Does xenotransplantation offer a large benefit for human patients?

We read with interest the report from Schmoeckel et al. regarding the March 3, 2023 Workshop of the German Heart Transplant Centers. Within the report, Schmoeckel et al. mention the ethical requirement that xenotransplantation offer recipients a favorable risk-benefit outcome. To our surprise, they write "a heart [xenotransplantation] can be expected to have a rather large benefit with sufficient certainty for patients in terminal heart failure" and that xenozoonotic transmission "does not appear to represent an obstacle from an ethical perspective." Our concern is that, in light of the two recent cardiac xenotransplantations, the risk-benefit analysis remains contested and not so clearly favorable. While we remain optimistic about the future of xenotransplantation, a more matter-of-fact analysis of the current situation is needed in light of the fact that in the only two genetically-modified porcine heart-to-human transplantations that have been conducted, the patients rapidly declined under uncertain circumstances.