Exclusive | Taiwan Could Lose Organ Transplant Independence to China Within a Decade, Top Scientist Warns

Taiwan's semiconductor industry has made the island indispensable to the global economy. But Chen Pei-jer (陳培哲), one of Taiwan's most prominent biomedical scientists, warns that the same concentration of talent and capital is quietly hollowing out another field with life-or-death consequences.

In an exclusive interview with The Storm Media, Chen — an academician of Academia Sinica and professor at National Taiwan University College of Medicine — argued that Taiwan is falling dangerously behind in xenotransplantation, the emerging medical field in which gene-edited animal organs are transplanted into human patients. If the island continues to neglect foundational biomedical research, he warned, Taiwanese transplant patients may have no option within ten years other than seeking treatment in China.

His conclusion was unsparing: the window to reverse course is narrowing, and the consequences extend well beyond medicine into national security.

The global shortage of donor organs has long pushed scientists to search for alternatives. Tens of thousands of patients wait years for kidneys, livers, and hearts that may never come. Xenotransplantation — using genetically modified pig organs as a substitute — has emerged as one of the most closely watched answers.

The fundamental obstacle has always been immune rejection. A normal pig organ transplanted into a human body would trigger a severe immune response and fail within an hour. Gene-editing tools, most notably CRISPR-Cas9, have changed that calculus by allowing scientists to reprogram donor animals before transplantation.

Chen outlined the three core interventions. The first is gene knockout — disabling the twenty to thirty pig genes responsible for triggering human immune rejection. The second is gene knockin — inserting approximately thirty human genes to make the organ compatible with the recipient's immune system. The third is viral clearance — eliminating porcine endogenous retroviruses (PERVs) embedded in the pig genome, removing a potential source of cross-species infection.

The resulting animal carries a partial human genetic signature and cannot meaningfully be called a conventional pig. Chen acknowledged the unsettling quality of the science with dry humor, calling it genuine "playing God" — while making clear that the clinical trajectory is real and already accelerating.

"Biotechnology has no shortcuts," he said. "In the future, almost every organ except the brain and microvasculature may be replaceable."

A common public concern is whether recipients of gene-edited pig organs could pass those foreign genes to their children. Chen was unambiguous: they cannot.

Xenotransplantation is somatic cell transplantation — it modifies a specific organ, not the recipient's germline cells. The edited genes remain confined to the transplanted tissue and cannot migrate to reproductive cells. Chen noted that this point commands broad consensus in both the scientific and bioethics communities, and that heredity is not the central ethical question in this field.

The United States and China have emerged as the two dominant forces in xenotransplantation, each leading in different organ categories.

American programs have been strongest in kidney and heart transplantation. Massachusetts General Hospital performed the world's first gene-edited pig kidney transplant into a living recipient. That patient, Richard "Rick" Slayman, later died, though the hospital said there was "no indication" the transplant caused his death. A subsequent Mass General patient, Tim Andrews, lived for 271 days with a gene-edited pig kidney before the organ was removed due to declining function, according to AP reporting. In 2025, the first formal clinical trial of pig kidney transplants in living patients was launched — a significant step beyond one-off compassionate-use cases.

China has moved faster in structurally more complex organs. In peer-reviewed studies, Chinese researchers have reported a six-gene-edited pig liver transplanted into a brain-dead recipient and monitored for ten days, and a gene-edited pig lung transplanted into a brain-dead recipient that maintained viability and gas exchange for 216 hours. These are early-stage results, not routine clinical treatment, but they point to rapid technical progress and sustained national investment.

Chen also addressed a widely circulated diplomatic report that organ transplantation was discussed during a recent summit between the Chinese and Russian heads of state. He dismissed the political interpretation: what the two leaders were actually discussing, he said, was precisely this field — gene-edited pig xenotransplantation — a domain of genuine great-power scientific competition.

In Chen's broader account, advanced clinical medicine currently divides into a rough tripartite structure globally: the United States accounts for approximately thirty percent of cutting-edge clinical trial activity, China for another thirty percent, with Europe and Japan sharing the remaining forty percent. Taiwan does not feature meaningfully in that picture.

Chen said the public debate should not focus only on whether pig organs can function inside human bodies. A deeper question is what happens after the species barrier is permanently breached.

"If a person carries a pig organ inside the body, the species barrier that once separated human and pig pathogens has been altered," he said. He pointed to diseases like African swine fever — viruses that do not currently infect humans under ordinary circumstances — as examples of the kind of cross-species risk the medical community must now plan for systematically.

That concern, however, simultaneously defines a commercial opportunity. A standard prophylactic dose for ordinary pigs may cost the equivalent of a few dollars. A specialized regimen designed to protect a gene-edited pig organ functioning inside a human patient — whose life depends on that organ — would command prices orders of magnitude higher. Chen described this category of "defensive medicine" as one of the most commercially explosive frontiers in biotechnology. Taiwan, he said, is not pursuing it.

Xenotransplantation also confronts a cultural barrier that technology must address rather than sidestep. Islamic and Jewish religious law both restrict contact with pigs, and some devout patients would refuse a porcine organ even under mortal threat, though interpretations and medical exceptions vary.

