Groundbreaking Pig Kidney Transplant in Boston Sparks Hope and Ethical Debate

Credit: The Wall Street Journal

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The successful kidney transplant into a patient in Massachusetts, Boston, from a genetically modified pig offers hope for a cure for renal and other human organ ailments. Still, it also opens moral and ethical questions that will consume generations to come. This discussion examines the opportunities and threats this ingenious medical breakthrough poses.

On 21st March 2023, surgeons at Massachusetts General Hospital in Boston, the US, said they had successfully implanted genetically modified pig kidney into Richard Slayman, 62, of Weymouth, Mass, who is suffering from end-stage kidney disease. Mr Slayman was on dialysis as he fought for his dear life.

More than 500,000 people in the United States live with end-stage renal disease (ESRD). The development of chronic kidney disease (CKD) and its progression to this terminal disease remains a significant cause of reduced quality of life and premature mortality. Chronic kidney disease (CKD) is a debilitating disease, and standards of medical care involve aggressive monitoring for signs of disease progression and early referral to specialists for dialysis or possible renal transplant.

Mr Slayman was expected to be discharged on Saturday, three days after the intrusive operation. Since he will have a pig kidney, he will have to take pills to resist the rejection of a foreign body for the foreseeable future, possibly for the rest of his days on Earth.

Evolution of Genetically Modified Animal Technologies

The field of genetically modified animal organs is stirring excitement about harnessing cloning and gene-editing technologies to solve the persistent shortage of organs for human transplantation. More than 103,000 people in the US alone are currently on the waiting list for organs.

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About 17 die every day because they can’t get one. End-stage renal disease is 3.8 times more common among Black people than white people in the U.S., according to federal statistics. The medical urgency to resolve this state of affairs is notable.

Genetically modified animals are vital for gaining a proper understanding of disease mechanisms. Mice have long been the mainstay of basic research into various diseases but are not always the most suitable means of translating basic knowledge into clinical application. The shortcomings of rodent preclinical studies are widely recognised, and regulatory agencies worldwide now require preclinical trial data from non-rodent species.

Pigs are well suited to biomedical research, sharing many similarities with humans, including body size, anatomical features, physiology and pathophysiology, and they already play an important role in translational studies. This role is set to increase as advanced genetic techniques simplify the generation of pigs with precisely tailored modifications designed to replicate lesions responsible for human disease.

Extending genetic modification technology to pigs has greatly increased their value in biomedicine, motivating efforts to develop porcine models that replicate human disease and, thus, ‘bridge’ the gap between bench and bedside.

Genetic modification of livestock became a reality when transgenic rabbits, sheep and pigs were first produced by pronuclear deoxyribonucleic acid (DNA) microinjection.

This method is straightforward but inefficient regarding the proportion of transgenic animals produced, a significant problem with larger species. DNA microinjection in its basic form also results in random transgene integration, which lacks the precision and power of gene targeting. Nevertheless, this remained the only practical technique available to livestock biotechnologists for over a decade.

The search for a functional equivalent led to the development of nuclear transfer from primary somatic cells that could be transfected and analysed in culture. Gene targeting in pigs is informed by mouse studies and aided by bioinformatics and genome sequence data.

The relatively short lifespan of cultured primary cells also strictly limits the time available for in vitro manipulation and cell expansion while maintaining the ability to generate animals by nuclear transfer. Nuclear transfer is itself difficult and time-intensive and, despite steady improvements, produces live, viable, healthy offspring with relatively low efficiency.

Generating gene-targeted pigs has thus been technically challenging, considerably more so than generating gene-targeted mice, as attested by the relatively few such pig lines.

The development of synthetic, highly specific endonuclease technologies as tools for ‘gene editing’ has probably had the greatest impact on the genetic modification of pigs. Highly efficient gene editing makes it possible to conduct genetic modification directly in zygotes and early-stage embryos, thus avoiding nuclear transfer altogether.

Given the complexity of animal genetic modification, nobody can ascertain how long the implanted genetically modified pig kidney will last.

Ethical and Moral Issues Considered

While the potentiality of solving illnesses of organ failures is immense, providing hope to those facing such life-threatening challenges, one cannot sidestep moral and ethical issues with a clean conscience.

Genetic modification, in a simplistic sense, is the mixing of seeds that many spiritual beliefs oppose for interference with God’s creative wisdom. However, science’s peak aspiration is to challenge the existence of God as fallacies propagated exemplified. Animal activism also argues that invasive human research jeopardizes the life, quality, and survival of species involved in the studies.

Pigs are an abomination to Islam, and many believers will find it offensive to have genetically modified pig organs implanted into their bodies, knowing other animals are unlikely to replace or be alternatives to pigs for the abovementioned reasons.

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Genetic engineering technology has numerous applications involving companion, wild, and farm animals and animal models used in scientific research. However, the majority of genetically engineered animals are still in the research phase rather than actually being used for their intended applications or commercially available.

The general concern becomes that humans who receive genetically modified organs from animals become lifetime guinea pigs since nobody knows what the result will turn out to be. In this case, the patients tend to be confronting life-threatening health situations in that they have no viable alternatives except to plunge themselves into the unknown.

While genetically modified organs from animals will grow, popular ethical and moral questions will continue to stalk the developments. The health benefits will always be compared to the costs of doing nothing.

The performance of these implants will shape future debates. Ethical and moral concerns will demand a ban if the benefits are too small. However, suppose the implants prolong human life and improve the recipients’ quality of life, terminating the need for dialysis and other invasive medical approaches. In that case, medical breakthroughs will be engendered in our lives.

More of concern is what experience has taught us about transplants. Even human organs to humans generate behavioural copying that is still not well known. For instance, if one receives an organ from a criminal or a drunkard or other habits like chain-smoking cigarettes, the recipients tend to acquire those habits.

The lingering question will be from pigs: what recipients will their organs imitate? Hopefully, the recipients will not begin to walk on four legs or snort like pigs do. Over time, we will learn the life cycle of these organs as one of the doctors responded that they have no idea how long the pig kidney will last in a human body despite regular ingestion of pills to arrest rejection syndromes.

The author is a Development Administration specialist in Tanzania with over 30 years of practical experience, and has been penning down a number of articles in local printing and digital newspapers for some time now.

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