By Dr. W. Gifford Jones
October 11, 1992
Why did Dr. Starzl transplant a baboon's liver into a 35 year old man? How did this patient feel about receiving the animals organ? Did this particular liver offer advantages a human liver did not? And how has the drug cyclosporin taken organ transplantation from dream to reality? To find answers to these questions I interviewed Dr. Thomas E. Starzl in Paris, France, during the XIV International Congress of the Transplantation Society.
Dr. Starzl emphasized at the outset that this operation was not a frivolous undertaking. Nor had the decision to transplant a baboon's liver been an easy one. Many meetings were held with the University of Pittsburgh Ethics Committee, The New York Academy of Science, U.S. Senators, government officials, and groups interested in animal rights. The final decision to go forward came after much deliberation. And Dr. Starzl was quick to reiterate that he was trained to save human lives.
Despite the months of consultation, animal rights groups condemned Dr. Starzl following this epoch-making operation that made headlines around the world. The outcry was, "Why sacrifice a baboon?" Most critics are still not aware that a valid medical reason existed.
The patient was suffering from liver failure due to chronic infection by the hepatitis B virus. Eradication of this virus from the blood is currently impossible. A transplanted human liver would be attacked by the same virus and suffer the same fate. The National Institute of Health confirmed, however, that the baboon's liver is resistant to the hepatitis B virus.
Will the transplanted baboon's liver survive? Dr. Starzl believes that if the human body's rejection of the baboon liver can be delayed for even two weeks the phenomenon of "accommodation" will occur, allowing the graft a chance of surviving. At the time I talked to Dr. Starzl the baboon's liver had already functioned for 53 days.
There's another reason for being optimistic about the outcome. Liver transplants of any kind tend to develop "accommodation", or tolerance, compared to other organs. For instance, over 20 per cent of Dr. Starzl's human liver transplant recipients are able eventually to discontinue immunosuppressant drugs. What about the psyche of the patient? How well did he psychologically accept the baboon's liver? Dr. Starzl explained that the patient was told in unusual detail about every aspect of the operation. That he would not only have the baboon's liver, but baboon cells would also be widely distributed throughout his body. He was assured that these cells would have no effect on his well-being. Provided with all this information the patient had no trouble accepting the baboon's liver.
This operation represents an historic moment for animal organ transplantation. Most transplant surgeons agree that the only way to remove the thousands of people from kidney machines, provide new hearts and livers is to use animal organs. But baboons will not be the animal of choice to fill this need.
DR. Starzl explained that baboon organs are too small for most transplantation operations. The baboon lifestyle also requires a great deal of living space. So finding room to house 200,000 baboons presents a major problem. Moreover society finds it hard to sacrifice baboons for this purpose.
So what animal will take the place of baboons? Dr. David White of Cambridge University, England, claims pigs will be used as donors. Pigs are easier to breed and produce large litters. This eliminates the problem of supply. He also suggests there will be little or no outcry when researchers sacrifice pigs for this purpose. As White says, "If you can eat a ham sandwich you can't object to a pig liver transplant!"
The main drawback at the moment is the immunological barrier. Cyclosporin, a drug dicovered by Sandoz researchers that counteracts organ rejection, has made it possible for surgeons to transplant thousands of human organs during the last decade. But even with cyclosporin a pig organ graft can be destroyed in minutes or hours because the species is so distantly related to humans.
Can this be overcome? One promising route is genetic manipulation of the pig. Professor White says it should be possible to alter the genetic constitution of the pig so that the genetic sites that define "pigness", or make a pig a pig, are rearranged. In effect Dr. White is trying to "humanize" the pig's genetic make-up so that the human immune system will not attack the transplanted pig's organ.
Currently Dr. White is working on mice to perfect the technique. The next step will be pigs. So don't be surprised when a future headline reads, "Surgeon transplants a pig's liver into a human."
Some people may find it hard to accept a pig liver transplant. But until Christians practice what they preach, that it's the soul, not the body that matters in the hereafter, animal organs remain the only hope for thousands of people waiting for an organ donation.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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