Health
How pigs became a “beacon of hope'' to solve the human organ donation shortage
When US surgeons transplanted a genetically modified pig kidney into a living human in March, it was seen as a major milestone in the quest to solve the world's organ shortage.
The chief surgeon said he was optimistic and believed the kidney could survive for two years.
However, about two months after the surgery, Richard “Rick” Suleiman, 62, has passed away.
Massachusetts General Hospital's surgical team issued a statement this week saying, “There is no indication that this is the result of a recent transplant.”
And leaders in xenotransplantation (transplanting animal organs into humans) continue to hope that pigs in particular will be the answer.
So how did pigs become the focus of the future of organ donation?
Non-human alternatives are desperately needed
As of May 1, around 1,400 Australians were waiting for a kidney transplant, the country's most sought-after organ.
More than 96,500 patients are on waiting lists in the United States.
If your kidneys are no longer functioning and you are living on dialysis, a transplant is performed.
According to the National Kidney Foundation, research shows that people who receive kidney transplants live longer than those who continue on dialysis.
Wayne Hawthorne, professor of transplantation and immediate past president of the International Xenotransplantation Society, said donation rates will not be able to meet demand.
He said Westmead National Transplant Unit had 10 times as many patients on its waiting list as it could offer a transplant.
“We have been working for decades to develop and improve human-to-human organ donation,” Professor Hawthorne told the ABC.
However, even if the hospital system changes, organs such as kidneys and hearts will still need to come from brain-dead donors.
And it's not easy to come across these.
“When the heart stops, breathing stops, blood circulation stops and organs stop functioning,” Professor Hawthorne says.
“That’s the problem, you have to have this cycle.
“That means there are very few organ donors…for thousands of patients, Australia only has a few hundred organ donors a year.”
Why a pig?
Researchers have been studying the use of transplanted animal organs and tissues in humans for decades.
In 1984, “Baby Faye” received a baboon heart, becoming the first infant to undergo xenotransplant surgery.
A 14-day-old baby in California survived for 21 days.
But while non-human primate organs are the best option, there are questions about ethics and supply, Professor Hawthorne says.
“People don't like these kinds of animals being used in research, much less as donors for humans,” he says.
“Another big problem is trying to reproduce them…Like humans, they usually take a very long time to produce and leave a single offspring.
“So it's very difficult to produce them as organ donors.”
Pig parts are already widely used in human medicine, including in insulin for diabetes and tissue for heart valves.
And given the similar size of their organs, pigs are the next ideal choice.
“Light of hope” through gene editing
Organ transplants overall have failed for decades because people's immune systems attack foreign tissue.
But researchers are now using advances in gene editing to make animal organs more compatible with the human body.
Suleiman became the first living person to receive an improved pig kidney after a human transplant failed in 2018.
Similarly edited pig kidneys were transplanted into monkeys and lived for an average of 176 days, and in some cases more than two years. researchers reported It was published in Nature magazine in October.
Tatsuo Kawai, who helped lead the transplant team for the operation, described the pig's organ as “truly the most beautiful kidney I've ever seen.”
“This successful transplant is the culmination of the efforts of thousands of scientists and physicians over several decades,” Dr. Kawai said in March.
“Our hope is that this transplant approach will provide a lifeline to the millions of patients around the world suffering from kidney failure.”
The surgical team has not yet linked Suleiman's death to the transplant, and the Procedures as a “light of hope”.
And Suleiman's family said they are grateful he was given a second chance.
“We feel comforted by the optimism he provided and continues to provide to patients in desperate need of a transplant,” the family said in a statement.
When he was discharged from the hospital in early April, Suleiman said: “Today I am leaving the hospital in the best health I have ever been in…the health I have wanted for many years.”
Toby Coates, director of transplantation at the Royal Adelaide Hospital, said Mr Suleiman's death was a tragedy but by no means a setback for xenotransplantation.
“It's an absolute tragedy, but this has moved things forward on the ground,” he told the ABC.
“In fact, it’s really amazing that we’ve completed three of these and this is the beginning of many more.”
Lessons learned from pig heart transplants
Two men in the United States have received gene-edited pig heart transplants since early 2022.
David Bennett, 57, was the first person in the world to undergo this procedure. He survived for two months.
Meanwhile, 58-year-old Lawrence Fawcett died about six weeks after receiving the transplant.
Although both had underlying health issues, Mr. Bennett The animal was found to have a pig-borne infection, which may have contributed to the transplant complications.
Professor Hawthorne said: “Patients who have had a transplant usually die after the transplant. They are simply unwell.”
“These people were not suitable for human transplants, which means they were even sicker than people receiving human transplants.”
Professor Coates said it was his “gut feeling” that the patient's poor health before the xenotransplant surgery was the main factor in the patient's death.
He added that the use of drugs that reduce the body's ability to reject transplants can also weaken the immune system.
In both cases, the men lived longer than they otherwise would have.
And Professor Hawthorne expects outcomes to improve significantly over time.
“People with human kidneys didn't magically survive for years…the first human kidneys only lived for a few weeks,” he said.
“We've been building for a long time to get the science and medicine right, and we're bringing it to patients very slowly, systematically and safely.”
Where is Australia?
Australia is a world leader in islet cell transplantation and is working alongside researchers in the US and Europe to enhance xenotransplantation.
But Australia faces restrictions on the entry of pigs needed for trials because “we didn't start with this magic pig,” Professor Hawthorne said.
And the development of local pig colonies for xenotransplantation requires significant financial support.
Professor Hawthorne said they were also working closely with the World Health Organization to ensure strict guidance and ethics.
“The reason we didn't do these transplants earlier is not just because we don't have transgenic pigs,” he said.
“We didn't want to make any mistakes. We wanted to get the ethics and all the background research right so we could have a safe and effective transplant.”
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