Organ Transplants and Scarcity, Innovation, and Politics
We all want to live a long time. And in vigorous good health while doing so.
Modern society and modern medical technology has transformed the prospect of a Biblical “three score and ten” lifetime, which used to be unlikely, if not unusual, into a strong, normal possibility.
But getting there is not always “half the fun.” And sustaining life after 70 requires more and more (often high tech) maintenance.
We are outliving our design specifications. Our organs—heart, kidney, eyes, lungs, liver are subject to wear-and-tear. Sometimes the damage is genetic; sometimes self-inflicted (smoking, alcohol). But the result is life shortening, and the search for life-extenders is relentless: first palliative (stop smoking/drinking), then surgical (heart by-pass), and finally heroic (organ replacement).
The first heart transplant was performed in Cape Town, South Africa in December 1967 by Christiaan Barnard. For those of us media-engaged 50 years ago, the operation was miraculous. But it opened the classic “Pandora’s box” of complexities.
Transplants are not forever fixes. Because not everyone has an identical twin willing to donate an organ, a good “match” must be found, and the organ recipient must contend with rejection concerns and antirejection drugs. For example, only 54 percent of kidney transplants last 10 years. Then another kidney is necessary.
Supply is limited. Recipients need healthy organs, which are increasingly in short supply. The classic “supply and demand” rules apply. Young, healthy people don’t often die. Or they die in accidents that preclude obtaining appropriate organs in a timely manner. Or they die of drug overdoses that make their organs questionable. So extended waiting lists have emerged with boards of doctors making agonizing choices regarding positioning on the list, degree of debility for the waiting recipient, compatibility of an available organ, etc.
But nobody wants to die, waiting.
The conundrum has created some adroit science fiction: “organlegging,” a term created by science fiction author, Larry Niven, postulates a 21st-22nd century universe wherein healthy persons are kidnapped and their organs harvested for those willing to pay the price.
Happily, technological solutions appear in the offing and more likely. Not in the “never-never” future, but reasonably close at hand. These include:
- Three-D Organ Printing. The potential for such “three-D” printing, first of skin and then of “simple” organs (kidney, liver) is being intensely researched. Human skin, using the donor’s stem cells to eliminate rejection, is projected for burn victims. The Economist has hypothesized that the first kidneys and livers could emerge within six years.
- Growing Organs for Transplant. Very recently scientists have succeeded in growing human cells in pig embryos—a first step in creating livers and other organs within animals, ultimately for transplant. One hopes that the SPCA will not protest.
Still the effects of the opened Pandora’s box are proximate problems for today.
Immediately, illustrative, was the Feb. 7-8 conference by the Pontifical Academy of Sciences at the Vatican, addressing Organ Trafficking and Transplant Tourism. Subject to intense controversy was the invitation to and presentation by senior Chinese political-medical officials. Former Vice Minister of Health, Dr Huang Jiefu, and his colleague Dr Haibo Wang, vigorously defended China’s transplant policies and the progress Beijing has made in meeting international ethical norms.
They were not comprehensively convincing. Dr Huang insisted that Beijing was adhering to regulation against using unwilling donors. He said, there are no “transplant tourists” being accommodated with organs. He was not, however, willing to deny any use of organs from executed prisoners (whose willingness to donate would be severely questionable). Since in previous statements, Huang admitted organ harvesting from inmates, his current protestations of purity were skeptically received.
For his part, Dr Wang professed the impossibility of policing “a million medical centers and three million licensed physicians.” Rather disingenuously, he suggested the World Health Organization form a global task force to help prevent illicit organ trafficking. Disingenuous since the current WHO head is China’s Dr Margaret Chan, who has endorsed Beijing’s organ transplant reform process.
More realistically, any WHO-directed review would require “anywhere; anytime” inspections by a cadre of medical experts. Such intrusive access is flatly impossible in a communist regime.
A salient facet is that, while Pope Francis strongly rejects organ harvesting, terming it a “new form of slavery,” the Vatican is maneuvering to improve relations with Beijing. Broken off in 1951, the Vatican wants to re-engage with approximately 12 million Chinese Catholics and regain control over the Catholic religious hierarchy in China.
Not only cynics would suggest conflicts between politics and ethical medicine.
David T. Jones is a retired U.S. State Department senior foreign service career officer who has published several hundred books, articles, columns, and reviews on U.S.–Canadian bilateral issues and general foreign policy. During a career that spanned over 30 years, he concentrated on politico-military issues, serving as adviser for two Army chiefs of staff. Among his books is “Alternative North Americas: What Canada and the United States Can Learn from Each Other.”
"Views expressed in this article are the opinions of the author and do not necessarily reflect the views of The Epoch Times."