Four days ago, BBC reports that “Man ‘recovering well’ after pig kidney transplant.” There has been a dying entry when it comes to the organ donation platform. Some have debated using alternatives such as 3D printing, others say that animal organ transplant can do a much better job. Here, I present to you the case of Mr Richard Slayman. He had a failed dialysis. Before that he had the added pressures of keeping up with repeated hospital visits every two weeks for de-clotting and surgical revisions. This puts a guaranteed strain on his quality of health.
This is where xenotransplantation comes into play. The tackle plan on aiding patients with chronic diseases and end-stage organ failure as well. The World Health Organisation (WHO) defines xenotransplantation as “any procedure that involves the transplantation, implantation or infusion into a human recipient of either: (i) live cells, tissues, or organs from a non-human animal source; or (ii) human body fluids, cells, tissues or organs that have had ex vivo contact with live non-human animal cells, tissues or organs.” In 1667, the idea of xenotransfusion of blood from lambs to humans came to existence. Transplantation of a rabbit kidney to human has been documented in 1905.
Non-human primates abbreviated as NHPs are an extremely valuable commodity in translational research. We no longer now require waiting lists for transplantation surgery! They are selected based on their primal bonds on the animal hierarchy tree. The one where we distinguish species and genus and assort them into familial origins. Proper husbandry of NHPs is a major investment to maintain animal health, reduction of its stress, longevity of these foreign organs in human body. These three factors determine where it can be made readily available for organ donation and transplantation.
We also need to take into account the chronic or latent infections that the chosen species can succumb to. In order for the recipient’s body to accept the sacrifice, a powerful immunosuppressive therapy needs to administered. Three types of rejections are known to occur successively in a universal pattern; hyper-acute xenograft rejection, acute humoral xenograft rejection, and lastly acute cellular rejection. The world’s first porcine-to-human transplantation was performed at the University of Maryland School of Medicine (Baltimore, MD, USA), where a genetically modified pig heart was successfully transplanted into a 57-year-old man in the end stage of heart disease. After highly experimental surgery, the patient was able to move about freely in the absence of cardiopulmonary bypass assistance.
Gene manipulation is highly crucial in reducing human immune rejection response. Another method is immune cloaking-regulation of cell-surface molecules expression from host species in donor cells. Proceeding with the case, eGenesis motivated this surgery forwards by being the sole provider of a genetically edited and modified special pig kidney. Slayman is still on his immunosuppressive class of drugs and it is still unclear as to what direction the science of medicine will take him. The slow and steady pace is mighty yet challenging!
Nivea Vaz
Manipal College of Medical Sciences, Pokhara
(1st submission to IFMSA-SCOME)
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