Saturday, July 21, 2012

Weekend Post - Transplants

It’s hard to write this. A year and a half ago my Dad died. This was a tremendous shock because he was still fairly young, was fit and healthy and seemed full of life. It was a devastating experience for the entire family but despite the shock, the grief and the sense of emptiness we all felt, my mother in particular, there were nevertheless certain comforts about the way he died. The first was that the cause of death was a sudden and catastrophic burst aneurysm in his brain that caused almost instantaneous death. According to the doctors he would have known virtually nothing about it and the knowledge that he didn’t suffer remains a huge comfort to us all.

However there was an even greater comfort, something that happened after he died. Because he died in the UK the family was automatically asked if we would consent to his organs be transplanted to people in need. None of us had any hesitation in saying yes. It helped that he’d discussed it with us several times in the past and on every occasion he’d made it plain that after he was gone he’d be delighted if any part of his body could be used to help others. As a result of Pete’s death two grandmothers who never knew him now have working kidneys and are off dialysis treatment for the first time in years. Burn victims who didn’t know he existed were given skin grafts as temporary dressings while their own skin could be grown. Two blind people who’d never heard of him can now see. Trying to describe these events is the closest I ever come to using the word “miracle”.

Organ transplantation has become one of the great achievements in science over the last half a century. Despite some legends about transplants done in ancient history, genuine transplantation began in the early 20th century and as often happens it was prompted by warfare. Skin transplants began shortly after the First World War as a result of the burns so many soldiers experienced but these weren’t “donor” transplants. Skin was moved from an intact part of the patient to another, damaged part of his own body. The first successful donor transplant was in 1954 when a kidney was transplanted from one person to their identical twin, neatly avoiding the issue of “rejection”. This was the biggest challenge that transplant surgery faced. An organ taken from a donor would be rejected by the recipient’s body. It wasn’t until the 1980s that we had drugs that effectively suppressed the immune system’s desire to reject foreign tissue.

Despite what you’ll hear from some people the real breakthrough wasn’t in South Africa, where Christiaan Barnard successfully transplanted a heart in 1967. In the next few years over a hundred more transplants were undertaken in South Africa but very few of the recipients lived more than a couple of months. Barnard and his colleagues cracked the plumbing side of things but the real breakthrough was the immune suppressors that became available in the 1980s. [Yes, I know describing transplant surgery as “plumbing” is insulting but I’m sure you get the idea.]

As a result of these immune response suppressors in countries like the UK transplants can now almost be described as routine but this is just one technique to fix broken bodies. Carnegie Mellon University in the USA recently announced the award of a $1.1 million grant to a researcher to develop an artificial retinal implant to help people with impaired vision to see better. A wafer thin film will be inserted behind the retina with electrodes to stimulate nerve signals from the eye to the brain using signals coming from a special pair of glasses the patient will wear. In effect the glasses will act as a camera feeding information into the brain through the retina.

The long-term future is even more impressive. Regenerative medicine offers the possibility of growing replacement parts of the body to replace damaged or diseased ones. Using stem cells either from umbilical cord blood or bone marrow, bits of body might be grown to provide spare parts. So far this has been done with fairly simple body parts like cartilage, trachea and even the tip of a finger but it’s early days yet. Once we become more familiar with how to manipulate stem cells the possibilities are amazing.

However all of this faces the usual threats from ignorance and religion. Shortly after Pete died I mentioned his death and organ donation to a shopkeeper who knew him. He expressed the usual sympathy for our loss but pointed out that “in my religion we don’t permit transplants”. I restrained myself from pointing out that I felt that whatever religion he followed was clearly an immoral one.

There’s been the same objection in principle to the stem cell research that would enable regenerative medicine, mainly because of the mistaken perception by certain faith groups that stem cells are obtained from aborted embryos. While this is possible, and was once thought of as a source of stem cells, things have long since moved on to much simpler sources. But that hasn’t prevented the religious right-wing in the USA and elsewhere from resisting progress yet again.

Stem cells offer humanity an unparalleled opportunity to cure disease and restore damaged bodies. The forces of ignorance cannot be allowed to prevail. My Dad would have wanted progress.

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