It's hard for me to imagine the bravery it takes to sign up for this -- even if you're dying already, something like this is unlikely to result in a peaceful final days on earth (between being a science experiment, the media, optional major traumatic surgery, etc...). The folks undergoing this are incredibly admirable.
waiting for a kidney transplant while slogging through dialysis is a brutal experience, the mental and post physical struggle is mad real. I was lucky enough to match with a family member eventually. I can see how on some last resort shit why not try this.
From what I’ve read, it is that these patients are too far along for much hope of anything. I’d certainly like to go out adding to the hope that future patients don’t have to suffer the same fate.
Disagree. The "choose life at any quality of life" ideology causes immense suffering.
Ideally in the long run, this is a step in the direction of keeping people alive with a higher quality of life, but that's unlikely to be this first person's experience.
Sure, but is a low quality life worse than oblivion? Even if you're not 25 and healthy and wealthy and happy, I think life is still worth living.
Plus, if the suffering experienced by this patient helps cause someone else (or many someones else for centuries to come) to have a higher quality of life, one person's suffering can buy a lot of QALYs.
Alternatively if as my mother tells me, I'm doomed to an eternity of unimaginable physical and psychological torture by supernaturally powerful fallen angelic beings with complete control of my entire sensorium, even a few more minutes of being hooked up to a hospital bed with doctors trying to make things better are preferable to that!
> Sure, but is a low quality life worse than oblivion?
Unequivocally yes. I think you are drastically underestimating how bad a life can get.
> Plus, if the suffering experienced by this patient helps cause someone else (or many someones else for centuries to come) to have a higher quality of life, one person's suffering can buy a lot of QALYs.
Exactly, that's why I'm arguing that this person's choice is brave.
I'd wager such choices are highly personal, and different people will weigh things differently. I've seen quotes from people undergoing dangerous and highly experimental treatments stating that they felt happy to help medicine learn, even at significant cost to themselves. The patient in this case said much the same.
Nonetheless, I do generally agree with you. I've seen several articles about how doctors die very differently than most people (they often have DNRs and far fewer end-of-life interventions).
Why? My doctor's job is to give me health advice and treatment not moral advice. And it's none of society's business so really they shouldn't be chiming in anyway.
So why say anything if it’s just an opinion if not a call to action seeking to censor certain opinions?
And my comment likened both, so to suggest the intent of the word censoring is somehow different is semantic nitpicking rather than any productive discourse.
> So why say anything if it’s just an opinion if not a call to action seeking to censor certain opinions?
Why not? I could make an argument that cultural change happens through conversations like this, but honestly I think people are just intrinsically motivated to share their opinions whether it makes any difference or not.
> And my comment likened both, so to suggest the intent of the word censoring is somehow different is semantic nitpicking rather than any productive discourse.
The difference between censoring someone and disagreeing with their opinion is NOT a nitpicky detail. It's literally one of the major differences between totalitarianism and democracy.
The position that censorship is the only way to get people to stop saying things you disagree with, is an absurd, extremist position.
The article addresses this. The patient previously had a human kidney transplant in 2018, which failed sometime in (reading slightly between the lines) 2023, as well as having other health issues. Another human Kidney wouldn't have been made available to him for five to six years, and his doctors didn't believe that he would live that long.
I still think it counts as brave though, certainly not an easy choice.
As others mentioned, there's no particular reason for the brain to be involved. But that didn't stop Alastair Reynolds from writing sentient pigs into the later sequels to Revelation Space, with that exact backstory. One of them is a major character in The Prefect (or whatever they renamed it to).
Quite amazing! Doubtful we'll see any Animal Farm animals. The modified genes are for mostly endothelial modifications.
>> The Yucatan miniature pig breed was chosen because its organ sizes are comparable to human organs28. In addition, pigs with OO blood type were selected to eliminate ABO blood-type incompatibilities29.
>> The pigs were engineered to carry 69 genomic edits, using the clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated protein 9 (Cas9)-mediated nonhomologous end joining and homology-directed repair30,31, and recombinase-mediated cassette exchange.
Some people are injecting BDNF from pig brains into themselves, and early insulin came from pigs as well. Hopefully this works or if there are issues they are minor.
I remember reading online a short sci-fi piece where people keep their own generically engineered pigs for spare parts, and the main character develops an affection for the animal (that is smart enough to almost talk). The story ends with him needing a transplant, and sitting in the mud with the pig, contemplating the choice he has before him.
Edit: In a more 'realistic' scenario, capitalism would ensure we were more remote from the ethical consequences of our consumerism.
