[Sunnyways]

On January 7, a 57 year old man with terminal cardiac failure underwent a nine hour operation at the University of Maryland School of Medicine and received a cardiac transplant from a pig. Three innovations made this historic procedure possible:

1. Genetic modification. Ten genes were changed in the pig: three were removed that would have caused a rapid, antibody-mediated rejection of the foreign organ; one was removed that would have made the heart too big; and six human genes were added to reduce inflammation, rejection and blood coagulation.

2. A perfusion solution to keep the porcine heart in optimal condition between operations. Apparently, this product contains cocaine which caused a regulatory headache for the researchers.

3. A powerful drug, KPL-404, that suppresses the body’s immunological reaction (in particular, CD-40) to the foreign organ.

The potential significance is enormous - many thousands die every year awaiting organ transplantation form human donors and demand will only increase - but there’s an army of potential problems ahead. One expert called the patient ‘courageous’ which is not something you want to hear.

On the medical side, rejection and infection are the two big immediate dangers. Rejection comes in three basic types - hyperacute, acute and chronic. The hyperacute stage seems to have been successfully navigated but the body has a myriad of responses to foreign antigens that are not fully understood.

An infection is made more likely because of the immunosuppressive medication the patient is on. This could be any extrinsic infectious agent or might have travelled in the transplanted organ itself. Longer term, one has to wonder how a heart from a quadruped will perform pumping blood all the way up to the head in a biped. Not a major worry right now.

There are ethical issues. If the patient dies in the next few weeks the decision to go ahead will be questioned; this is an experimental treatment and I’d say the surgical team are not getting much sleep at the moment. Some people may have concerns about any animal transplants to humans although I think we’re less bothered by that than we were and don’t expect to start hunting for truffles all of a sudden. There are also those may be put off specifically by a pig donor for religious reasons.

The patient was denied a human transplant partly because of poor compliance with treatment recommendations in the past, including management of hypertension. One aspect of the story dominating coverage at the moment is that the patient did time for a serious assault and the family of the victim are asking why a person guilty of a serious felony deserves such expensive care. Doctors would say they treat anybody regardless of their past.

https://www.dicardiology.com/videos/vid ... gery-human

BTW this is not the first time a surgeon has attempted such an operation. In 1997 an Indian surgeon had a go without the gene modification and other mod cons. The patient died and he was jailed.

https://timesofindia.indiatimes.com/hom ... 111349.cms

[DrCaleb]

It does make some pretty big ethical decisions necessary.

But it's also a stepping stone to making organs out of base materials and without a living donor.

[Sunnyways]

Something I didn’t realize - how seriously brain death can affect organ quality:

$1:

Brain-dead organ donors represent the major source of organs for organ transplantation. The path from a brain-dead potential donor to a favorable graft and recipient outcome is long, and can have a cardinal impact on the quality of transplanted organs. Brain death-related systemic changes can damage the organs to the point where donation is not possible. Severe systemic inflammatory response enhances graft immunogenicity and affects graft survival and transplant outcome. Thus, immunomodulatory agents can become pivotal in donor procurement and preservation in future.

https://www.intechopen.com/chapters/73733

[Thanos]

South Park actually predicted this a long time ago.....

[herbie]

Oh FFS there's already millions of people with the heart of a pig. I'm sure we all know a couple personally....
they damn near re-elected one in 2020

[DrCaleb]

Sunnyways Sunnyways:

Something I didn’t realize - how seriously brain death can affect organ quality:

When I was working on the project on getting Alberta's Organ registry going, we found that there are many factors that affect organ donations. For example, just because you are brain dead, doesn't mean your heart stops beating. You may stop breathing, but your heart can beat for a couple hours if you are physically fit. And they won't harvest your organs if your heart is still going, and they will do nothing to stop it.

There is about 20 minutes from brain death to when organs are still viable for transplant. If your heart doesn't stop by then, your organs are not viable. There are also many other conditions that make your organs not viable, such as certain diseases and cancer.