TRANSPLANTS for pets in the UK were approved for the first time
when the Royal College of Veterinary Surgeons said that cats
could have kidney transplants.
The move was sanctioned by the general council of the Royal College despite widespread resistance from animal charities and serious ethical misgivings among senior vets. Operations are expected to cost up to £8,000. The vets' governing body insisted that their guidelines for the procedure would be robust and that surgical teams would require the appropriate qualifications.
But the British Veterinary Association and animal charities, including Cats Protection and the RSPCA, said that many ethical concerns had not been fully considered, particularly choice and consent.
The College attempted to allay concerns at the RSPCA by making it clear that no animals could be commercially bred or privately bought for the purpose of supplying a donor, but it did not state where the cats could come from.
Instead, centres licensed to carry out the transplant expected to be the veterinary teaching schools were given the onus to find "a suitable source".
A number of leading vets last night speculated that this could lead to secret deals in which the owner of a sick cat might pay friends or neighbours to offer their own animals as donors, or even lead to a black market for organs, whereby animals would be specially bred or even stolen to fulfil demand.
Peter Jinman, the president of the BVA, said there were still "big questions to be answered" on finding donor animals, "particularly as they are not in a position to give consent".
"While the technical capability to perform such complex procedures exists, serious consideration needs to be given to whether such surgery will be in the best interests of the animals involved.
"The RCVS may have decided that the process is ethical, but the BVA remains unhappy as to how it may be ethically undertaken. This is a landmark decision but there are still ethical questions to consider. This is something the BVA has debated on three occasions and still no agreement has been reached. How are we going to identify the donor animals? There are suggestions that we should look at groups of animals or choose donors from the same litter.
But if a cat is born with a congenital kidney disorder who is to say the others in the litter are not suffering the same disease? The immediate problem for owners seeking surgery for their cats in the UK will be that there are no surgeons qualified to conduct the transplant."
Royal College regards the approval of pet organ transplants
as part of a trend towards ever more complex pet surgery in
which dogs are given second-hand human pacemakers and many pets
have surgery to overcome cataracts with artificial lenses
Stephen Ware, the president of the Royal College, defended transplants and said he expected "only a handful in the early years". Guidelines will require transplant centres with advanced specialist equipment to be set up according to strict standards. Two American universities are leading the field in developing the operation in dogs as well as cats.
In the United States, where 300 cat kidney transplants have taken place in 12 years, owners are allowed to adopt a cat from a shelter to supply the organ, but in Britain the RSPCA, Blue Cross and Cats Protection have made it clear they will not consider allowing a cat to go to an owner seeking an organ for another animal.
A Blue Cross spokesman said: "We do not believe the welfare of one pet should be compromised to save another. We would certainly never accept that an underclass of unwanted or stray animals should be considered as a bank of organs."
The RSPCA has serious concerns about unnecessary suffering of donor cats and questions whether this would be allowed under the Protection of Animals Act of 1911. The Society said it would even consider a test case prosecution under the circumstances of a kidney being taken from a healthy animal. The question certainly raises a number of difficult legal and ethical questions, as well as a moral conundrum on the rights of both the doner and recipient animal.
A spokesman for the RSPCA said: "The RSPCA is opposed to the introduction of pet transplant operations for the following reasons:
There is a threat of unnecessary suffering being caused to the donor animal as a result of the operation. If this did occur, it could be prosecutable under the 1911 Protection of Animals Act. The RSPCA would take into account whether RCVS guidelines have been followed when considering any prosecution.
The issue of informed choice. Neither the donor nor recipient animal is able to make a decision based on the possible long-term health implications for both.
The possible effect on the quality of life of the organ recipient. There would be frequent blood testing and the animal would probably be required to use drugs for the rest of its life."
RSPCA Director of Veterinary Services Chris Laurence has consulted with the RCVS and advised them that the RSPCA would be opposed to the introduction of pet transplant operations in Britain.
Mr Laurence said "The RSPCA is opposed to the introduction of pet transplants. However, the Society is pleased that the RCVS is taking the lead on this deeply serious and ethical matter to ensure that, if pet transplants are to be carried out in this country, these guidelines will at least go some way to make sure that measures are in place to protect the welfare of both donor and recipient as far as possible".
