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Transplant panel 'could be model for ethics thinktank'

22 April 1999 (Nature Vol. 398, page 643)

[PARIS] A small group of academics will meet in Canada in June to discuss new ways to generate public debate on the risks and benefits of clinical application of xenotransplantation, the transplant of animal cells, tissues and organs.

The meeting's organizers hope that this issue will serve as a testbed for a more ambitious goal -- the creation of an international think-tank covering ethics, science and governance.

The meeting at Meech Lake, Quebec, is the brainchild of Fritz Bach, a xenotransplant scientist at Harvard Medical School. Given the potential risk that xenotransplants may create pandemics, Bach has argued that there should be a moratorium on clinical trials until there has been an informed public debate at the international level (see Nature 391, 320-325 & 326; 1998).

The June meeting will be co-chaired by Strachan Donnelly of the Hastings Center in New York State, and Farkhonda Hassan, a member of the Shoura Assembly (senate) of Egypt, and professor of the science deparrtment at the University of Cairo. The meeting will bring together over a dozen xenotransplant experts, ethicists, and non-governmental organizations such as Pugwash.

Elizabeth MacGregor, former coordinator of its National Biotechnology Advisory Committee, has been responsible, along with Bach, for organizing the meeting.

One outcome is expected to be an international panel on xenotransplantation, and the convening of a broad public consultation in liason with national and international organizations, to produce a detailed case study and international guidelines, says Bach.

The choice of panel members will be crucial to its validity, he adds, arguing that it should include sensible representatives of the various points of views on xenotransplantation, "including the extremes."

Xenotransplantation will serve as a test case for the organizers' more ambitious idea of creating an broader international think-tank. Discussions are at an early stage, but it has already attracted the interest of some prominent academic personalities, including Keith Bezanson, director of the Institute of Advanced Studies at the UK's University of Sussex, and Geoffrey Oldham, former director of the university's Science Policy Research Unit.

No name for the body has yet been decided, although it would be along the lines of 'The International Council on Science for Policy', or 'International Council on Science , Technology and Society'. The think-tank would identify other areas of technology where the risk benefit equation is difficult to resolve, and seek ways to better engage public debate and provide impartial information, through the setting up a series of working groups.

Bach sees the think-tank as a body free from political pressures, commercial interests and excessive scientific enthusiasm. "This is a tall order  ", admits Abdullah Daar, from the Sultan Qaboos University in Oman, who will attend the Meech Lake meeting.

Nonetheless, Daar believes that there is a need to try to create such a body, to break what he claims is excessively uniform thinking in many regulatory agencies and institutional ethics bodies. "National and professional organizations tend to mirror their perception of what the public ought to accept rather than saying these things need to be thrashed out first. "

For the moment, the main outstanding questions are the council's scope, how best to consult the public, and who should choose its members, says Oldham, "We share a concern to find international approaches which genuinely involve developing country participation; and a belief that these approaches must involve consultation with relevant stakeholders, including the public.

"Any mechanism that is devised must be complementary to what others are doing well; hence our current concern is in identifying an appropriate niche, " adds Oldham, emphasizing that if the idea is to fly it will require "major efforts to reach decision makers and to try to ensure that action follows. "

Margaret Somerville, from the McGill Center for Medicine, Ethics and Law at McGill University, Montreal, welcomes the proposed think-tank. Existing ethics committees tend to be made up of representatives of various constituencies, she argues, with the result that in practice they often act as political bodies, with consensus being negotiated on the basis of "what do we do here to make a compromise to get the best deal for what we want to promote."

Somerville says there is a need for transnational structures with no vested interests, that can put complex issues on the table, provide impartial information on their various aspects, and solicit wide input, while being free from the pressure to reach an immediate consensus.


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