Technology restoring cell function in dead pigs raises questions
Yale’s OrganEx system may solve the transplant organ shortage, but it may also violate the rights of organ donors
A team of scientists at Yale University recently developed a system that restored blood circulation and organ function to pigs hours after they died. The pigs’ hearts started beating again, and cells in organs—including the heart, kidney, and liver—regained function.
“We did not know what to expect,” Dr. David Andrivejec, one of the researchers, told The New York Times. “Everything we restored was incredible to us.”
The research has the potential to one day preserve human organs for longer, thereby increasing the number of organs available for transplantation. That sounds like good news for more than 100,000 Americans waiting for an organ transplant, but Christian bioethicists caution the technology could be used in a way that violates the humanity of organ donors.
The Yale scientists, who published their findings Aug. 3 in Nature, described the system they developed, OrganEx, as a device similar to a heart-lung machine. It pumps a mix of blood and synthetic fluid throughout the body. The fluid consists of critical nutrients, anti-inflammatory medicine, drugs preventing cell death, nerve blockers, and artificial hemoglobin.
In the experiment conducted, the researchers put pigs to sleep and placed them on ventilators before shocking their hearts to induce cardiac arrest. Once the pigs no longer had a detectable pulse, they were pronounced dead and taken off of the ventilators. One hour later, the pigs were placed back on ventilators and received either OrganEx treatment, no treatment, or else were put on traditional life support.
After six hours of treatment, the scientists reported significantly decreased cell death, improved tissue integrity, and restored cellular and molecular processes across multiple pig organs when treated with OrganEx. In comparison, the pigs placed on traditional life support exhibited swelling and damaged organs, as well as collapsed blood vessels.
Adam Omelianchuk, a clinical ethicist and associate fellow at the Center for Bioethics & Human Dignity, noted that both the research paper and surrounding commentaries published in Nature suggest incorporating OrganEx into an already controversial organ transplant protocol. The protocol, donation-after-circulatory-death using normothermic regional perfusion (DCD-NRP), restarts blood circulation throughout the body while also intentionally stopping blood flow to the brain. In standard DCD, the donor is taken off all life-sustaining therapies. DCD-NRP has limited use in most countries and is even banned in some, such as Australia.
Omelianchuk believes DCD-NRP violates the dead donor rule, which states that a patient’s death cannot be caused by organ procurement. That’s because the cause of death, irreversible cessation of circulation, is reversed, calling into question whether the donor is still dead without the measures taken during DCD-NRP to ensure irreversible brain death.
Omelianchuk explained that while it’s understandable that transplant teams want to avoid the nightmare scenario of an organ donor suddenly gaining consciousness during surgery, the fact that major arteries to the arms and head are blocked in order to prevent this possibility suggests a lack of knowledge that the patient is dead. Throwing OrganEx into the equation, then, could muddy an already ethically problematic procedure. “I worry [that] we’re going to start redefining death just so that we can get more organs,” he said.
There’s no denying that OrganEx is a remarkable technology, Omelianchuk said, which is why he hopes the team at Yale is able to find a way to use it ethically. His suggestion is to investigate using OrganEx to rejuvenate a single organ after its removal from the donor’s body.
One organ transplant procedure that Omelianchuk thinks might benefit from using OrganEx this way is pediatric heart donation. More than half of pediatric donor hearts are rejected each year due to factors including extended ischemic time, meaning time outside of the body without blood supply. If OrganEx technology could be developed enough to revive these rejected donor hearts, many more children would receive life-saving heart transplants.
Dr. D. Joy Riley, who is board certified in internal medicine and executive director of the Tennessee Center for Bioethics & Culture, echoes Omelianchuk’s concerns about OrganEx potentially breaching the dead donor rule. She observed that the Nature paper and commentary on it pushed for using the technology to procure organs more easily. “At what point are we using a human being as a means instead of seeing them as an end in themselves?” she asked.
Riley also thinks the framing of OrganEx as a technology that can reverse the biological processes involved in dying gives a false impression that death is a continuum. But Riley firmly asserted that death of our earthly bodies is final. What’s not final, is “how much the culture is going to tolerate changing the definition [of death] in order to get transplantable organs.”
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