May 6, 2015 • 55 mins
A Russian man plans to be the world's first head transplant patient. Is such a thing possible? We look at the story and the future of transplants.
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Episode Transcript
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Speaker 1 (00:00):
Brought to you by Toyota. Let's go places. Welcome to
Forward Thinking. Hey, they're in love in the Forward Thinking,
the podcast that looks at the future and typically makes
a reference to a song lyric, which I'm not doing today,
and I'll explain why in a second. But I'm Jonathan
Strickland and I'm Joe McCormick, and today we're gonna be
(00:24):
looking into a very special listener request. Yeah. Camillo wrote
in and said, hello, guys, I'm a long time listener
since Tech Stuff in two thousand eight. That's going all
the way back to the very beginning of Tech Stuff.
That's when we were doing fifteen minute long episodes. I
love all of how stuff works podcasts. And to keep
this email short, I recently saw news of a head
transplant that is expected to be performed in a couple
(00:46):
of months. I can't recall a podcast specifically about head transplants,
not off the top of my head. Wink wink. This
sounds like a spooky subject, but very interesting. Keep up
amazing tech at Futuristic Podcast. I wouldn't know what to
do about you, guys at work. So Camillo's referring to
a news item about a proposed head transplant that would
(01:09):
not be taking place in a couple of months, unless
you guys are listening to this in two thousand seventeen,
because that is when it would the proposed surgery would
actually take place, right, and the technology necessary for this
feat is not quite so far along as the popular
media has perhaps made it sound ye that the story
okay is this? Back in July of one, doctor Sergio
(01:30):
Carnavero of the Turn Advanced Neuromodulation Group or TANG in
Italy announced his project to make head transplants possible. The
project is called heaven Gemini, which is an acronym for
something I do not know what. It sounds like, a
like a robot in a video game. I know, right,
we'll get there. Yeah. But so this February in he
(01:54):
announced that the project's coming along well and that he
thinks he'll be ready to conduct a head transplant surgery
within the next two years. Yeah. Then it started making
more headlines because in April he got a volunteer with
a medical necessity, one Valerie spird Nov. Now Spritanov has
Type one spinal muscular atrophy a k A worden ing
(02:17):
Hoffman disease. Uh kinda vera has also being contacted by
the way by transgender people. But the procedure is so
risky that, you know, even he would not want to
try it, you know, with a healthy body, even if
that healthy body is is not the one that you want. Right. So,
in other words, he would want only to perform the
(02:37):
surgery for someone who is already at risk of dying
or or whose quality of life is such that it
would be considered a worthwhile risk. Right. And along those lines,
let's take a second to talk about worden ing Hoffman. Sure,
this is an inherited trait. The trait is an autosomal
recessive trait, and it's a disease that's caused by disruptions
(03:00):
or mutations in the s m IN one or survival
motor neuron one gene, which is located on chromosome five.
And it's also known as infantile spinal muscular atrophy and
characterized by the degeneration of nerve cells within the lower
brain stem and certain motor neurons in the spinal cord. Now,
this leads to muscle weakness, generally beginning in the extremities
(03:24):
and eventually leading to other areas including muscles involved in chewing, swallowing,
and breathing. Uh. And tragically, a large percentage of infants
who developed this pass away before reaching the age of two.
So you can see why somebody suffering from this condition
might be a candidate for something like a head transplant,
if that were possible. Yeah, and Sprintanov himself has said,
(03:46):
you know, he has lived beyond what most people had
expected he would be able to to. You know, most
people thought he would have passed away by now, most
of the doctors he had been consulting through out his
entire life. And so his his position on the matter
is that he he is experiencing a difficult life. He's
(04:10):
not expected to have a very long lifespan, and so
for him, this is a risk that's worth taking. Sure. Sure.
And you know, if if these headlines about the possibility
of a head transplant have sounded kind of incredible to you,
you're not the only one that the medical community has
has kind of been an agreement about that, and that's
(04:32):
been kind Yeah, and that's partially because a successful organ
transplants have really only been happening for the past fifty
years or so. So before we go into the specifics
about this head transplant surgery and the controversy surrounding it.
I want to take a look at the history of
the medical technology surrounding transplantation. Sure, I actually didn't know
(04:53):
that this was such a recent phenomenon. I imagined it
would be one of those things that had been done
in a dirt, an unpleasant way for hundreds of years. Well,
there were certainly lots of early attempts that almost always
resulted in the immediate death of the patient. If not that,
then it resulted in the eventual death of the patient. Right,
(05:16):
We've we've actually only had the technology, or rather than
the methods to perform vascular anastomoses that that's joining up
to blood vessels since the very beginning of the twentieth century.
