Future of xenotransplantation in Korea

As the chronic shortage of human donor organs becomes an undeniable clinical reality, xenotransplantation has transitioned from a theoretical concept to the threshold of clinical integration. Recent successful pig-to-human kidney trials signify a pivotal milestone, shifting the scientific focus from feasibility to long-term sustainability and systemic implementation. This review critically evaluates the current status and future trajectory of xenotransplantation, challenging the "more is better" paradox of genetic engineering. It emphasizes the minimum viable edit set and the physiological superiority of miniature pigs overgrowth hormone receptor knockout models. Furthermore, the paper outlines a Korean-style governance model, integrating advanced digital transformation and specialized infrastructure. Key proposed strategies include (1) digital monitoring: implementing a noninvasive surveillance system utilizing donor-derived cell-free DNA, digital twins, and AI-driven early warning systems; (2) blockchain integration: establishing data integrity and tokenomics-based patient compliance through a sovereign medical coin system to incentivize lifelong surveillance; (3) infrastructure innovation: introducing the Hybrid Hospital Model, featuring a sterile barrier window between porcine and human surgical suites to achieve a zero-ischemia workflow. Finally, the study stresses the necessity of a Xenotransplantation Special Act and the collaboration between public organ procurement organizations and specialized private contract research organizations. By combining genetic minimalism and a robust legal framework, South Korea can establish itself as a global standard setter, transforming xenotransplantation into a standardized, manageable precision medical service.