first blush, some stakeholder groups may not welcome public consultation, fearing perhaps that the public may not support their aims. Experience suggests that this is not necessarily the case. After the near-wholesale European rejection of their genetically modified foods program, Monsanto's president, Hendrik Verfaillie, admitted that they had made a mistake and acknowledged the value of public consultation:6 “As we tried to understand what had happened, we realized that we needed to hear directly from people about what they thought, what their concerns were and what they thought we ought to do.”

From the biological perspective, significant immunological hurdles still need to be overcome before xenotransplantation becomes viable. But with many scientists investigating various solutions to these problems, there is at least reason for optimism that xenotransplantation will become a viable medical option. Between now and then, it is essential that we better understand the public's views on this new technology. The CPHA report is certainly a valuable contribution and should indeed influence the Canadian government's deliberations. But it is not a referendum result that on its own should dictate policy. Rather, it is an essential mechanism for adding the public's voice to those of the traditional stakeholders.

𝛃 See related article page 40

Footnotes

  • Contributors: Dr. Ivinson drafted the article, and Dr. Bach critically revised the first draft. Both authors contributed substantially to the development of the opinions expressed in the article and approved the final text for publication.

    Competing interests: None declared for Dr. Ivinson. Dr. Bach is a paid consultant to Novartis, which has an interest in commercializing xenotransplantation.

References

  1. 1.↵
    Wright JR Jr. Alternative interpretations of the same data: flaws in the process of consulting the Canadian public about xenotransplantation issues. CMAJ 2002;167(1):40-2. Available: www.cmaj.ca/cgi/content/full/167/1/40
    OpenUrlFREE Full Text
  2. 2.↵
    Animal-to-human transplantation: Should Canada proceed? A public consultation on xenotransplantation. Ottawa: Canadian Public Health Association; 2001. Available: www.xeno.cpha.ca/english/finalrep/page1.htm (accessed 2002 June 2).
  3. 3.↵
    Cooper DKC, Lanza RP. Xeno: the promise of transplanting animal organs into humans. Oxford: Oxford University Press; 2000.
  4. 4.↵
    Platt JL Xenotransplantation: new risks, new gains. Nature 2000;407:27-30.
    OpenUrlCrossRefPubMed
  5. 5.↵
    Bach FH , Fishman JA, Daniels N, Proimos J, Anderson B, Carpenter CB, et al. Uncertainty in xenotransplantation: individual benefit versus collective risk. Nat Med 1998;4(2):141-4.
    OpenUrlCrossRefPubMed
  6. 6.↵
    Bach FH, Ivinson AJ. A shrewd and ethical approach to xenotransplantation. Trends Biotechnol 2002;20:129-31.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

CMAJ
Vol. 167, Issue 1
9 Jul 2002
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
The xenotransplantation question: public consultation is an important part of the answer
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
The xenotransplantation question: public consultation is an important part of the answer
Adrian J. Ivinson, Fritz H. Bach
CMAJ Jul 2002, 167 (1) 42-43;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
The xenotransplantation question: public consultation is an important part of the answer
Adrian J. Ivinson, Fritz H. Bach
CMAJ Jul 2002, 167 (1) 42-43;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Footnotes
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • Highlights of this issue
  • Alternative interpretations of the same data: flaws in the process of consulting the Canadian public about xenotransplantation issues
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Time for a regulatory framework for pediatric medications in Canada
  • Optimizing timing of completion of the Surgical Safety Checklist to account for emergence from anesthesia
  • Shifting from cytology to HPV testing for cervical cancer screening in Canada
Show more Commentary

Similar Articles

Collections

  • Topics
    • Transplant medicine

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2022, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire