Daniel Rodger

Since 2022, genetically modified pig organs have been transplanted into both deceased and living human subjects, and first-in-human clinical trials began in 2025. Yet, little is known about the experience of performing such procedures. The first kidney xenotransplant studies involved human brain-dead recipients, with graft function ranging from hours to months. Interviews were conducted with one of the first surgeons with experience in performing a pig-to-human kidney xenotransplant and analysed using interpretative phenomenological analysis. Following analysis, four personal experiential themes were identified: Desiring a more equitable patient future; Being changed by bonding with the family; Crossing a boundary without feeling the difference and Everything changed when the pig kidney turned pink. As the first exploration of a surgeon’s lived experience of xenotransplantation, the study highlights how motivations, uncertainties and ethical commitments influence engagement with emerging biotechnologies. While uncertainties remain, the findings provide insight into how a surgeon interprets and navigates the conceptual and emotional terrain of crossing into first-in-human xenotransplantation.

The permissibility of conscientious objection (CO) in healthcare presents a complex balance of benefits and harms, and philosophers disagree on whether it should be permitted at all. For example, consequentialists such as Udo Schuklenk argue that healthcare professionals should never be allowed to object, a position known as the ‘incompatibility thesis’.1 Steve Clarke, however, believes that there is a positive consequentialist case for permitting CO in healthcare.2 The most important benefits he notes are that permitting CO prevents moral injury, and it means objectors do not have to leave their profession. Potential harms include denial of healthcare services, which can result in impairment, even death, and patient distress or humiliation when a request is refused, particularly in time-sensitive contexts. In Clarke’s view, a good consequentialist solution is to try to acquire the benefits of CO while avoiding its harms. One approach is Dan Brock’s ‘conventional compromise’, whereby healthcare professionals with a strong moral objection to providing a legal service can abstain from doing so, provided they inform the patient of the service and refer the patient to another healthcare professional willing to provide it.3 Clarke sees Brock’s proposal as an improvement on the incompatibility thesis from a consequentialist perspective, but identifies two important issues that could cause harm. First, the act of referral still makes …

Alexandre Erler’s commentary challenges our argument against creating human ‘bodyoids’. While he considers our concerns speculative, we briefly defend speculative bioethics as vital for anticipating ethical risks before technologies emerge. We maintain that historical practices such as organ procurement and embryo experimentation illustrate how instrumental uses of human bodies can erode moral boundaries. Erler’s confidence in safeguards like the dead donor rule is, we suggest, misplaced. Ethical reflection at this formative stage is essential to prevent the normalization of technologies that risk profound dehumanization.

Alexandre Erler’s commentary challenges our argument against creating human ‘bodyoids’. While he considers our concerns speculative, we briefly defend speculative bioethics as vital for anticipating ethical risks before technologies emerge. We maintain that historical practices such as organ procurement and embryo experimentation illustrate how instrumental uses of human bodies can erode moral boundaries. Erler’s confidence in safeguards like the dead donor rule is, we suggest, misplaced. Ethical reflection at this formative stage is essential to prevent the normalization of technologies that risk profound dehumanization.

Although much has been written about how generative artificial intelligence (GenAI) may affect bioethics, there is limited research on its use in bioethics scholarship. The objectives of our study are (i) to assess the extent to which GenAI is being used in the production of bioethics scholarship and (ii) to analyze how such utilization is described when disclosed. 20 bioethics journals were selected based on Google Scholar’s 2024 H5-index rankings. All publications from these journals’ 2024 volumes were reviewed for disclosure of GenAI use. In parallel, we examined each journal’s and publisher’s stated policies regarding GenAI-generated content, classifying them as permissive or prohibitive. The frequency and contextual framing of GenAI-utilization acknowledgements were analyzed. Of 1,808 publications, only 12 articles across five journals included a reference to GenAI use or non-use. Among the 12 mentions, nine disclosed GenAI utilization, while three stated non-utilization. The nine utilization acknowledgments appeared in different sections of the papers, with ChatGPT being the most frequently cited GenAI model and “tool” the most commonly used descriptor. Drawing on wider research trends, a disclosure rate of at least 10% was expected; however, the observed rate was under 1% and may reflect limited uptake, underreporting, or both. This finding raises important questions about transparency, methodological reporting standards, and the evolving norms of scholarly practice within the field of bioethics. We recommend clearer standards for when, how, and where GenAI use should be disclosed.

The persistent shortage of organs, cadavers, and research participants in medicine has prompted proposals such as human 'bodyoids'—engineered human bodies lacking neural components necessary for consciousness and pain. Here, we critically assess the feasibility and ethics of creating bodyoids, highlighting significant technological challenges that render their development highly speculative and economically impractical. We further argue that even if feasible, engineering bodies devoid of consciousness raises profound ethical issues, including moral ambiguity, potential dehumanization, and legal concerns akin to those surrounding patients with severe brain injuries. Our analysis suggests that pursuing bodyoids raises concerns about respect for human life and dignity. We conclude that resources should instead focus on more viable and ethically sound alternatives to address urgent clinical needs in transplantation and research.

Is it ethically defensible to remove xenotransplant recipients’ right to withdraw from long term biosurveillance on grounds of theoretically possible but potentially excessive third-party risk? Some think so arguing that to protect public health from potential infectious diseases originating in the xenograft, xenotransplant recipients should not be allowed to withdraw from long term biosurveillance. We present a dilemma for this view: if xenotransplant research poses such significant risk to public health as to warrant the requirement that xenotransplant recipients voluntarily waive their right to withdraw, then the research warrants long term quarantine. If the risk is not so great as to require long term quarantine, however, then individuals should not have to forfeit this right in order to participate in xenotransplant research. Either way, xenotransplant recipients should not be required to waive their right to withdraw from long term biosurveillance.

To determine when the life of a human organism begins, Mark T. Brown has developed the somatic integration definition of life. Derived from diagnostic criteria for human death, Brown’s account requires the presence of a life‐regulation internal control system for an entity to be considered a living organism. According to Brown, the earliest point at which a developing human could satisfy this requirement is at the beginning of the fetal stage, and so the embryo is not regarded as a living human organism. This, Brown claims, has significant bioethical implications for both abortion and embryo experimentation. Here, we dispute the cogency of Brown’s derivation. Diagnostic criteria for death are used to determine when an organism irreversibly ceases functioning as an integrated whole, and may vary significantly depending on how developed the organism is. Brown’s definition is derived from a specific definition of death applicable to postnatal human beings, which is insufficient for generating a general definition for human organismal life. We have also examined the bioethical implications of Brown’s view, and have concluded that they are not as significant as he believes. Whether the embryo is classified as a human organism is of peripheral interest—a far more morally relevant question is whether the embryo is a biological individual with an identity that is capable of persisting during development.

Aim To examine the challenges and opportunities presented by generative artificial intelligence in healthcare education and explore how it can be used ethically to enhance rather than compromise future healthcare workforce competence. Background Generative artificial intelligence is fundamentally changing healthcare education, yet many universities and healthcare educators have failed to keep pace with its rapid development. Design A discussion paper. Methods Discussion and analysis of the challenges and opportunities presented by students' increasing use of generative artificial intelligence in healthcare education, with particular focus on assessment approaches, critical thinking development and artificial intelligence literacy. Results Students' widespread use of generative artificial intelligence threatens assessment integrity and may inhibit critical thinking, problem-solving skills and knowledge acquisition. Without adequate artificial intelligence literacy there is a risk of eroding future healthcare workforce competence and compromising patient safety and professional integrity. Conclusion While generative artificial intelligence presents significant challenges to healthcare education, it offers great promise if used carefully with awareness of its limitations. The development of artificial intelligence literacy is crucial for maintaining professional standards and ensuring patient safety and mitigating its potentially negative impact on the formation of critical thinking skills.

Rapid advancements in artificial intelligence (AI) pose novel ethical and practical challenges for scholarly publishing. Although AI-related policies are emerging in many disciplines, little is known about the extent and clarity of AI guidance in bioethics and health humanities journals. A search of publicly available journal lists from the American Society for Bioethics and Humanities, Health Humanities Consortium, and Association for Medical Humanities was supplemented with Google Scholar’s top 20 bioethics journals ranked by h5-index. This yielded 54 unique journals, of which 50 remained after excluding those without a functional website or recent publications. AI policies were reviewed at the journal and publisher levels were assessed via website review, and editors were contacted for clarification when required. Data extraction was conducted by one author and independently verified by two additional researchers to ensure accuracy. Of the 50 journals analyzed, only 8 (16%) had a clear AI policy, while 27 (54%) were published by a publisher with an identifiable AI policy. Publisher AI policy statements were favorable to considering AI-assisted manuscripts. Five (10%) of the 8 journals with a clear AI policy explicitly prohibited AI-generated text in submissions. The remaining 15 (30%) journals did not have a publicly available AI policy. Ten of these 15 journals confirmed an absence of any formal AI policy, and seven indicated that discussion to develop guidelines was ongoing. The adoption of AI policies in bioethics and health humanities journals is currently inconsistent. Some journals explicitly ban AI-generated text, whereas others permit AI-assisted writing, with publisher policies being favorable to considering AI-assisted manuscripts. The lack of standardized AI guidelines underscores the need for further discussion to ensure the ethical and responsible integration of AI in academic publishing.

Artificial intelligence is now widely accessible and already being used by healthcare researchers throughout various stages in the research process, such as assisting with systematic reviews, supporting data collection, facilitating data analysis and drafting manuscripts for publication. The most common AI tools used are forms of generative AI such as ChatGPT, Claude and Gemini. Generative AI is a type of AI that can generate human-like text, audio, videos, code and images based on text-based prompts inputted by a human user. Generative AI is trained on large amounts of data, and the outputs are sophisticated and can be indistinguishable from a response from a skilled human. In this article, we outline several AI applications that can be used in healthcare research, examining their benefits, limitations and outline best practices for maintaining research integrity and ethical standards.

Patients need to be given the relevant information to be able to give informed consent, which might require the disclosure of a provisional diagnosis. Yet, there is no duty to give information to a patient if that patient is aware that this information exists but chooses not to request it. Diagnostic radiographers and healthcare scientists are often responsible for ensuring that patients have given informed consent for the investigations they undertake, but which were requested by other clinicians. Here we examine if they have a duty to disclose a patient’s provisional diagnosis made by a referring clinician if the patient asks for this information as part of the informed consent process to a diagnostic investigation. We first consider aspects of UK law, professional guidance and salient ethical principles, emphasising that while professional codes of practice highlight the need to act in the patient’s best interest, they do not require giving patients information they do not require for the examination or have not requested. We then propose that diagnostic radiographers and healthcare scientists placed in such a position use a ‘minimally necessary disclosure’ framework. This framework fulfils their commitment to their patient and the principle of veracity, while respecting the boundaries of their professional duties. The framework ensures that enough detail is given to the patient for them to be able to give informed consent, while shouldering the diagnostic professional from making a full disclosure, which is the duty of the referring clinician.

Xenotransplantation has the potential to alter the U.S. transplant system in profound ways. However, this emerging “spare parts” solution spearheaded by biotechnology companies raises concerns about its impact on the organ shortage, healthcare systems, population health, and health inequalities. We contend that xenotransplantation may have limited benefits in improving health, could prove prohibitively expensive for many, and may divert resources away from proven public health measures. Additionally, it carries the risk of perpetuating stigma. Xenotransplantation may thereby exacerbate existing healthcare inequities across racial, ethnic, socio‐economic, and geographic lines. To mitigate these risks, we contend that public health expert input is integral for xenotransplant policy development and outreach and that this underscores the importance of federal government investment in transplant infrastructure.

Arguments that claim opponents of abortion are inconsistent in some manner are becoming increasingly prevalent both in academic and public discourse. For example, it is common to claim that they spend considerable time and resources to oppose induced abortion, but show little concern regarding the far greater numbers of naturally occurring intrauterine deaths (miscarriages). Critics argue that if abortion opponents took their beliefs about the value of embryos and fetuses seriously, they would invest more time and resources combating these naturally occurring deaths than those caused by induced abortion. The implication is that abortion opponents do not take their beliefs about embryos and fetuses seriously—and so why should anyone else? These “inconsistency arguments”, as we have called them, have considerable intuitive appeal: showing that someone is living inconsistently or holding beliefs that seem prima facie inconsistent seems to many to undermine those beliefs. However, upon closer examination, these arguments become less convincing. In short, we show that the inconsistency arguments we are aware of are severely flawed, and so, if critics wish to continue their criticism, they should abandon inconsistency arguments in favor of other styles of argument. We will proceed in four stages. First, we describe the basic form of inconsistency arguments against abortion opponents. Second, we outline specific instances of the inconsistency argument that have been advanced. Third, we outline specific responses to these arguments, noting ways in which responses also conform to set patterns. Finally, we assess the debate and suggest how it might progress in productive ways.

Anna Smajdor and Joona Räsänen argue that we have good reason to classify pregnancy as a disease. They discuss five accounts of disease and argue that each account either implies that pregnancy is a disease or if it does not, it faces problems. This strategy allows Smajdor and Räsänen to avoid articulating their own account of disease. Consequently, they cannot establish that pregnancyisa disease, only that plausible accounts of disease suggest this. Some readers will dismiss Smajdor and Räsänen’s claims as counterintuitive. By analogy, if a mathematical proof concludes ‘2+2=5’, readers will know—without investigation—that an error occurred. Rather than dismiss Smajdor and Räsänen’s work, however, the easiest way to undermine their argument is to describe at least one plausible account of disease that (1) excludes pregnancy and (2) avoids the problems they raise for it. This is our strategy. We focus on dysfunction accounts of disease. After outlining Smajdor and Räsänen’s main arguments against dysfunction accounts, we explain why pregnancy is not a disease on these accounts. Next, we defend dysfunction accounts against the three problems that Smajdor and Räsänen raise. If successful, then contra Smajdor and Räsänen, at least one plausible account of disease does not imply that pregnancy is a disease. We suspect that defenders of other accounts can respond similarly. Yet, we note that insofar as dysfunction accounts align with the commonsense intuition that pregnancy is not a disease, this, all else being equal, seems like a point in their favour.

Solid organ xenotransplantation may have the potential to help address the shortage of organs for transplantation. There is concern, however, that a novel zoonotic disease could be transmitted from the source organ to the human recipient, and then from the recipient to others. Theoretically, this could result in an epidemic or pandemic. Because of this potential risk, it has been argued that collective consent is required. Our goal is to critically evaluate the claim that collective consent is necessary for xenotransplantation to be ethically permissible. We argue that collective consent is not required and highlight the important roles of public engagement and due diligence in xenotransplant research moving forward.

We read the four commentaries on our article with much interest.1 Each response provides stimulating discussion, and below we have attempted to respond to specific issues that they have raised. We regret that we are not able to respond point-by-point to each of them. However, before our responses, it may benefit the reader if we briefly summarise the claims in our article. First, we hold two presuppositions: (1) xenotransplantation research will inevitably continue for the foreseeable future, and (2) causing suffering and pain requires sufficient justification and should be mitigated where possible. Second, based on these two presuppositions, we posit an argument for the further genetic modification of pigs for xenotransplantation that would eliminate certain experiences of pain and suffering should it become possible to do so. Gibson,2 in his commentary, is sceptical—for good reason—that ‘xenotransplantation-motivated disenhancement would be a temporary stopgap until the organ and tissue shortage problem is solved via less contentious means’. Gibson’s argument is grounded in the fact that the biotechnology industry—of which xenotransplantation is part of—is beholden to economic and market forces that would likely perpetuate constancy, thereby making it difficult to transition away from using disenhanced genetically engineered pigs for xenotransplantation. This point is well taken, …

The development of artificial womb technology is proceeding rapidly and will present important ethical and theological challenges for Christians. While there has been extensive secular discourse on artificial wombs in recent years, there has been little Christian engagement with this topic. There are broadly two primary uses of artificial womb technology—ectogestation as a form of enhanced neonatal care, where some of the gestation period takes place in an artificial womb, and ectogenesis, where the entire gestation period is within an artificial womb. Ectogestation for the latter weeks or months of pregnancy could be possible within a decade or so, while ectogenesis for humans is far more speculative. Ectogestation is likely to significantly decrease maternal and neonatal morbidity and mortality, and so there is a strong case for supporting its development. Ectogenesis, however, may bring a number of challenges, including the commodification of children, and the pathologizing of pregnancy and childbirth. Its long-term effects on those who are created through this process are also unknown. In the event that it becomes ubiquitous, we may also find the central theological significance of pregnancy and birth diminished. The dilemma for Christians is that the development of ectogestation seems likely to normalise the use of artificial gestation, and, in time, pave the way for ectogenesis

One objection to xenotransplantation is that it will require the large-scale breeding, raising and killing of genetically modified pigs. The pigs will need to be raised in designated pathogen-free facilities and undergo a range of medical tests before having their organs removed and being euthanised. As a result, they will have significantly shortened life expectancies, will experience pain and suffering and be subject to a degree of social and environmental deprivation. To minimise the impact of these factors, we propose the following option for consideration—ethically defensible xenotransplantation should entail the use of genetic disenhancement if it becomes possible to do so and if that pain and suffering cannot be eliminated by other means. Despite not being a morally ideal ‘solution’, it is morally better to prevent unavoidable pain until a viable non-animal alternative becomes available.

Preclinical xenotransplantation research using genetically engineered pigs has begun to show some promising results and could one day offer a scalable means of addressing organ shortage. While it is a fundamental tenet of ethical human subject research that participants have a right to withdraw from research once enrolled, several scholars have argued that the right to withdraw from xenotransplant research should be suspended because of the public health risks posed by xenozoonotic transmission. Here, we present a comprehensive critical evaluation of the claim that xenotransplant recipients should be required to waive their right to withdraw from lifelong biosurveillance. We conclude that if xenotransplantation requires participants to waive their right to withdraw, then clinical trials may not be justifiable, given the ethical and legal obstacles involved with doing so. Consequently, if clinical trials are permitted with a right to withdraw, then they may pose a significant public health risk.

Xenotransplant patient selection recommendations restrict clinical trial participation to seriously ill patients for whom alternative therapies are unavailable or who will likely die while waiting for an allotransplant. Despite a scholarly consensus that this is advisable, we propose to examine this restriction. We offer three lines of criticism: (1) The risk–benefit calculation may well be unfavorable for seriously ill patients and society; (2) the guidelines conflict with criteria for equitable patient selection; and (3) the selection of seriously ill patients may compromise informed consent. We conclude by highlighting how the current guidance reveals a tension between the societal values of justice and beneficence.

Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only one ‘buyer’—in this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the ‘crowding out’ of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England.

Formal clinical trials of pig-to-human organ transplant—known as xenotransplantation—may begin this decade, with the first trials likely to consist of either adult renal transplants or pediatric cardiac transplant patients. Xenotransplantation as a systematic scientific study only reaches back to the latter half of the 20th century, with episodic xenotransplantation events occurring prior to that. As the science of xenotransplantation has progressed in the 20th and 21st centuries, the public's knowledge of the potential therapy has also increased. With this, there have been shifting ethical stances toward xenotransplantation in key areas, such as religious and public viewpoints towards xenotransplantation, animal rights, and public health concerns. This review provides a historical–ethical account of xenotransplantation and details if or how viewpoints have shifted over time.

It is envisioned that one day xenotransplantation will bring about a future where transplantable organs can be safely and efficiently grown in transgenic pigs to help meet the global organ shortage. While recent advances have brought this future closer, worries remain about whether it will be beneficial overall. The unique challenges and risks posed to humans that arise from transplanting across the species barrier, in addition to the costs borne by non-human animals, has led some to question the value of xenotransplantation altogether. In response, we defend the value of xenotransplantation research, because it can satisfy stringent welfare conditions on the permissibility of animal research and use. Along the way, we respond to the alleged concerns, and conclude that they do not currently warrant a cessation or a curtailing of xenotransplantation research.

In this commentary, I will consider the implications of the argument made by Christopher Stratman in ‘Ectogestation and the Problem of Abortion’. Clearly, the possibility of ectogestation will have some effect on the ethical debate on abortion. However, I have become increasingly sceptical that the possibility of ectogestation will transform the problem of abortion. Here, I outline some of my reasons to justify this scepticism. First, I argue that virtually everything we already know about unintended pregnancies, abortion and adoption does not prima facie support the assumption that a large shift to ectogestation would occur. Moreover, if ectogestation does not lead to significant restrictions to abortion, then there will be no radical transformation of the practice of abortion. Second, abortion is already associated with stigma, and so the presence of ectogestation would need to create additional stigma to modify behaviour. Finally, I argue that ectogestation shifts the debate away from the foetus to the human subject of the artificial womb—the gestateling, therefore creating a new category of killing—gestaticide. However, this would only reorient the debate rather than end it.

There is a global shortage of organs for transplantation and despite many governments making significant changes to their organ donation systems, there are not enough kidneys available to meet the demand. This has led scientists and clinicians to explore alternative means of meeting this organ shortfall. One of the alternatives to human organ transplantation is xenotransplantation, which is the transplantation of organs, tissues, or cells between different species. The resurgence of interest in xenotransplantation and recent scientific breakthroughs suggest that genetically-engineered pigs may soon present a realistic alternative as sources of kidneys for clinical transplantation. It is therefore important for nurses and allied health professionals to understand what is involved in xenotransplantation and its future implications for their clinical practices. First, we explore the insufficiency of different organ donation systems to meet the kidney shortage. Second, we provide a background and a summary of the progress made so far in xenotransplantation research. Third, we discuss some of the scientific, technological, ethical, and economic issues associated with xenotransplantation. Finally, we summarise the literature on the attitudes of healthcare professionals toward xenotransplantation.

William Simkulet has recently criticised Colgrove et al ’s defence against what they have called inconsistency arguments—arguments that claim opponents of abortion act in ways inconsistent with their underlying beliefs about human fetuses. Colgrove et al presented three objections to inconsistency arguments, which Simkulet argues are unconvincing. Further, he maintains that OAs who hold that the fetus is a person at conception fail to act on important issues such as the plight of frozen embryos, poverty and spontaneous abortion. Thus, they are morally negligent. In response, we argue that Simkulet has targeted a very narrow group of OAs, and so his criticisms are inapplicable to most OAs. We then explain why his responses to each of Colgrove et al’s objections do not succeed, even for this restricted group. Finally, we note that Simkulet fails to provide evidence for his claims regarding OAs’ supposed failures to act, and we show that OAs veritably do invest resources into these important issues. We conclude that Colgrove et al ’s reasons for rejecting inconsistency arguments remain intact.