If successful, this is great. However, I would like to see how long this lasts. I can recall seeing similar stories with either a rejection at the end, or some negative outcome for the patient.
Speaking for liver transplants, they are a many hour traumatic affair. My daughter lost and received more than her entire blood volume during hers. Initial recovery is extremely immunosuppressed and some of the drugs we had to handle with masks and gloves, and had 4x a day medication schedules. So you couldn't burn through pig livers I believe getting them swapped frequently. My daughter received her liver at age 8 months by the way and is now 19 yrs old.
Wow, congrats. Does she still take immunosuppressants? If so do you and your family take extra caution to not bring home any sickness (for example always washing hands or similar). If her body accepted the liver, how long did it take for that to happen? It's very interesting to me, especially if we can figure out how to force the body to learn/accept the transplant with something better than immunosuppressants and not immunosuppressants. Thanks.
She takes immunosuppressants every day still. We do not practice any additional caution. We've all had Covid more than once, and she gets every cold and other virus and fights them off no problem. She got EBV with her liver, and when that flares up they will reduce her suppressants at times.
The first six weeks are pretty intense. The recovery is amazing as how fast liver labs drop and how fast the jaundice yellow clears. I would probably say six weeks is a fair figure until you are a whole new person!
For renal transplants - not sure if there’s an upper limit, although each subsequent transplant becomes a more difficult match (as antibodies build up) and eventually may have to remove previous transplants. Generally renal transplants go in the right or left groin with native kidneys left in place. If one transplant fails, a transplant to the opposite side may be attempted, or a different location (such as intra-abdominal). Otherwise, will need to explant the first transplant
I remember that too, and can't believe it's already been a year since that happened. Now I wonder what the next organ to cross the pig-human border will be.
I have CKD and need a transplant. I'm keeping an eye on this progress. I hope I get to eat the rest of the pig when I wake up from the surgery, myself. Mmmmm bacon!
As a mild CKD patient 60 to 80 percent fluctuating function (diagnosed at 55 function raised it to average 75 for many years until a recent illness) I avoid all meats except chicken..sometimes turkey. Drink 3 liters of water a day (80 percent of a gallon).
I don’t think you’d want to eat severely genetically modified pigs though. Who know what kinds of viruses can make the jump to humans in a chimera like that. Ideally those pigs would be kept in some kind of sterile biohazard location and their bodies would ideally be incinerated afterwards.
Well the organ recipient’s body is now an incubation chamber for pig human virus crossovers. But it’s a human, so we deal with the risks. Hopefully he doesn’t deal with a lot of pigs on a daily basis.
imo only way forward (in broad terms) is taking ones cells, fixing dna/genes, growing cells as neccesary and transplanting them back and having valid cells of your own making.
everything else is just suffering and living with "incompatible" parts.
But a bladder is just a tube. Cultivating and growing a multilayered higher functioning organ like a kidney or a heart is a lot harder.
I do hope they can pull it off though, especially if they can reset the genetic clocks on the new organs.
I imagine there are trillions of dollars on the line as well. Organs are big money and necessary for life but there's also the plastic surgery aspect.
For instance, new skin.
I could see 25-50 years from now being able to go to the doctors and drop off a few skin cells and then coming back 3 months later, shucking your old skin and getting the new skin put on, floating in a star wars bacta tank for a week or so while the nerve integrate and the sutures heal, and then coming out looking like a teenager again.
But not just for old people but for burn victims, too.
Of course, while you're at it, get your new heart / lungs / kidneys / knees / eyes / hair follicles / breast & genital upgrades / remove all of the excess fat from your body / upgrade muscles / get a new set of adult teeth installed / get any bone level deformities handled...
The wealthy could go into these retreats for a few months and come out as basically a brand new human if they had the cash or credit.
I would like to have more details on the list of genetic modifications needed to make the kidney implantable in an human without being rejected/attacked by the immune system.
It was done over the course of decades by the company that made Dolly the cloned sheep all those years ago.
There are a handful, maybe a dozen genetic changes that were needed, but that's not the most interesting part.
Endemic to the general swine population are several retrovirus'. They are communicable, so they had to create an entirely separate breeding population of these pigs, with the genetic modifications, and then raise and otherwise maintain a breeding population that is totally separate from other farms. Something as simple as a feed truck delivery could lead to a compromise. Think about a farm, but total microbiological isolation.
I'm sure (99.9%) its patented, so you can find and read those patents. i expect there should also be a list of publications in it what it was based on. its probably heavy biology / chemistry though (i know, as I've been researching other gene modification patent stuff before)
It's easy to transplant a pigney into a human. The hard part is keeping them alive afterward, especially in the long term. It seems like the event is not far enough in the past to know.