And it wasn't until then that people could really start
to attempt real organ transplants. And I'm sure that there
were a few unfortunate cases earlier than that where people
(05:36):
kind of like stuck an organ in a thing and went, oh, nope,
that's not working. But there well, I know there are
a lot of cases in like mythology, and you don't
know to what extent that might have been based on
some horrific ancient experiment. Yeah, yeah, absolutely, um So. One
of the researchers who was working on on the methodology
of joining blood vessels together began attempting organ transplants in
(05:58):
nineteen o six. Uh He He was trying to put
a goat or pig kidneys into human patients who were
experiencing renal failure, which, to be fair at that time
was was a mortal organ failure. There was no coming
back from that one. Um It obviously did not work out,
but it did get the field started. In the meanwhile,
(06:20):
another technology was in kind of co development in the
medical community, and that's artificial respiration and circulation, and by
nineteen fifty three, the heart lung machine or or the
pump as we know it today had been created. That's
something that can artificially circulate a patient's blood and an
(06:42):
oxygen during a surgery. It was it was used for
the first successful open heart surgery in and the next
year in we get the very first successful human organ transplant,
which was a kidney transplant. The doctor uh ended up
transplanting a kidney from one identical twin to another identical twin.
(07:03):
And the benefit of that is there was no risk
of oregon rejection. In fact, that's the only case apart
from using someone's own tissue, where you don't have to
worry about the the rejection of tissue that you would
in other transplant surgeries, right, Right, And I'm not sure
whether people knew at that specific time that that was
(07:25):
why it was successful. Yeah, I'm not entirely sure either,
because there was a lot of unsuccessful transplants after that, right,
There were quite a few. So Dr Joseph Murray was
the one who performed the procedure and was eventually awarded
the Nobel Prize for this work. Yeah, and the recipient
of the kidney lived for eight years after the transplant surgery,
so that was considered a success. It led to other
(07:49):
surgeries that were not as successful. Yeah. If you look
at the history of transplantation other than this, which the
person lived for eight years afterwards, very often you see like,
well they lived for seven days after d or twenty days,
and that has a lot to do with the rejection
of tissue that I was talking about. And then even
after we started to develop drugs to help prevent that,
(08:12):
the drugs themselves could lead to complications that could lead
to fatalities. So it all depends upon the the technology
and the drugs and the processes at the time. So
nineteen fifty four is the first Oregon transplant. We moved
to nineteen sixty three and we get the first lung
transplant surgery, performed by Dr James Hardy. The recipient was
(08:36):
actually a patient who was serving a life sentence in prison.
The patient had lung cancer which had resulted in a collapsed,
long and recurrent pneumonia. So Dr Hardy performs the lung transplant.
It's considered to be a success. The patient begins breathing
almost immediately, uh, without any problems. However, the patients subsequently
suffered progressive kidney failure and died eighteen days after the transplant. Goodness, yeah,
(09:00):
so the autopsy didn't show any signs of organ rejection.
But other procedures that followed in the next few decades,
and there weren't a whole lot. It wasn't like there
were hundreds, but you know, the next several decades saw
similar problems, with patients dying within a few months of
the procedure, and the first truly successful lung transplant one
(09:21):
where the patient would go on to live a normal
lifestyle after the procedure was done. That didn't happen until
nineteen eighty three, so two decades after the first one
was when you had the first truly successful one um
and that just kind of tells you that, you know,
this is really complicated stuff. The first heart transplant took
place in nineteen sixty seven, that was performed by Dr
(09:44):
Christianne Barnard, and the patient passed away eighteen days after
the procedure due to pneumonia. And this is where we
see that the the anti rejection drugs, those are immunosuppressive drugs,
because when you get somebody else's organ in planted in you,
unless it's just the right one, like from your twin
or something, typically your immune system regards that organ as
(10:08):
something that shouldn't be in there and goes to work
attacking it. Exactly, so, your own immune system is attacking
your new oregon and that is obviously going to be
a true complication. So that's why these immunosuppressive drugs have
been administered in order to reduce that. But that also
opens up the doorway to other potential uh, you know, pathogens,
(10:30):
other potential illnesses, and you need your immune system. Yeah,
it's it's pretty good to have around. Um. But advances
started being made to those drugs in the nineteen seventies, right, Yes,
that's when the chemists began to the chemists, that's when
chemists in general began developing the anti rejection drug cyclosporing,
which worked much better than earlier anti rejection drugs. Wouldn't
(10:54):
be until nineteen eighty three that the FDA would give
it clearance to be used in transplant surgeries. And like
we were just saying a second ago, these immunosuppressant drugs, well,
I mean in general, they interfere with either the creation
or the activities of your your body's T cells, which
are these specific types of white blood cells that that
(11:14):
remember and attacks stuff that they identify as dangerous in
your body. Um. And and this drug, cyclosporing is particularly
useful because it, uh, it's the way in which it
messes with your ear T cells is a little bit
gentler that that some of the previous drugs, which were
(11:36):
a little bit more of a nuke it from orbit
kind of option, right. Uh. And yeah, So so being
able to to mediate T cells response means that you
can prevent them from attacking stuff that you want in
your body, like a new heart or like your joints.
The drug is also used in a rheumatoid arthritis care
for example. Yeah, it's interesting. I mean we when we
(11:56):
talk about our immune systems, they are incredibly important, but
way they can cause some big problems right when you
you least need those big problems, and things like allergies.
See yeah, cats, dumb body. Yeah, I want to hug
the cats. Yeah, we can have a whole discussion about
(12:17):
my allergies and how I'm not very pleased with them,
but at any rate, UH immune systems. Clearly we'd be
much worse off without them, but we do have to
take them into account with something as traumatic as a
transplant surgery. UH. Now, when we move on with some
more kind of cool updates to transplant technology, we start
(12:38):
looking at UH synthetic and regenerative medicine approaches, which are
really awesome. This is the idea where we don't necessarily
have to rely upon a donor to get the organ
that we need in order to perform the transplant, and
the earliest examples of this are actually UH in skin
grafting products. So like a not like an internal organ
(13:02):
but rather an external Yeah. So the first one would
be an apple graph, which was a skin grafting product
that the FDA approved, and in two thousand one the
FDA approved Dermographed, another kind of skin graph product. So
this would allow doctors to grow the skin externally, you know,
(13:23):
not attached to the patient, and then grafted onto the
patient without having to remove a patch of skin from
one part of the body and transplant to another part
of the body. Right, it's really useful for stuff like
like ulcers that are not healing under their own power.
And these things are all basically fake skin that contain
real human cells. And and by fake skin, it might
(13:46):
be a collagen that's been composed of of of cow
cells or something like that. But but at any rate,
it's it's a bio structure that that you can put
on a patient and it will grow into the patient
and his body and attached to the patient's own skin.
So that is so gross and amazing. At the same time,
(14:07):
I started thinking about the dark Man series, one of
those and you don't go out in the sun because
otherwise it all just end up bubbling off of you.
It's only in dark Man, though not this stuff. Dark Man,
the one that had a certain set of skills. Well
he he later proved to a certain set of skills. Yes, yes, yes,
many things were taken from dark Man. In two thousand
(14:29):
and eight, a patient received an airway transplant that was
regenerated airway, so the airways scaffold came from a donor.
That part was remained like a traditional transplant, but the
doctors had removed the donor's cells from the scaffold, the
various cells that were attached to the scaffolding, so it's
(14:50):
just kind of a raw structure at that point. They Yeah,
they added bone marrow cells from the patient, and the
bone cells are essentially kind of like stem cells subset
of stem cells, if you think of it that way.
They used the bone marrow which would ended up creating
the the tissue for the airway, and then they transplant
(15:11):
that into the patient and this helped reduce the possibility
of an oregon rejection because it was the patient's own tissue,
right right. The thing about bone marrow is that all
of your T cells are grown there. So if you
have some some bone marrow cells creating T cells, then yeah, yeah,
it's already saying hey, Uh, we're all on the same
(15:32):
team essentially. Then we saw the first full face transplant. Uh,
you know, bone bones and all like like cheekbones, jaw, nose, teeth,
all the muscles and eyelids and all of that stuff. Uh.
And it's so hard to not make a face off
reference here, but man, that movie is really terrible and
this surgery is really incredible. Uh. And this was basically
(15:54):
made possible, I mean because we had all of the
all of the elements of that, all of the bone
afting and and uh and muscle connection and all of
that stuff. But but anti rejection medication was really what
allowed the surgery to be a success. Um. The the
patient went through two phases of rejection and was saved
successfully both times. Wow. Uh. In two thousand eleven, that's
(16:16):
when a patient received the first regenerated airway transplant that
used a synthetic scaffold rather than one from a donor,
so in this case, there was no need for any
kind of donation. They were able to build it from
the ground up essentially, and in the first successful regenerated
trachea transplant takes place, as well as a successful regenerated
(16:36):
trachea with synthetic scaffold transplant in a child man. So
now we're getting to that point where we'll talk more
about this in a little bit. But the idea of
being able to build these synthetic structures and then incorporate
the patient's tissue into those synthetic structures to create new
versions of the patient's own organs, that's where we're headed.
(16:59):
But we'll talk more about that in a little bit.
Um As for head transplants, to get back to the
topic at hand, Uh, well, we've seen some experiments, some
pretty crazy mad science style experiments involved. Well we can
certainly recall those Russian experiments with like dogs taking the
head off of a dog and putting it on another
(17:21):
dog or well I think they were also just experimenting
with if they could keep a dog's head living not
attached to the dog body, so they attached it to
like a circulatory Uh yeah, and you can see videos
of this if you believe that no special effects were
involved in creating them. At the time. They would like
(17:42):
do incredibly disturbing things like pound a hammer on the
table where the severed dog's head was, and the dog's
head would seem to sort of react react to it. Yeah. Um, yeah,
we talked about that in our episode about Frankenstein. Yes
we did. I cannot, I cannot ever watch those again.
Once was enough. It was truly disturbing. Yeah. But in
(18:04):
the nineteen fifties and sixties and even into the seventies,
there were some experiments, largely in Russia but in other
places as well, with head transplants with dogs and monkeys. Um.
There was one monkey head transplant that was successful for
eight days. The monkey was able to continue eating and breathing,
(18:25):
but had was essentially paralyzed from the neck down and
died eight days after tissue rejection. But it did kind
of work that the spinal cord never fused back. That
was one of the things we'll talk about too. Well.
That seems like a pretty major issue, a huge issue obviously.
But anyway, these these were these were um experiments, but
(18:45):
none of them were like, uh, you know, a ground
the foundation for further work, right. No one looked at
them and said, you know, this is a great plan. Yeah, Okay,
Well I think we should look at where the science
of transplantation rests today, like what are we good at
doing and what are the things that that are still
(19:06):
presenting problems for us. Well, guys, we are so good
at cutting. We are terrific at cutting stuff like seriously.
And this is important because, uh you know, as you
have perhaps seen in your own kitchen, if your knives
are getting a little bit dull, a less than sharp edge,
(19:27):
what will damage the tissue that you're cutting and and
invite an immune response, which is what you do not want.
Right Cutting with a dull knife tends to sort of
do some ripping and crushing exactly. Um. So with it,
with advances in material science necessary to create very sharp blades,
and with the advent of laser systems that can be
(19:48):
used in surgery, we are able to keep both the
organs and the patients much healthier. Uh. We've also developed
ways of keeping organs viable while waiting for to perform
transplant surgery. Typically this involves bathing the organs in a
cold salt water solution or saline uh. And it well
(20:12):
usually let the organs last several hours, depending upon the organ.
So for kidneys it could be forty eight hours, for
livers it's about twenty four hours. For all heart only
five to ten hours, So it's very dependent upon the
type of organ. Obviously, with something like a person's head,
you've got a lot more to consider, you know, keeping
the brain oxygenated and everything. So, but the the whole
(20:35):
idea here is that by lowering the temperature, you lower
the amount of energy the cells need to exert in
order to survive, and that prolongs their viability so that
you can get them to where they need to be
in the surgery can be performed, but it is a
matter of hours, right. This isn't something where you can
just you know, you've got a freezer full of organs
and you can just go and pull one out whenever
(20:56):
you need it. It's it's one of the things that
makes this such a delicate and difficult um field of medicine.
Here's another thing that I think is fascinating, which is
the ability to keep a patient alive while you're sort
of like moving around or removing or inserting organs that
(21:17):
we normally think of as absolutely critical to survival. How
do you actually do a heart transplant? Uh, you hook
someone up to one of those artificial heart lung machines
and kind of let it go and you you also
one of the advances that we've seen since the nineteen fifties,
was the capacity to do that with artificially cooled blood,
(21:39):
which helps the rest of the patient's body. Oh, I'm sorry,
literally chill out. It just kind of it preserves the
rest of the organs while the transplant is going on. Yeah,
we talked a little bit about that when we were
talking about the possibility of suspended animation in a previous episode.
How this is something that's apt hypothermia. I don't know
(22:00):
if this would technically qualifies that, but at least it's
a similar principle. Keeping temperature is low to prevent tissue degeneration. Yeah. So,
and even in that episode, if you recall, it was
really all about keeping a patient alive in order to
address a medical issue immediately, as opposed to perpetually keeping
(22:20):
that patient alive until you can thaw them out, like
a hundred years from now. That's not what That's not
where the technology is right now. Um. Then, of course
we've got the immunosuppressive drugs, the anti rejection drugs we're
talking right, So the early ones were pretty pretty damaging
to a person. Even if they were working as they
were intended, they could cause other consequences. For example, because
(22:42):
in general killing stuff in your body, like like we
all know from an example for for chemotherapy, Yeah, kill
stuff in your body. Yeah stuff, the good and the bad. Right,
So the newer drugs have lower toxicity with fewer side
effects like side effects like raising your blood pressure or
your coless role or even uh, giving you diabetes that
(23:04):
could be one of the side effects of these older
immuno suppressive drugs and still a risk with the current ones. Um,
even with those advances, there are a lot of things
you have to take into consideration. They can be toxic,
toxic to kidneys, they can cause they may cause cancer
and uh. And the thing about them is that most
(23:24):
patients who have to start taking them due to a
transplant have to take them for the rest of their lives. Yeah.
So one of the things that people are really looking
into our ways of performing surgeries that would not require
immunosuppressive drugs. So in other words, these were generative medical
approaches where you're using the tissue from the patient him
(23:46):
or herself, then you don't need to worry about using
the immunist suppressive drugs for the rest of their lives.
That because they're getting a transplant of their own tissue um.
Obviously that would be a huge benefit. All right, well,
let's bring it back to the discussion of the head transplant,
because that's what everybody's got to know. Can I get
(24:06):
my head put on a more attractive body or maybe
like a dinosaur body? Right? Well, I'm sorry to sound
like a tale from the crypto. I'm sorry, No, that
that was in bad taste. I shouldn't make light of it. Actually,
you know, can you if you have a dise he
is affecting your body? Yeah? Can you? Can you actually
get a head transplant? So let's let's look at Canavero's proposal.
(24:27):
It's pretty it's pretty intense. Yeah, he's estimating that it
will require the coordinated efforts of a hundred surgeons working
for a grand total of thirty six hours, although the
surgery itself would be very short. Yeah, we'll talk about
that in a second. So your head disconnected for thirty
six hours. No, that would be bad, um because for
(24:49):
one thing, a head can't remain viable on its own.
It would have to be kept alive throughout the procedure,
which would be pretty tricky. Yeah, you can't. You can't
put it in a a saline solution like you could
with a liver or a heart, you would have to have,
you know, some form of circulation going with that head
(25:10):
the entire time. Plus the head is home to lots
of stuff like it's not an oregan like a heart,
right you're talking about. You have your eyes, you have
your nose, your um, your ears, you've got skin, you've
got glands that are very important um all located in
that area, and of course you have the brain. So
if you decapitate ahead, which obviously would be one of
(25:32):
the steps of this surgery, you immediately have a decrease
in blood pressure in the head. No big surprise there,
there's no way of pumping blood continuously there. But that
also means that you have a you start to deprive
the brain of oxygen, so then the patient would go
into a coma, which would be shortly followed by death. Right,
(25:53):
You'd start to have that cell death throughout the brain,
which is exactly what you don't want to happen because
we generally consider that your river postables is damage to
the brain that's going to kill you. So Canavero has
based the the idea that it needs to the procedure
of actually hooking up the head from the patient to
the donor body would need to happen in less than
(26:15):
one hour based upon previous surgeries, including the one I
was referring to earlier about the the monkey head that
had been transplanted and lived for eight days. Uh, that
was all based on those earlier experiments. And so the
actual point where you separate the patient's head from the
patient's body and then attach it to the donor body
(26:37):
would have to take less than an hour out of
that full thirty six hours we were talking about previously. Um,
you would have to have that connection there so that
the the brain could remain viable. However, when you're actually
doing the the transplant, both bodies, the patient and the
(26:58):
donor body would have to be in cardiac arrest. And
then you could start the heart of the donor body
afterward once the the head has been attached, but until
then they would both be in cardiac arrest. And then,
assuming that the surgery is in fact a success, any
signs of rejection would have to be handled immediately. And
(27:19):
the head is home to so many systems like the
eyes and the brain and all of this that the
risks of rejection would be much greater than if it
were a single oregan. You have a lot of potential
points of failure. In other words, and uh, during this
time after the surgery, that the patient would have to
be kept unconscious. Uh, you know, not just immediately, but
(27:40):
for like three to four weeks in order to allow
the spinal cord to grow new connections, and and medically
induced coma has come with other risks on top of
the ones we've already talked about, including things like blood clots, infection,
and reduced brain activities. So that would be another thing
to keep your ion, assuming that the surgery itself had
(28:02):
gone well. Oh sure, Although as we were mentioning earlier
that that spinal cord severance might be the real problem
in getting the surgery to be effective, because you know,
muscles and blood vessels can be cut and then sutured
back together, or or not sutured but reattached in the
(28:22):
zany medical ways that they do. I do not actually
understand the process, so I'm not going to talk about it.
But spinal cord severing and and fusion would have to
be so sharp and clean and uh kind of Ourrow
says that the chemicals he mentioned polyethylene glycol and cheetahs
on um. It's kind of essentially like a biologically uh
(28:47):
created glue, is what these tend to be sure, he
claims that those could encourage fusion. Um electrodes would be implanted,
and while the patient was kept unconscious after the surgery,
that the team would be a dyeing electrical stimulation via
the electrodes in order to help boost new nerve connections. So,
in other words, it's it's not enough to have everything
(29:09):
plugged in properly. You also have to have these signals
passing through in order for the body to recognize that
their actual impulses passing along the spine, right, in order
to recognize, hey, we're brain tissue, your brain tissue. Let's
make brain happen. Yeah. Well, and it's not just in
our sort of non expert point of view that this
sounds like a very very ambitious proposal. Well, especially when
(29:33):
you take into account what Cannaverro has said that assuming
that everything goes well, what the patient will be capable
of doing after the surgery, Ah yeah, I mean, so
they'd be down for about a month while their spinal
cord is reconnected. But then he claims that a patient
would be able to walk within a year after the surgery. Yeah,
(29:55):
that's I mean, so if you think that we are
a little skeptical, you're right, because they're just so many
different hurdles to overcome in order for this to even
remotely work. But yeah, we're not the only ones to
express skepticism. The medical community at large has expressed everything
(30:16):
from cautious skepticism to outright disbelief. Like there aren't a
whole lot of people coming out and saying, yeah, I
think this is gonna work. In fact, most of the
reports I've read have said, uh that they were they
were very skeptical. Some of them even went further to
suggest that kind of Vera's idea is crazy, like that's
(30:39):
I've seen that word being yeah, uh, and it could
in fact be crazy for a reason. Yeah. So this
was something I came across while I was researching the story.
And let's just prevace it by saying that this is
a kind of like sort of con spiratorial allegation. But yeah,
(31:02):
it this this falls. This can fall under the category
of conspiracy theory. There's a lot of circumstantial evidence that
that seems to support it, but it's circumstantial evidence, right,
And why we're dancing around this is because there are
now allegations that perhaps the timing of these announcements has
(31:22):
coincided with the promotion of a certain video game, that
video game being Metal Gear Solid five, the Phantom Pain.
In other words, that this entire thing about head transplantation
is a marketing stunt. Yeah. Now that now there's some
who say that Canavero seems actually sincere about head transplants,
(31:44):
but perhaps the timing of this particular discussion is in
fact more of a collaboration, and that right right right,
in other words, saying like, this is something I want
to do sometime in the future, but I'm gonna say
I'm gonna do it now because oh it's being it's
part of this other grander stunt of promoting a video game.
(32:07):
So so what's the deal with the promotion? Alright? So
here here's the circumstantial evidence that has come about, Um,
the game Metal Gear Solid five has there's been images
leaked of are not even leaked, I mean promoted of.
There's a character in the game. There's a doctor who
looks I wrote eerily similar to Cannavero. But if you
(32:28):
look at the pictures, they look like it's looks like
it's the same guy, right, Like on casual glance, you
wouldn't even be able to tell. We're looking at a
pair of photos in our notes right now. The top
photo in our notes is a picture of Canavero. The
bottom photo is a picture of the character in the game,
and the bottom photo looks like it's just another picture
of Canavero. It's a little uncanny. Yeah, yeah, so so
(32:53):
there's that. Then there are a couple of other pieces
of against circumstantial evidence. Not so not this, No, this
is oaking gun. The patient of Valerie Spirridanov is also
a CG artist in game development supervisor, So some have
said that maybe that Spiritanov is in on this as well,
(33:13):
and it's not a sincere attempt at this surgery. Again
it this is just an allegation. Cannavero has published work
about Phantom Pain in the past, and the subtitle of
the game is The Phantom Pain. There are several acronyms
used by Cannavero, you know, things like heaven that are
(33:33):
also used in the Metal Gear Solid game. So there's
some terminology that is seems to be shared between the
publications written by Canavero and the stuff within the game
which came first, don't know. Uh. Hideo Kojima, who was
one of the creators of the game, tweeted back in
two thousand ten that he had found an quote ally
(33:57):
to help address a huge taboo. He planned the game
to have this enormous taboo incorporated in it, and did
not give any more details. So people looking at this
now are retroactively looking back at all the tweets and
stuff and saying, maybe Kennevero is this ally someone who
would support an idea like a head transplant, which supposedly
(34:20):
happens within the course of Metal Gear Solid five. So,
in fact, there are some promotional images of Metal Gear
Solid five which show this this scientist character uh holding
some form of device to a decapitated head on a platter. Um,
it doesn't like a scene of violence. It looks like
(34:42):
a scene of mad science in that case at any rate,
So that more circumstantial evidence. Uh. And Kajima is um
kind of a well certainly a well known figure in
the video games circles about Yeah, and he recently made
headlines when he when he left Konami, who he had
(35:03):
been collaborating with for for a very long time. Um.
His most recent project economy was Silent Hills, which is
that Greadmo del Toro Norman ritas Silent Hill new Silent
Hill game that it was making so many waves a
few months ago, I just got canceled, and that has
been very upsetting. I mean, you the big news from
(35:26):
like a year ago was when uh Konami released PT
and didn't say what PT was for, and PT ended
up being a playable trailer for Silent Hills. You didn't
know that while you're playing it. It was only after
you had completed the trailer, which by the way, was
incredibly creepy. Oh yeah, yeah, it's very effective. I watched
(35:46):
a playthrough of it and it's very yeah, very unsettling.
So this was one of those things where, you know,
Kojima has been known for going through elaborate setups to
promote video games in non traditional and and very media
savvy ways. Well, I have to say, if this is
a promotional stunt for a video game, it is a
(36:08):
bizarre one in very bad taste. Yeah, I mean there's
certainly there have been plenty of of ways of marketing
games that were not directly tied back to the games,
at least not initially. Like like alternate reality games, there
are quite a few that started off that no one
was even sure what it was trying to promote at
the beginning, so it's possible that this was promotion. However, Canavero,
(36:32):
for his part, denies involvement, and Coginia also denied that
Cannavera's likeness was used. So Cannivera had come out and said,
I didn't give permission for my likeness to be used.
They shouldn't be using my my image without my permission,
and Cogima said, oh, we weren't actually using him. It's
just a coincidence. It's a coincidence. If it's a coincidence,
(36:54):
it's a phenomenal coincidence, because this whole thing is a
phenomenal coincidence. If it's all a coincidence, I mean, and
strange things happen in the universe. Chaos theory, I get it.
Law law of truly large numbers says that even things
that would seem impossible sometimes happen. But yeah, it's it's
(37:15):
one of those where the circumstantial evidence is such that
if there's nothing there, it's really, it almost seems more
weird that there'll be nothing there then that this is
all about a promotion for a video game. So we
will see, I suppose, eventually how all of this shakes out,
and whether whether it's a clever ruse or not. But
(37:39):
at any rate, I'm glad that the headlines popped up
for it because we got to do this research into
transplantation and and all of the amazing research it's going
into it. Yeah. Well, whether or not we can transplant ahead,
we are going to be forging some new territory and
transplantation soon, and I think we should talk about future
(38:00):
of medical transplantation. Sure, uh yeah, yeah. One thing that
researchers are looking at doing is keeping organs alive longer, because,
as as we said earlier, you know, the the expiry
date on organs from a donor is really short, a
matter of hours or two days at most for kidneys.
In August, though, the FDA approved a device that uh
(38:22):
preserves one particular organ, the lungs, for long enough to
determine whether they're a really good match for a transplant,
about four extra hours on top of the normal time. Lungs,
by the way, are really particularly tricky. About eighty percent
of donated lungs are deemed unfit for transplant. Yeah, and
the creators of the machine, which is called the x
(38:43):
vivo Profusion system, um, they're they're hoping that eventually their
their system will allow for the storage of lungs for
up to two or three days. That's pretty cool. Yeah.
I gotta say though, x vivo profusion system sounds like
something I would see in a spay. Just step into
our x vivo perfusion system and you will come out
a new person. Another thing that we're seeing advances in
(39:07):
our going back to the the regenerative medicine approach and
the synthetic scaffolding for things like airways, it's three D
printing and transplants. Um. So this is something that we've
been talking about for a while and our three D
printing episodes. I think we've referred to it once or twice.
But the idea of using tissue as essentially ink and
(39:30):
being able to print upon first designing the scaffolding the
structure of whatever organ you're making, and then printing the
tissue directly onto that scaffolding. So yeah, so that you
have a a healthy organ to transplant, and it's made
from the patient's own tissue. So the yeah, you've got
you've got a nice uh a nice heads up. You're
(39:52):
able to get to a point where you can make
this transplant surgery without the worry of the organ being
rejected the body reacting in negative way. However, you know
that being said, it sounds like I'm making it sound
way easier than it really is, because depending upon the organ,
some of these organs are incredibly complex. You know you're
talking about you know, it's not just a massive tissue. Obviously,
(40:15):
it's important and has lots of different parts to it.
