La perspectiva de los xenotrasplantes. Aspectos científicos y consideraciones éticas | Vial Correa | ARS MEDICA Revista de Ciencias Médicas

La perspectiva de los xenotrasplantes. Aspectos científicos y consideraciones éticas

Juan de Dios Vial Correa, Elio SGRECCIA

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La expresión animal donante tiene en este texto un significado exclusivamente técnico y traduce, de la manera más directa y sintética posible el inglés source animal; fuera de tal contexto, de hecho, el adjetivo ‘donante’, que implica en sí mismo el concepto de libertad y de capacidad de consenso, resultaría impropio porque hace referencia a un animal, que obviamente no posee dichas características

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Cfr. Soares, M.P.; Lin Y.; Sato, K., et al., Accommodation, Immunol Today 1999, 20:434-7 Aspectos científicos y consideraciones éticas 31 Cfr. Soares, M.P.; Lin, Y.; Sato, K., et al., Accommodation, Immunol Today 1999, 20:434-7; Lin, Y.; Soares, M.P.; Sato K., et al., Accommodated xenografts survive in the presence of antidonor antibodies and complement that precipitate rejection of naive xenografts, J Immunol. 1999 Sep 1;163(5):2850-7

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Cfr. Cozzi, E.; Bhatti, F.; Schmoeckel, M. et al., Long-term survival of nonhuman primates receiving life-supporting transgenic porcine kidney xenografts, Transplantation 2000, 70:15-21; Vial C.M., Ostlie D.J., Bhatti FN. et al., Life supporting function for over one month of a transgenic porcine heart in a baboon, J Heart Lung Transplant 2000, 19:224-9

Cfr. McCurry, K.R.; Kooyman, D.L.; Alvarado, C.G., et al., Human complement regulatory proteins protect swine-to-primate cardiac xenografts from tumoral injury, Nature Med 1995, 1:423- 7; Cozzi E., Yannoutsos N., Langford G.A. et al., Effect of transgenic expression of human decayaccelerating factor on the inhibition of hyperacute rejection of pig organs. In: Cooper DKC, Kemp E, Platt JL, White DJG, eds. Xeno-transplantation. The Transplantation of Organs and Tissues Between Species. 2nd ed. Berlin: Springer-Verlag 1997: 665-682

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Bhatti F.N., Schmoeckel M., Zaidi A et al., Three-month survival of HDAF transgenic pig hearts transplanted into primates, Transplant Proc. 1999, 31: 958; McCurry K.R., Kooyman D.L., Alvarado C.G., et al., Human complement regulatory proteins protect swine-to-primate cardiac xenografts from tumoral injury, Nature Med 1995, 1:423-7

Cfr. Bhatti, F.N.; Schmoeckel, M.; Zaidi, A. et al., Three-month survival of HDAF transgenic pig hearts transplanted into primates, Transplant Proc. 1999, 31: 958

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Juan de Dios Vial Correa - Elio Sgreccia 47 Cfr. Brevig, T.; Holgersson, J.; Widner, H., Xenotransplantation for CNS repair: immunological barriers and strategies to overcome them, Trends Neurosci 2000; 23: 337-44

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Cfr. Cozzi, E.; Bhatti, F.; Schmoeckel, M. et al., Long-term survival of nonhuman primates receiving life-supporting transgenic porcine kidney xenografts, Transplantation 2000, 70:15-21; Vial C.M., Ostlie D.J., Bhatti FN. et al., Life supporting function for over one month of a transgenic porcine heart in a baboon, J Heart Lung Transplant 2000, 19:224-9; Bhatti F.N., Schmoeckel M., Zaidi A et al., Three-month survival of HDAF transgenic pig hearts transplanted into primates, Transplant Proc. 1999, 31: 958

Se refiere al esquema narrativo, de corte teológico-litúrgico, adoptado en Gen. 1,1-31; para una mejor comprensión del cuadro antropológico bíblico, desde el punto de vista protológico, hay que tener presente también el segundo relato de la creación en Gen. 2, 1-25

Giovanni, Paolo II, Carta. Enc. Laborem exercens, n. 4

Conc. Vat. II, Constitución Dogmática Lumen Gentium, n. 36

Conc. Vat. II, Decreto Apostolicam actuositatem, n.7

S. Ireneo di Lione, Trattato contro le eresie, Lib. 4, 20, 7

Vedi, Bondolfi A., I rapporti tra uomo e animale nelle tradizioni giudaico-cristiane e la sfida degli xenotrapianti, in Larco di Giano, 1999; 21: 49-62; DAgostino F., I diritti degli animali, in Bioetica nella prospettiva della filosofia del diritto, 1997, Giappichelli Ed., Torino, pág. 239-265

