At any given time, there are over 100 000 people on a waiting list for a lifesaving organ transplant in America alone. Every nine minutes, one more person is added to that list.
A single organ donor can save up to eight of those people and better the livelihoods of up to seventy-five others. In the United States and much of Canada, with the exception of Nova Scotia, organ donation is considered an “opt-in” system where one must intentionally indicate that they wish to be considered for organ donation upon death. According to Donate Life America, 95% of US adults support organ donation, but only 54% are registered donors. Of those who die, only about 1-2% meet the criteria to donate.
There is a critical lack of supply of organs for transplantation–every day, seventeen people die, waiting for an organ that never arrives.
The gap between supply and demand is increasing despite record-high numbers of donors. There are two possible ways of remedying this issue. The first: change to an “opt-out” system where anyone of age is automatically assumed to be an organ donor unless they intentionally indicate that they do not wish to donate their organs upon death. This is currently being attempted in Nova Scotia, and has multiple precedents in the international community. The second possibility: xenotransplantation. This is the controversial process in which, usually genetically modified tissue and organs from non-human donors are transplanted into a patient.
This branch of medicine is still growing, but steady progress is being made. David Bennett Sr., the first patient in the world to undergo a genetically modified heart xenotransplantation, died on 8 March 2022, almost exactly two months after his initially successful surgery.
David Bennett Sr. of Maryland was 57-years-old when he died. He suffered from terminal heart disease. Having been denied a human-donated heart due to a history of “medical noncompliance” and for missing medical appointments, he agreed to undergo an experimental transplant with a genetically modified pig’s heart, an operation he described as “a shot in the dark.”
Bennett being chosen as the recipient of this experiment sparked various moral and ethical debates on who should be granted organs amidst their current shortage. Thirty-four years prior, he had stabbed and immobilized Edward Shumaker, who was then confined to a wheelchair and died of a stroke nineteen years later. Bennett was convicted of battery and for carrying a concealed weapon. However, criminal records are not factored into the decision to grant people donated organs, as doing so would “set a dangerous precedent and would violate the ethical and moral values that underpin the obligation physicians and caregivers have to all patients in their care,” stated officials at Maryland Medical Centre, the same site that performed Bennett’s transplantation.
The Food and Drug Administration granted emergency approval for the operation on 1 January 2022, which was carried out on 7 January 2022. The pig was provided by Revivicor, a regenerative medicine company. Ten genetic modifications were made, some to inhibit growth of the transplanted organ and others to reduce the chance of an immune system response and consequent rejection of the organ. The seven-hour operation seemed like a success with no rejection of the modified organ.
Bennett spent the next two months spending time with his family, undergoing physical therapy, and even watching the Super Bowl. His condition was described by doctors as “frail,” but the surgery was deemed a success. His health deteriorated several days before his eventual death.
While a timespan of two months would seem to be relatively short to many, it is a significant improvement from previous attempts in history. The first heart xenotransplantation was performed in 1964, which the patient did not survive. The second was performed in 1984, where the patient survived for an additional twenty days after the operation. Bennett’s operation marks the third time a heart xenotransplantation has been attempted, and is the most successful trial as of yet amidst many other breakthroughs in xenotransplantation and genetic modification technology.
“We hope this story can be the beginning of hope and not the end,” Bennett’s son, David Bennett Jr. says on the topic. “We also hope that what was learned from his surgery will benefit future patients and hopefully one day, end the organ shortage that costs so many lives each year.”
[1] https://myhealth.alberta.ca/alberta/Pages/organ-and-tissue-donation-topic-overview.aspx
[2] https://www.americantransplantfoundation.org/about-transplant/facts-and-myths/
[3] https://www.organdonor.gov/learn/organ-donation-statistics
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212358/
[5] https://www.nytimes.com/2022/03/09/health/heart-transplant-pig-bennett.html
[6] https://www.npr.org/2022/03/09/1085420836/pig-heart-transplant
[8] https://www.donornetworkwest.org/organ-donation-facts-statistics/
[10] https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.059277
