Terry H. Schwadron
March 29, 2024
The first pig kidney transplant in a live patient seems to be thriving a week later, a landmark medical achievement.
Perhaps just as remarkable, there has been no public pushback from ethicists or religious communities or animal advocate groups. Somehow, we have just experienced a politically immaculate advancement.
There are no protests at the Supreme Court or no threats of hospital boycotts, no humans-only marches. Just maybe we have an overlap between the ability to place pig parts, however biologically engineered for the effort, into humans with the recognition that there is a need for the increasing numbers of patients with failing kidneys.
At age 62 and facing end-stage kidney disease, Richard Slayman became the first patient to receive and survive implant of a genetically altered pig kidney, thanks to the medical team at Massachusetts General Hospital more than a week ago. That work followed decades of research and gives hope to hundreds of thousands who depend on dialysis machines to do the work of kidneys.
An average of 17 Americans die daily awaiting kidney transplants, especially among Black patients who suffer a disproportionate number of end-stage kidney failure. The world’s first successful human kidney transplant was at Brigham and Women’s Hospital in Boston in 1954. But sick patients continue to languish on lists waiting for a possible donor death with a compatible organ.
In 2021-2022, there were 786,000 patientsliving with kidney failure, with less than 25,000 transplants. that year. So, news of a successful transplant from a renewable animal source seems important. It could mean that people don’t die waiting on a list.
Behind the Surgery
The medical details are interesting. The pig kidney was specially altered by researchers at biotechnology company eGenesis in what one doctor called “a mini-Manhattan project.”
Human and pig kidneys are similar in size, but researchers had to make 69 different changes to the pig’s genetic code to reduce the risk that the patient’s immune system would attack the transplanted organ.
In 2022, surgeons at the University of Alabama at Birmingham transplanted a genetically modified pig kidney into a brain-dead man and a patient in Baltimore received a genetically modified pig heart.
What made this latest surgery possible has been the gene-editing developed a decade ago, the ability to produce accurate and speedy sequencing of our massive genetic code. and improved methods of suppressing the immune system. The operation took a year of planning and obtaining the required approvals. The Food and Drug Administration (FDA) allowed the surgery under its “compassionate use” rules.
The patient had suffered from kidney disease for more than 10 years, had been on dialysis and had survived a human kidney transplant in 2018.
Ethical Considerations
A successful transplant raises the possibility of eliminating lifetime dialysis altogether and a new industry for raising and altering genetic codes of pigs on a huge scale.
In other words, it’s just the kind of futuristic medical front that usually gets the protest juices going for animal protection groups, and prompts lawyers and politicians to start issuing ethical warnings.
Plus, this involves pigs, who’s very being is shunned by Jews, Muslims, and others, to say nothing of human-centric thinkers who oppose anything approaching cross-species experimentation.
Maybe it’s too early, but so far, there is little sign of any of that kind of pushback, indeed religious ethicists have gone out of their way to note that the idea of extending life or of intervening in a medical emergency remains paramount.
David F.M. Brown, president of Academic Medical Centers at Mass General Brigham, stressed in his explanations how long patients, families, surgeons, and scientists have clung to hope that a safe, ready supply of organs fit for human transplantation could be found.
The National Institutes of Health say that lots of human clinical trials will be needed to show that xenotransplantation, as it is called, is safe from immunologic and infectious standpoints. Transplant centers will need to show the long-term benefit to recipients and financially viability and receive regulatory approval to make all this routine.
Still, “practical issues with ethical implications remain.” the NIH statement says.
If only we had a government in place that was prepared to deal with a future that includes medical advance. Perhaps we could transplant one from a genetically engineered pig farm.
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TerryHSchwadron 