Vedi, Singer P., Animal Liberation, 2nd edit., 1995, Pimlico, London; Regan T., The case for Animal Rights, 1983, London, Routledge & Kegan Paul; Christian Medical Fellowship, Animal experimentation, 1997, (http://www.cmf.org.uk, 10/7/2001)

Ver las reflexiones sobre la responsabilidad humana respecto de la vida animal en Schockenhoff E., Etica della vita. Un compendio teológico, Brescia: Queriniana 1997: 407-451

El precepto veterotestamentario que consideraba impuros algunos animales (cfr. Lv. 11,3- 8.26-29) se ha de considerar abolido por Cristo (cfr. Mc. 7,14-23; At. 10,14-15; Rom. 14,14)

Hay que observar que los ‘indicadores de identidad’, en la persona humana, son múltiples (objetivos: nombre, sexo, edad, etc. –culturales: lengua, religión, ideología, etc. –de grupo – social – profesional)

Cfr. Grinberg, L. e R., Identità e cambiamento, Roma: Armando, 1992; Jervis G., La conquista dellidentità: essere se stessi, essere diversi, Milano: Feltrinelli, 1997 62 Es bueno precisar que, mientras el encéfalo está en relación con la identidad personal del sujeto en cuanto órgano que representa la ‘sede principal de la conciencia sicológica’, el ‘depósito’ de su memoria existencial, las gónadas lo son en cuanto órganos encargados de la gametogénesis (producción de gametos); estos representan, por decirlo así, el ‘transmisor’ mediante la procreación, de la identidad personal (patrimonio genético) del sujeto a su descendencia. Por este motivo,

mientras un hipotético trasplante de encéfalo no podría en ningún caso ser considerado lícito, un eventual trasplante de gónadas tampoco lo sería si tuviese como fin la función gametogenética. Por el contrario, un trasplante de gónadas que fuese concebido exclusivamente con una finalidad hormonogenética (es decir para la obtención de una función hormonal suficiente), una vez asegurada la integridad de 165 La perspectiva de los xenotrasplantes

Aspectos científicos y consideraciones éticas la identidad personal del sujeto receptor, y asegurada la falta de vinculación con la procreación, no presentaría particular reserva moral. A este respecto, ver Faggioni M.P., Il trapianto di gonadi. Storia e attualità, Med Mor 1998, 48: 15-46

Ver Cuer, P., Quelques considérations éthiques, notamment sur lidentité lors de xenotrasplantations, Path Biol (Paris) 2000, 48 : 426-428

Cfr. También Juan Pablo II, Discurso a los participantes al XVIII Congreso Internacional sobre los trasplantes de órganos, 20/6/1991; Catecismo de la Iglesia católica (1994) n. 2296; JUAN PABLO II, Carta. Enc. Evangelium Vitae (1995) n. 86; Pontificio Consejo para la pastoral de los agentes sanitarios, Carta de los Agentes Sanitarios (1995), nn. 83-91

Para tener una visión del debate actual, ver: Caplan A.L., Is Xenografting Morally Wrong, Transplantation Proceedings, 1992, 24:722-727; Hanson M.J., The Seductive Sirens of Medical Progress. The case of Xenotransplantation, Hastings Center Report 1995, 25: 5-6; Nuffield Council of Bioethics, Animal-to-Human Transplants: the Ethics of Xenotransplantation, London: Nuffield Council of Bioethics, 1996; Mc Carthy Ch.R., A New Look at Animal-to-Human Organ Transplantation, Kennedy Institute of Ethics Journal, 1996, 6: 183-188; U.S. Institute of Medicine Committee on Xenograft Transplantation, Xenotransplantation: Science, Ethics, and Public Policy, Washington: National Academy Press, 1996 ; Bach F.H., Fishman J.A., Daniels N., et al., Uncertainty in Xenotransplantation: Individual Benefit versus Collective Risk, Nature Medicine, 1998, 4: 141- 144; Hughes J., Xenografting: Ethical Issues, Journal of Medical Ethics, 1998, 24: 18-24; Vanderpool H.Y., Critical Ethical Issues in Clinical Trials with Xenotransplants, The Lancet, 1998, 351: 1347- 1350; Clark M.A., This Little Piggy Went to Market: The Xenotransplantation and Xenozoonose Debate, Journal of Law, Medicine and Ethics, 1999, 27: 137-152; Comité Consultatif National dÉthique pour les sciences de la vie et de la santé (France), Avis sur léthique et la xénotransplantation, n.61, 11 juin 1999; Cooper D.K.C., Lanza R.P., Xeno, the Promise of Transplanting Animal Organs into Humans, New York: Oxford University Press 2000; U.S. Dpt. Healt & Human Services, Food and Drug Administration, Center for Biologics Evaluation and Research, Source animal, product, preclinical, and clinical issues concerning the use of Xenotransplantation products in humans: guidance for industry (Draft, February 2001), (http://www.fda.gov/cber/guidelines.htm)

