With the pressing shortage of human organs and recent breakthroughs in gene editing, xenotransplantation—using animal organs, tissues or cells for human transplants—offers new hope for patients on wait lists. The use of genome editing technologies to produce xenotransplants from pigs with reduced immunogenicity has recently brought renewed attention to the field while also raising a host of ethical dilemmas. These concerns include animal welfare, the risks of zoonotic diseases, the moral implications of crossing species boundaries and the potential inequities in (...) access to such treatments. In their article ‘Who shall go first? A multicriteria approach to patient selection for first clinical trials of cardiac xenotransplantation’,1 Kögel and colleagues propose an ethical framework for selecting patients in cardiac xenotransplantation trials. They argue that while significant advances have been made with xenotransplants in brain-dead humans, limited knowledge can be gained from procedures performed outside clinical trials. According to them, knowledge production should be prioritised, and terminally ill patients who are unlikely to survive would not contribute meaningfully to scientific understanding or benefit from the procedure. At the core of xenotransplantation ethics …. (shrink)