Not the same as a human, but transplants to other primates were moderately successful [1]:
> Researchers transplanted kidneys from genetically engineered Yucatan pigs into cynomolgus monkeys such as the one above. The monkeys survived for up to two years with the xenografts.
I don’t feel like that’s the most important thing. If we can farm kidneys for folks with kidney failure, rather than rely on a combination of the kindness of live donors and harvesting organs from corpses, it will be a huge step forward, even if recipients still need immunosuppressants (as they do with human organs).
I do wonder if the immunosuppressants for cross-species organs have to be stronger/nastier than for intra-species organs though.
Immunosuppressants are very commonly used for various diseases that are caused by overreactions or undesired reactions of your immune system. Glucocorticoids, for example, are very widespread for all sorts of stuff (rashes, asthma, allergies, inflammations, ...). Monoclonal antibodies are also getting popular as a way to treat allergic reactions by means such as "killing" your IgE antibodies (They're basically antibodies that, in this instance, are used against your own body's antibodies).
Anyone who gets a transplant needs to take immunosuppressants for the rest of their life (except some older patients with liver transplants many years post transplant).
In general for many patients, immunosuppressants have relatively little impact on daily life.
Many immunosuppressed patients will disagree. Viruses hit harder and can often require antibiotics (not a good idea long term). And Covid/Flu/Noro is a constant risk to immunosuppressed people.
It does at the end of the article: "The procedure was performed under a Food and Drug Administration protocol known as a compassionate use provision, which is granted to patients with life-threatening illness who might benefit from an unapproved treatment. New drugs to suppress the immune system and prevent rejection of the organ were also used under the protocol."
Why would I care at that point? I'm not living with a pig's heart. That's disgusting. Imagine someone being so afraid of dying they were willing to have a pig's heart transplanted. There's nothing someone like that wouldn't do.
Imagine someone being so afraid of a little piece of their meat being replaced that they would rather die. My point is, you're allowed your opinion, but if you're simply deriding others for not sharing yours, you're not really enriching the conversation.
Inequality exists in the health system, especially for exclusive treatments like supply-limited organ transplants. Pretending it doesn't is ignorant and naive.
> This is confusing, because one possible reading of this is that the procedure works only on Black people.
Thats not a reasonable interpretation.
They're just saying that the recipient is a member of a group with higher rates of kidney disease, and therefore the transpant techniques may particularly (but not solely) benefit that group.
The rest of your comment is unnecessary supposition.
> The patient is a Black man, and the procedure may have special significance for Black patients [because they] suffer high rates of end-stage kidney disease.
I grant you that the grammar of the sentence does leave a smidgen of ambiguity. But I don't see any other plausible reading if you bring even a little bit of context to the interpretive exercise--which is just as much a part of reading as understanding the syntax. The author is justified in expecting that good faith readers will understand the final clause as explaining the clause that goes immediately before it.
It's also a huge and unreasonable leap to go from "this sentence has a slight ambiguity" to "the sentence can be reasonably interpreted to mean that the procedure only works on black people." It can't.
I'm saying that, even on a grammatical level, it's visible that the author must have had a motive for putting the sentence there that was somehow extraneous to and different from the motive for putting the other sentences there.
Noticing that sort of thing is a useful skill in the critical reception of media. That's why I pointed it out.
14% of the US population is black, whereas 0.001% of the US is a zookeeper. So, I'd imagine that the bar for mentioning a particular group most affected by a disorder is somewhere between 14% and "so low as to be a rounding error."
If there are relevant factors that are associated with a particular disorder, mentioning that fact seems pretty relevant. This is particularly true for something as complex as a transplant, where the difference between rejection and non-rejection is small.
> This is confusing, because one possible reading of this is that the procedure works only on Black people.
I don't see that being a possible reading.
> Imagine, for the sake of argument, that it happens to be true for zookeepers, and the patient happened to also be a zookeeper. Would they have said "The patient is a zookeeper, and the procedure may have special significance for zookeepers, who suffer high rates of end-stage kidney disease?"
I mean, if one can get beyond the implausibility of your example, maybe? If the authors of the article were aware of it, I can absolutely see them pointing that kind of thing out in other cases. But at the same time, so what?
> Or did an editor see an earlier draft and say something like: "Hey, there isn't a single mention of any race issue in this article. Not cool. So not cool."
Is there some evidence I'm not aware of the the New York Times mentions race issues in every (or even most) articles?
