by Keisha Ray, PhD
Here is a list of just some of the things that contribute to Black people’s inequitable access to proper health outcomes and health care:
Structural and Institutional racism
Interpersonal racism and race-related stressors
Healthcare providers’ biases
Health care policies
Lack of political power
Inequitable voting rights
Inequitable access to social determinants of health
Minimum wage policies
No universal health care, childcare, or parental leave
Inequitable student loan debt
Racist housing policies
Yet, now we have pig hearts.
In a Baltimore hospital, in early January 2022, transplant surgeons put a heart from a genetically modified pig into a 57-year-old human being. This is not the first instance of xenotransplantation but it is the first where the organ recipient hasn’t died immediately or soon after transplantation. With CRISPR-Cas9 genome editing making it more likely that human bodies won’t reject organs from non-human animals, researchers seem excited about the possibility of continuing to harvest and genetically modify non-human animals for the sole sake of producing organs for humans, similar to the ways some animals only exist for humans’ meat consumption. Even journalists are excited about this new research if the number of interview requests I have received is any indication, which signals a general human interest. Indeed David Bennett, the new owner of a pig heart is contributing to the excitement. Although, I wish Mr. Bennett well and good health, and I see the potential of pig hearts, as a researcher of Black health I can’t help but feel a little disappointed in this new instance of biomedical advancement and what it means for racial disparities in health.
There are many ethical issues raised by this latest instance of xenotransplantation, including (but not limited to) the welfare of the animals used for this medical intervention, cross-species transmission of diseases, and patient vulnerability, which have all gotten attention elsewhere. One of the ethical issues that I’m concerned with, however, is how does this new instance of xenotransplantation make health care more or less equitable for Black people?
Being enthralled with the latest biotechnology is nothing new and squarely within humans’ short attention spans. But it is also our nature, to pursue advancement and find ways to live longer and happier lives. Using human ingenuity to better our lives is something to celebrate, but I just wish more of this ingenuity would use to secure basic access to health care for all Black people and other marginalized groups. When we focus on the latest and shiniest biotechnological intervention, I worry that we lose sight of things like illness prevention and addressing social determinants of health that can ensure better health outcomes for the least well-off among us. For instance, Black men have some of the highest rates of cardiovascular disease and untreated hypertension. One reason for this is their lack of access to primary care physicians. Black men also have the highest mortality rate among all racial and gender groups in the US. Pig hearts do not help Black men have better access to health care even though having better access to physicians would have huge implications for lowering their risk of heart disease and their risk of mortality. This is a matter of where our priorities lie and whose lives matter in health care. What advancements in xenotransplantation show me is that Black people’s health is once again not prioritized in health care or in biomedical sciences.
Anti-Black racism exists in all of our social and political institutions and interpersonal racism is also a part of living while Black, all of which affects Black people’s access to health. As such, this means that proper health is intentionally and strategically withheld from Black people. I’m sure some may see this as an unfounded conclusion, but what other conclusion could we draw? What are we to think when we see advancements in biomedical technology that was once just a topic of science fiction, come to fruition, yet we are in a pandemic where Black people and other people of color have high rates of infection, hospitalization, and death and little to no access to basic health care like proper masks, COVID-19 at-home testing, or even hospitals? It truly feels like we are living in a dystopian science-fiction novel and Black people are the casualty of the privileged’s scientific advancement.
Although the source of organs for xenotransplantation is rightfully ethically questionable, I hold out hope that xenotransplantation could be used to end Black people’s lesser access to organ transplantation by creating a new source of organs. But if history is a proper guide, there will be racial discrimination in the distribution of organs, or the costs of the intervention will price out many Black people. Even if policies are implemented to ensure equitable access, it is likely the policies will be rooted in racial discrimination or in social and political privileges that most Black people do not have. So I remain hopeful but cautious, optimistic, yet doubtful. When you study Black health and new biotechnology debuts you’re put in this weird place filled with all of these dichotomous emotions. All I want is health equity for Black people, for us to not die preventable deaths and to be treated with humanity, but instead, all I got was a pig heart.
Keisha Ray, PhD (@DrKeishaRay) is an assistant professor with the McGovern Center for Ethics and Humanities at the University of Texas Health Science Center at Houston.