Lynne Hill, chairman of the RCVS advisory committee, said: "The supply of the donor cat is a very difficult area but we would expect those carrying out any operation to check the source of the animal. If a neighbour of a cat owner said he or she was willing for the cat to supply a kidney most vets would go along with that. This is not about exchange of money."
She accepted that it may not be possible for vets to know the precise arrangement between friends and neighbours. She insisted, however, that any centre licensed to carry out the operation would have to have an ethics committee to ensure guidelines were followed..
Dan Brockman, the senior lecturer in soft tissue surgery at the Royal Veterinary College, was based at the University of Pennsylvania, where the technique was pioneered, for nine years.
He said that he would need to take part in six transplants before he would oversee such an operation himself. He would also need to take a course in micro-vascular surgery.
He said: "You must also remember that two teams of surgeons are required for the two cats which are operated on at the same time."
Senior vets expect little demand for the operation even if it is available. Pet insurance policies generally have a £4,000 to £5,000 upper limit on surgical procedures so owners will have to find a minimum of £3,000 themselves.
Kidney conditions are common in cats and are treated by a reduction of salt, protein and phosphorus in the diet. It is more difficult to match a donor to a dog than a cat. The operation does not cure renal failure in cats and normal life expectancy is not guaranteed.
The average life span afterwards is up to two years.
Nadine Daniel, a barrister from Toxteth, Liverpool, who owns two cats with chronic renal failure, voiced the feelings of a significant number of pet owners who could afford the procedure. "I would definitely be interested, even if I had to pay an extra £3,000," she said.
RCVS Guidelines approved for kidney transplantation in cats
Though relatively routine in human medicine, organ transplants are less common in veterinary medicine. Increasingly pet owners are expecting the same treatments for their pets as they can receive themselves. Kidney transplants in cats so far have only been carried out overseas - particularly in the US, but it may not be long before the procedures are carried out in the UK.
ethical issues surrounding transplants in animals are complex
and RCVS Council felt it prudent to set strict ethical guidance
- so as to ensure the highest welfare standards for both recipient
and source animals. Approved transplant centres will need to
be set up under strict guidelines.
RCVS President, Stephen Ware, commented: "The RCVS guidelines set out a framework within which the procedure should be carried out. It is important to note that the decision to carry out the procedure will be a clinical veterinary decision in the first instance, which will depend on the condition of the patient and the suitability of the potential source animal. We are only expecting a handful of cases in the UK in the early years."
ORGAN TRANSPLANTATION THE FACTS
1. A copy of the RCVS guidance on renal transplantation in cats can be obtained from the RCVS press office.
2. It is worth noting that kidney transplantation is one of very few treatment options for cats with near-terminal renal failure. Renal transplantation is not a cure. It hopes to provide a good quality of life for a cat, which would not otherwise survive. The procedure does not provide a "normal" life expectancy - average at present in the US is up to 2 years. Post-operatively, cats then take a range of drugs every day and they require regular weekly check-ups.
3. The guidance requires for transplant centres to be set up according to strict standards. These transplant centres will normally be responsible for providing the source animal. The source animal would ideally be a sibling or cohort and its suitability is usually confirmed through tissue typing and blood testing.
4. It is also worth noting that the RCVS guidance requires that the members of the veterinary team have additional postgraduate qualifications over and above the normal veterinary degree, including Medicine, Soft Tissue Surgery and Anaesthesia.
5. The Universities of Davis and Pennsylvania (Philadelphia) in the USA are leading the developments in renal transplantation in dogs as well as cats. A note for owners and referring veterinary surgeons detailing the guidelines for the transplantation procedure may also be obtained from the RCVS press office.
6. The guidance will be included in the RCVS Guide to Professional Conduct.
The American way
Cats having a kidney transplant in the US need two weeks of post-operative care, regular blood tests and anti-rejection drugs for life, which could cost £100 a month.
Some cats have lived for another ten years after having the surgery.
Only cats in the early stages of renal disease are accepted for a transplant. They must have no other health problems and have tests to check that they do not have feline leukemia virus, any immune deficiency or urinary tract infection.
Donor cats need not be of the same breed but must have the same blood type.
In the US, owners may adopt a cat from a shelter or give a stray a home in return for a kidney. They must then care for it for life.