Over the past decade, the number of solid organ transplant procedures done in the United States each year has increased substantially, from approximately 13,000 in 1988 to 20,000 in 1996.1 Despite the increased availability of these procedures, the number of potential recipients awaiting organ donation has more than tripled since 1988. At the end of 1996, an estimated 50,000 persons were awaiting organ donations.1 This shortage of available human allografts has prompted the development of investigational therapeutic approaches that use animal tissues or organs (xenografts) in human recipients. Xenotransplantation refers to any procedure that involves the use of live cells, tissues, or organs from a nonhuman animal source for transplantation, implantation, or ex vivo perfusion in humans. In the United States, the modern era of xenotransplantation began with the transplantation of chimpanzee kidneys into patients with chronic renal failure.2 It is likely that, in 1964, when this procedure was introduced, it was viewed as one with limited clinical utility and a procedure for the future. However, recent scientific and biomedical advances have made possible more extended use of animal tissues or organs for human clinical applications beyond organ transplantation; animal cells, tissues, or organs have been used for extracorporeal perfusions of patients awaiting organ donation and as a treatment for medical conditions such as Parkinson's disease, diabetes, and human immunodeficiency virus (11W) infection. Although xenotransplantation may be one partial solution to the unmet demand for human organ and tissue donations, its use raises some unique public health concerns, most notably the poten ial for transmission of infections of animal origin (xenozoonoses) to humans.3 In this issue of the Journal, Bone and colleagues have provided an overview of the potential infectious agents and infectious risks associated with use of tissues harvested from pigs, one of the primary species proposed as a source for xenografts.4 While considerable debate has centered around the qu stion of whether one animal source or species may pose a greater risk for xenotransplant-related inf tion than another, the article raises global and provocative questions about the potential infectious isks that may accompany the use of xenotransplantation as a routine therapeutic modality: What is the risk of transmitting endogenous animal pathogens to the human recipient? What is the risk of secondary transmission of xenozoonoses from the recipient to thei contacts (eg, family members, healthcare providers)? Lastly, what risk do xenozoonoses pose to the general population? Currently, the infectious risks posed by xenotransplantation are unknown. However, experience with human allografts has shown that infectious agents (eg, hepatitis B virus, hepatitis C virus, rabies virus, HIV, Candida albicans, and Creutzfeldt-Jakob agent) can be transmitted via transplanted human tissues or organs.5,6 Some investigators have suggested that the ability to produce and use pathogen-free animal sources to obtain clean xenografts would eliminate b th the infectious risks associated with the use
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