Xenotransplantation has seen recent global interest peak due to several clinical xenotransplants being performed in decedent and a live cardiac recipient. However, underpinning these latest transplants have been decades of invested scientific research programs that have been developing the ideal donor source animals to avoid the overwhelming hyperacute xenograft rejection (HAR) seen using non-genetically modified (Non-GM) animal organs, tissues, and cells. But this also needs to be undertaken along with the development of safe and efficacious xenotransplantation technologies, immunosuppression, monitoring, disease screening, patient selection, societal education and acceptance.

Paralleling the advent of such extraordinary transplants there have been several decades of establishment of world xenotransplantation authorities such as the International Xenotransplantation Association (IXA), and the development of guidance documents and regulations for the assessment of these cutting-edge technologies. Like all new technologies there remain outdated concerns and fears of theoretical potential for transmission of xenozoonosis, ethical concerns and outdated or appropriately educated societal concerns and religious views of the benefits or risks and issues for xenotransplantation use of organs, tissues, or cells from animals to humans.

Here we discuss the development of xenotransplantation and the intricate balance in managing the various challenges we are faced with; in the absolute benefits of xenotransplantation with the dichotomy faced in balancing the pros and cons of xenotransplantation with social, religious, ethical, scientific, and medical opinions. Ultimately, the benefits are to those patients suffering from the many and various diseases that drive the need for xenotransplantation, that it may be implemented as soon as possible to help the many millions of patients who can truly benefit.

• To develop a wider understanding of what xenotransplantation is and how it can provide a novel means for curing the organ donor shortage.
• To provide an understanding of the issues in undertaking xenotransplantation.
• To provide a broad understanding of the current legislation involved in provision of xenotransplantation.