13 Americans will die today waiting for an organ transplant. That is a sobering line. Despite remarkable advances in transplantation medicine, the United States still cannot supply enough organs to meet demand. In 2024 alone, more than 3,400 Americans remained on the heart transplant waitlist while thousands more waited for kidneys, livers, and lungs. Yet a potential solution already exists, one that may soon move from research labs to operating rooms: xenotransplantation using genetically engineered pig organs.
Reality vs. fiction
It was not Mary Shelley in Frankenstein who envisioned this, nor was it Philip K. Dick in his futuristic masterpiece Do Androids Dream of Electric Sheep? But on January 13, 2026, Tim Andrews made the national news after becoming the first human to receive a genetically engineered pig kidney as a bridge to a human transplant at Massachusetts General Hospital (MGH). For someone like me, a transplant cardiologist who has been quietly savoring the advances within the xenotransplantion field for the past five years, it felt as if I were reliving one of those fictional classics. Whether it was genetically engineered pig hearts or kidneys in humans, I felt hopeful for the not-so-distant future.
However, as I write this piece, I am struck by the weight of reality: Despite major advances in xenotransplantation and the donation of organs after cardiac death (DCD), the imbalance between demand and supply persists. What is worse is that only a handful of centers possess the necessary research and program capabilities to provide these therapies. As a result, in the year 2026, we still face a critical decision between what is medically necessary and what is scientifically possible. To save more lives, society must unite in prioritizing increased organ donations while continuing to invest in broad xenograft research.
People are dying
In 2024 alone, 3,456 Americans remained on the heart transplant waitlist; despite 4,545 receiving a transplant in 2023. For context, Vanderbilt University shattered all previous records by performing 193 adult heart transplants in 2025. At that record-breaking pace, it would take a single high-volume center nearly 18 years to clear the current heart transplant waitlist. The same is true for other specialties, with almost 90,000 patients waiting for a kidney transplant alone. As a result, organ shortages claim over 4,700 deaths annually. Imagine the social upheaval if these deaths were directly attributed to firearms or opioids.
This crisis in organ demand has been looming since perhaps the dawn of modern civilization, now exacerbated by a mix of genetics, poorly controlled diabetes, hypertension, poor diet, and lifestyle habits endemic to our culture. Despite major advances thanks to weight-loss peptides and statins, our nation continues to die from cardiovascular diseases at a rate faster than any other condition, including any cancer.
Advanced heart failure therapies
Cardiac transplantation, offering over 92 percent survival at one year and median survival of 11.3 years, is the best treatment for end-stage heart failure but is limited by organ scarcity and eligibility. The FDA-approved durable left ventricular assist device (LVAD) represents an alternative for patients who cannot be transplanted, with a two-year survival of 79 percent and median survival beyond five years. There is hope that a second option for LVAD therapy may soon emerge with the newly designed BrioVAD, currently undergoing clinical trials in the United States. This contrasts with a median survival of 2.1 years for those with heart failure hospitalizations per Medicare data. While LVADs do not reach the life extension of heart transplants, they surpass terminal-stage medications in effectiveness.
A bridge to xenotransplantation
On January 7, 2022, the University of Maryland School of Medicine achieved a major milestone within the field by performing the first successful xenotransplantation of a genetically engineered porcine heart (Revivicor) into a human, who then lived for 60 days. By September 2023, the same team took on a second attempt and successfully kept the patient alive for nearly six weeks.
For historical context, Dr. Christiaan Barnard performed the first human-to-human cardiac transplant on December 3, 1967, in Cape Town, South Africa, where the patient survived 18 days. His next attempt, less than one month later, extended survival to 18 months, proving cardiac transplantation viable. Nearly seven decades after pioneering kidney transplantation on December 23, 1954, we stand awed by something just as special. On March 16, 2024, MGH performed the first successful transplant of a genetically-edited pig kidney (eGenesis) into a human. This opened the doors to Mr. Andrews becoming the first human to receive the same eGenesis pig kidney as a bridge to a human transplant at the same institution on January 13, 2026. These milestones mark another significant advance in xenotransplantation.
A new hope
Xenotransplantation’s ethical, religious, legal, economic, and welfare issues are widely debated. In addition, animal welfare, a key concern, cannot be overlooked. Despite skepticism over Americans suddenly shifting to plant-based diets, producing almost 28 billion pounds of pork in 2025 shows the minor impact of using 5,000 extra pigs for heart transplants and 44,000 for kidneys, under 0.04 percent of total production. Regardless, it is imperative for scientists to continue striving for ethical care of these animals, who may one day become someone’s heroes.
Ultimately, the widespread availability of xenografts could immediately clear the U.S.’s waitlist with the proverbial snap of a finger. In early 2025, the FDA took the first step toward the most critical next move by allowing the first gene-edited pig kidney trials in end-stage kidney disease patients. However, other pig-to-human attempts, such as lungs, hearts, and livers, still rely on “compassionate use” exceptions to be tested. Until the gates are open equally to every organ, progress hinges on isolated case studies, stalling broader research efforts.
A new type of fiction: Cypork
Who knows? Perhaps someone like me will envision a speculative novel about a cyborg pig named “Cypork,” whose failing heart and kidneys need both an LVAD and dialysis because humans have used all the hog grafts. This story could explore how an advanced porcine society addresses these organ shortages and fights to save its species. Would they have nightmares about whether they received a “mechanical heart” instead of a transplant? After all, machines function, pigs are living beings, and they might dream, even if we cannot talk to them to understand their fears and hopes.
In sum
Today, the United States must fast-track xenotransplant clinical trials in all organs, not only kidneys, or accept preventable deaths as policy. I urge you to help turn the narrative of limitless organs from fiction into reality. Support these efforts by registering as an organ donor and educating your communities, advocating for policy changes to address shortages, or spreading awareness through your social media. If all this seems beyond grasp, at least offer your compassion to those longing for another chance. Whether dreaming of human or pig grafts, everyone is in a desperate fight to survive, including the 13 Americans who will tragically lose their battle by day’s end, all searching for that elusive, lifesaving golden ticket.
Rafael S. Garcia-Cortes is a transplant cardiologist.
