Consensus Conferences (Xenotransplantation)
Consensus conferences are a method pioneered by the Scandinavians of involving the public and politicians in a variety of policy questions and decisions. An appropriate government body advertises for volunteer “jurors” to study the topic with materials provided and from any other source. The jurors then meet formally about three times for a day at intervals of a few weeks for discussion and on at least one occasion with experts and stakeholders to answer questions. The final meeting is to write a report for parliament and the news media. In Denmark, these conferences are duplicated in secondary schools and any unique ideas produced among the school participants are summarized and also transmitted to parliament and the media.
These conferences seem to be most useful when they deal with new questions about which opinions are not yet polarized. For instance, Canada in 2001 sponsored conferences about xenotransplantation. This is the use of animal organs for replacement in humans especially kidney, liver, and heart. There is currently research in progress to modify pig genetics in hopes of making pig organs compatible for humans. Xenotransplantation is not entirely new. In 1963, a school teacher lived nine months after receiving two transplanted kidneys from a chimpanzee. She did resume teaching for much of the nine months.
The current push for xenotransplantation stems from the fact that there are now 80,000 people eligible for transplants and only 15,000 available human organs annually. Pigs are being studied because they match us in size and are available in any quantity. There are ethical problems for study beside the technical and economic questions. If pig organs can be bred to fill this unmet demand, there will be great pressure to use them. So it is appropriate to start educating the public about the issues involved.
Six consensus juries in Canada concluded that the risk to the general public of xenotransplantation was too great to accept for now considering our present state of ignorance of porcine endogenous retroviruses. It was a chimpanzee endogenous retrovirus that got loose in humans and became more virulent to cause AIDS (Acquired Immunodeficiency Syndrome). These Canadian juries suggested a greater effort to obtain more human organs. For example, implied consent for donation, meaning that only a specific request by an individual that his/her organs not be used after death, would prevent their use if the organs were otherwise acceptable. The jurors expressed the hope that stem cells might be a better solution in some specific instances. They also felt that there currently is insufficient public health infrastructure for long term monitoring of the health of the recipients and their relatives and associates. They recommended waiting for an international regulatory framework. They also had some concerns about society’s increasing resistance to animal experimentation and undefined health care costs.
Here are some other public questions which might be appropriate for consensus conferences:
1. Stem cells and cloning, but this might have better been done two to three years ago before polarization of opinion and confusion about reproductive and therapeutic cloning.
2. Genetically modified organisms: In the United States, we seem to have remained more open minded on this topic than the Europeans. Consider this November 2000 quote from the president of Monsanto Company: “We thought we were doing some great things. A lot of other people thought we were making some mistakes. We were blinded by our own enthusiasm. We missed the fact that this technology raises major issues for people- issues of ethics, of choice, of trust, even of democracy and globalization. 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. If we are to close the gap between those who believe in the benefits and those who have concerns, then something has to change.”
3. We need a more informed public about the issue of missile defense and military solutions to world problems in general.
4. Last year, two billionaires, Ted Turner and Bill Gates, stated that we shouldn’t eliminate inheritance taxes completely because after a few generations, a small group of families would own too much. When this happened in Europe hundreds of years ago, there was a new world open for emigration. Let us get Ted Turner or Bill Gates on a consensus conference about tax fairness and simplicity. A pipe dream?
John A. Frantz, M.D. See also: Public Health, Public Costs and Public Benefits under Public Health
March 14, 2002