Transplantation shows good results for patients with end-stage disease, but
there is an increasing lack of organs. Xenotransplantation, the transfer o
f live animal cells, tissues, or organs to another species, offers a potent
ial solution to this shortfall. Pig is regarded as the animal of choice for
this purpose. Meanwhile demonstration of pig endogenous retrovirus (PERV)
in all porcine herds has caused serious concern with respect to a possible
transmission of the virus to humans with a transplanted organ. Transmission
to human cells has been documented under certain in vitro conditions. Howe
ver, no such transmission has been demonstrated in vivo. The possible conse
quences of introducing PERV into immunocompromised human organisms are not
known and it is necessary to collect more information. Novel and sensitive
genomic assays to detect PERV infection are now available in addition to es
tablished virological, immunoserological and molecular methods. In order to
minimise the risk of PERV transmission rigorous procedures should be estab
lished. International guidelines to reduce the risk should be followed. Alt
hough a number of immunological, physiological and virological questions ne
ed to be answered before the introduction of xenotransplantation as an alte
rnative clinical treatment, some problems can only be solved by judicious c
linical trials.