Surgeons transplant pig kidney into a patient | Hacker News Reader

Surgeons transplant pig kidney into a patient

nytimes.com

109 pointsjonwachob91103 comments

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.

The alternative is certain death so not a lot to choose from

All death is certain. And taxes.

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.

Doctors (and society) should not be encouraging this mentality.

But individuals surely have the freedom to think like this and make decisions accordingly.

Don’t many religions encourage the complete opposite mentality? Shouldn’t they be censored also?

I don't think censorship is a necessary part of addressing this problem.

Parent poster suggested censoring doctors..

Parent poster did not suggest censoring doctors.

You're making a very big leap from "doctors should not be encouraging this" to "we should not allow doctors to encourage this".

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.

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.

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!

This viewpoint comes about from a lack of empathy/knowledge of the type of pain that would want someone to seek death.

As a general rule of thumb, trying to decide someone’s own stream of consciousness is assholeish behavior.

> 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.

> Sure, but is a low quality life worse than oblivion?

In my opinion having had a firsthand view of what life with major illness, disability, and suffering can be like, absolutely yes.

For an excellent dive into this topic, I highly recommend the book Being Mortal by Atul Gawande.

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).

> The alternative is certain death so not a lot to choose from.

Human kidney transplants (both cadaveric and from a living donor) have been a common operation for many years.

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.

If you actually read the article, it goes into details about why he's ineligible for a normal transplant and also why his dialysis is failing.

The patients, the nurses, the surgeons, doctors, researchers.

Literally magic. The Indian god Ganesha for example has a head of an elephant and we humans are doing something similar.

What an amazing species we are when we are doing something positive.

That's a lot of organ replacement done when you've only got your original head left. ;)

It's my experience for those that left this world with kidney failure, that they have already lost when it comes to peaceful final days.

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.

Maybe volunteering for this procedure makes the patient get prioritised for a human kidney transplant?

No, that would be unethical to dangle a carrot.

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.

It's impossible for me to see this as anything but an amazing development.

But the sentient-pig SF horror genre pretty much writes itself.

… does it? It’s a kidney, not a brain. Brain transplants from a pig seem like a pretty obviously bad idea.

Sorry, overcomplicating English syntax:

The ... SF horror genre, as written by sentient pigs ... pretty much writes itself.

But you never know until you try.

You meant until the pig tries. A brain transplant is a misnomer, it's actually a body transplant.

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.

https://www.alzdiscovery.org/cognitive-vitality/ratings/cere...

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.

https://www.nature.com/articles/s41586-023-06594-4

Oh, where the sentient pigs have set this all up, but for reverse kidney transplants from humans to pigs, and we pay for it?

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.

You should read Never Let Me Go.

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).

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.

Even if not successful, it's fascinating and a necessary step along the way to something that is successful.

Good luck to the guy though!

The hearts lasted weeks, about 2 months. The test primate for the kidney lasted 2 years, which would be impressive.

How many times can you receive a transplant for the same organ? Does scar tissue for at the transplant site?

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.

Just curious, about how long does the initial recovery phase last? Congratulations to your daughter by the way, happy you all pulled through.

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!

AMAZING - bless you and your family, thank you for sharing your experience!

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.

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

The old kidneys tend to shrink quite a bit

A close relative required a kidney transplant back in the early 60s when it was still quite new. They told her they expected it to last 2-3 years.

Took over 40 years before the kidney gave up, and she led a quite normal life up until the last couple of years.

Sadly, because she was given only 2-3 years she felt she lived on borrowed time, and never felt comfortable having kids.

It’d be best if everyone just offered to be an organ donor.

I remember this; didn't last long :-(

https://www.npr.org/2022/03/09/1085420836/pig-heart-transpla...

Different cases and different organs

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.

What happens to other parts from these genetically modified pigs? Can some be used for other transplants? Can rest be eaten?

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.

Do we also do that to the organ recipient?

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.

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).

Of course Everyone's ckd journey is different

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.

That would be the holy grail, but there are innumerable hurdles to cross first.

They seem to have had success with making a bladder:

https://www.bbc.com/news/business-45470799

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.

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 so interesting.

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.

quite impressive, there must have been an insane amount of work that went into this

the forecasting market should capitalize on if someone dies who is it or who dies first? this guy or the neuralink patient

Alternatively, let's wish the best to both of them.

That merely means go long on them :)

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.

[1] https://www.scientificamerican.com/article/monkeys-with-tran...

“easy”

comparatively

It doesn’t mention the most important thing. Does he have to take immunosuppressants? If so is it for the rest of his life.

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.

I didn’t realize you had to take lifelong immunosuppressants with human organs as well. That makes this indistinguishable, provided it keeps working.

I'm curious, when did you think patients had to take immunosuppressants?

There's also a number of autoimmune diseases out there...

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).

Autoimmune diseases like lupus

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."

It does mention that? Read the whole article.

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.

Source: liver transplant recipient.

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.

Source: son of a transplant patient.

Very promising!!!

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