Cfr. Schöne-Seifert, B., Risk, in Reich T.W. (ed.), Encyclopedia of Bioethics, vol. 4, New York: MacMillan 1995 (revised edition), 2316-2321

Una visión de conjunto de las reacciones sociales sobre los diversos aspectos del xenotrasplante: Appel J.Z., Alwayn I.P., Cooper D.K., Xenotransplantation: The Challenge to Current Psychological Attitudes, Prog Transplant 2000, 10: 217-225

Ver Beckmann J.P., Xenotransplantation aus ethischer Sicht. Eine Skizze, Zentralbl Chir 1999, 124: 636-640; Welin S., Starting Clinical Trials of Xenotransplantation. Reflections on the Ethics of the Early Phase, J Med Ethics 2000, 26: 231-236

Con este propósito, se han conducido algunas investigaciones entre la población para sondear el grado de aceptación del público en relación con un eventual xenotrasplante: Ver, por ejemplo

Mohacsi P.J., Blumer E.C., Quine S. et al., Aversion to Xenotransplantation, Nature, 1995, 378 :434 ; National Kidney Federation, Survey reveals positive feelings on animal-to-human transplants, Dialysis and Transplantation, 1995, pág. 677; Mohacsi P.J. et al., Patients attitudes to xenotransplantations, Lancet 1997, 349:1031

Ver Crafen J., Rodin G.M., Psychiatric Aspects of Organ Transplantation, New York: Oxford Medical Publications, 1992

Ver Barker J.H., Polcrack L., Respect for persons, informed consent and the assessment of infectious disease risks in xenotransplantation, Med Health Care Philos 2001, 4(1): 53-70

Ver Kress, J.M., Xenotransplantation: ethics and economics, Food Drug Law Journal 1998, 53 (2):353-384; Urruela Mora A., Workshop on the ethical, sociologic, economic and legal aspects of xenotransplantation, Law Hum Genome Rev 2000 Jan-Jun;(12):245-6

Cfr. Tratado de Cooperación acerca de las patentes (Washington, 1970), art.33; Convención de la Patente Europeo (Munich de Baviera, 1973), 54-57; ver también Marchetti P., Ubertazzi L.C., Commentario breve al diritto della concorrenza, Padova, CEDAM, 1997:1343 74 Cfr. WIPO/OMPI, Introduction to Intellectual Property: Theory and Practice, Kluwer Law International, London 1998: 145-150; Acuerdo de Marrakech instituido por la Organización Mundial del Comercio, anexo 1 C: Acuerdo sobre los aspectos de la propiedad intelectual relativos al comercio (Marrakech, 1994), art. 31

Citamos, a modo de ejemplo, algunos importantes organismos que han elaborado orientaciones en esta materia: the Council of Europe, the Health Council of the Netherlands, the Swedish Committee on Xenotransplantation, the Spanish Xenotransplantation Sub-committee, the Argentine National Commission on Xenotransplantation, the US Department of Health and Human Services Committee on Xenotransplantation, the United Kingdom Xenotransplantation Interim Regulatory Authority, and the Italian Xenotransplantation Commission. In France, the ethical aspects are currently being examined by the French National Ethics Committee and applications for clinical trials will need the approval of the newly formed Agency for the Security of Health Products and of the Ministry of Health. In Germany, the German Medical Council has established a committee to prepare guidelines on xenotransplantation. En Canadá, Health Canada has the authority to regulate xenotransplantation as a new technology.




DOI: http://dx.doi.org/10.11565/arsmed.v33i1.248



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