Chen said the technology is not inherently limited to pigs. "We could develop gene-edited sheep or gene-edited cattle," he said. Broadening the range of donor animals would allow the technology to serve patients across different religious and cultural traditions — a consideration he described as both ethically important and commercially rational. The platforms that eventually dominate this market, he suggested, will need to solve biological, safety, and cultural barriers simultaneously.

Chen contrasted the U.S.-China race with Japan's experience — a country with extraordinary foundational research capabilities that has repeatedly failed to convert discovery into globally dominant products.

He named two landmark examples. Statins, the cholesterol-lowering drug class that transformed cardiovascular medicine, were pioneered by Japanese biochemist Akira Endo. PD-1, the immune checkpoint pathway whose therapeutic application reshaped cancer treatment, was discovered by Japanese immunologist Tasuku Honjo. In both cases, the major clinical development and commercial returns were captured by large Western pharmaceutical companies.

Chen attributed the pattern to Japan's entrenched Koza system — a rigidly hierarchical university structure in which senior chair professors exercise near-absolute control over resources and research direction. Young scientists with innovative ideas rarely have the independence or funding to pursue clinical translation. The gap between laboratory and clinic has become structural.

Japan's decade-long national investment in induced pluripotent stem cell (iPSC) therapy illustrates the same problem at a policy level. Despite enormous public expenditure, no iPSC-based treatment has received FDA approval. The gene-edited xenotransplantation programs led by the United States and China cleared FDA clinical thresholds in a fraction of the time.

South Korea offers a sharply different lesson. Chen credited the foundations laid during the Park Chung-hee era for what he described as a mature, multi-sector industrial strategy — one that pursued automobiles, heavy industry, semiconductors, and biomedicine in parallel rather than concentrating national resources in a single direction.

That diversification has paid dividends. Samsung Biologics has become a dominant global player in contract development and manufacturing (CDMO), while South Korea's clinical research quality has continued to improve. Chen cited a recent study in a leading international medical journal in which Korean researchers produced rigorous and persuasive clinical evidence on LDL cholesterol targets for cardiovascular disease prevention — work he assessed as surpassing comparable American research in both rigor and originality.

South Korea, he concluded, is no longer content to be a manufacturer. It is positioning itself as a clinical research leader. The contrast with Taiwan's single-sector concentration is pointed.

Taiwan's "Dutch Disease": How Semiconductor Success Is Weakening Biomedical Research

Chen's sharpest criticism was directed at Taiwan. He described the island as suffering from a variant of Dutch disease — the economic condition in which the dominance of one industry draws capital, talent, and policy attention away from everything else, leaving the broader economy structurally weakened. In Taiwan's case, the dominant sector is semiconductors.

The result, Chen said, is that biomedical research struggles to attract sustained funding, skilled personnel, or serious industrial partners. Worse, the biotech sector that does exist has often been shaped by market speculation rather than science. Much of what passes for biotechnology in Taiwan, he said, is "just driving narratives to pump stocks." The companies actually producing results are few, small, and not internationally competitive.

He described his own experience at National Taiwan University as a cautionary illustration. Years ago, he advocated for a cross-disciplinary program — combining NTU's colleges of agriculture, veterinary medicine, and medicine — to develop gene-edited pigs for xenotransplantation research. The effort stalled. After years of work, the team had edited only one or two genes, far short of the twenty to thirty knockout modifications that competitive programs require. Funding dried up, talent was unavailable, and the private sector showed no interest.

"Apart from semiconductors," Chen said, "it is hard to see what Taiwan has left."

Chen's warning is not only about industrial competitiveness. It is about medical sovereignty.

If Taiwan continues on its current course, he said, transplant patients will face a stark choice within a decade: pay the prohibitive cost of treatment in the United States, or turn to China. China, he argued, will combine technical maturity with clinical scale — and will likely offer preferential access programs targeted specifically at Taiwanese patients as a form of strategic attraction.

That scenario, Chen warned, would leave Taiwan dependent on China for life-sustaining medical procedures. For a country already facing intense political and military pressure across the Taiwan Strait, such medical dependency would carry implications far beyond health care. It would represent, he said, both a strategic vulnerability and a profound institutional failure.

Chen stopped short of full pessimism. He and a small number of colleagues continue working in the field, and he outlined a specific path forward rather than simply cataloguing the problem.

Taiwan's major medical institutions — he named National Taiwan University Hospital and the Chang Gung Medical Foundation — should exercise strategic foresight and take direct ownership of high-barrier biomedical programs such as gene-edited xenotransplantation. A single medical center capable of establishing a first-generation platform and sustaining transplanted organs for one to several years could break through the current bottleneck and position Taiwan as a leading transplantation hub in Asia.

The deeper requirement, Chen said, is a change in culture. Taiwan's biomedical sector must return to foundational science, long-term clinical development, and cross-disciplinary cooperation. Semiconductor dominance may remain Taiwan's most visible global asset. But Chen's warning is that chips alone cannot define the island's future.

"In medicine," he said, "the next decade may determine whether Taiwan becomes a participant in the coming transplantation revolution — or a patient waiting for others to provide it."

​Original Article in Chinese

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