Transgenic pigs are promising donor organisms for xenotransplantation as they share many anatomical and physiological characteristics with humans. Recently, a step has been moved closer to xenotransplantation by producing genetically modified pigs that has no α-1,3-Gal epitope, the major xenoantigens triggering HAR of pig to primate xenografts. Further genetic modifications such as expression of human complementary regulatory proteins, CD39, endothelial protein C receptor, heme-oxygenase 1, thrombomodulin, tissue factor pathway inhibitoras well as modulators of the HLA-E/β-2-microglobulin, and CTLA-4Ig are due to address for further rejection mechanisms and incompatibilities between porcine and primate blood coagulation systems. Although the pig is the favored species for use as a xenograft donor, a detailed description of the transgenic pig development and surgical technique is lacking which seems mandatory to address for broader understanding of this issue.