So to be able to synthetically create a working version
of that ourselves from the ground up is depending on
the organ, easier said than done. Actually, for all of
the organs, it's easier said than done. We are not
lumpy space people. Not just if we could just like
(40:35):
have a massive tissue that's generally liver shaped and you're fine,
it would be so much easier. But no, that's not
the way it works. However, it is very promising and
we're seeing more and more, um uh, you know, advances
in that. In March of this year, of a Russian
company called three D bio Printing Solutions announced it had
(40:57):
successfully printed a mouse by roid using these bioprinting techniques
and they're planning on transplanting this printed organ into a
mouse that suffers from hypothyroidism. And uh, the results have
not yet been published. They said that they will be
presenting their results at a conference called the Second International
(41:18):
Congress on Bioprinting, which will take place in Singapore in July.
So in July they will announce how this experiment went,
whether it was a success or not. Uh. And you know,
a thyroid is relatively simple, so it was a good
thing to target for this kind of procedure. And also
it's important because thyroid cancer is a real thing. It
(41:42):
can it affects around three thousand people, or rather three
hundred thousand people are diagnosed with it every year. So
being able to print a thyroid on an as needed
basis could potentially save thousands of lives every year. So
if this ends up being a success, it could be
it could be the getting of something truly transformational in medicine. Yeah. Yeah,
(42:05):
other researchers are looking into entirely artificial organs and of
course we do have some systems right now, that that
will keep a patient alive until a real biological organ
can be transplanted. But as our technology and also our
our understanding of human biology improve, we might end up
with some some medical cyborgs. There are research labs working
(42:27):
on artificial kidneys. Those are still in development, but with
artificial hearts, which you know, replace a whole a whole
heart like ventricles and valves and all. Uh. Some artificial
hearts have supported patients for up to four years before
a transplant organ became available, right Yeah, And and I
mean we could do an entire episode about about artificial
(42:47):
organs and the development of those, because that's also a
fascinating story, uh and and an amazing achievement in technology
to have been able to create something that is medically
safe to implant in a person and can keep them
alive until an actual organic uh replacement is available. And
that Yeah, I'm excited to see that continue with other
(43:09):
organs besides the heart and kidneys. Oh. Absolutely. Also on
the immuno suppression front, there is a team out of
Massachusetts General Hospital that's been conducting a clinical trial for
bone marrow transplants in addition to organ transplants. Kidney transplants specifically,
so uh so, So the idea here is like, like
(43:30):
we were saying, with the scaffolding, the throat scaffolding issue
in some other patients. If you, uh, if you give
someone a kidney transplant and also destroy some of the
patient's native bone marrow and give them a transplant of
some of the donor's bone marrow. Oh, I see. So
the so in other words, the patients getting bone marrow
(43:52):
and an organ from the same donor. So that means
that the bone marrow which is generating these T cells
is already familiar with the tissue of up donated organ.
So you wind up with these two bone marrow T
cell creating systems working together to support the patient's original
tissue and the new organ. I see. So that would uh,
(44:13):
that would at least hopefully cut down the incidence of
organ rejection, because the patient's own systems would be generating
the same native T cells as the tissue that was donated.
Right right. We're still waiting for the results of these trials,
but as of two thousand eight, four of the original
five patients had gone for five years without having to
(44:34):
take immuno suppressive dress. That's pretty incredible. That's amazing. So
obviously I think the ultimate future that we want to
get to with organ transplantation is the ability to have
these regenerative techniques where you sort of regrow organs with
your own stem cells. They're based on your own biology.
That seems like the ideal solution all around, but as
(44:55):
you pointed out, that is a ways off, and there
are people who need organs to day. Right in the meantime,
we have a need that is not going to just
sit on hold for the decade or so it'll take
for us to get that that technology to maturity. Right,
So in the meantime, I wanted to talk about something
else I read about, which is a more controversial sort
(45:17):
of temporary solution in the meantime, and that would be
open markets for organ donation. And by market I mean
the exchange of money. You would a physical market, It
looks like a farmer's market. That would be a little No,
that would be very that would be very unsafe. Would however,
(45:37):
fit right into silent hills. Yes, but so so of
course today you cannot purchase an organ for transplant. No, well,
in most countries you can't. And so like you could
maybe go to Iran and purchase a an organ for transplant.
But in the United States and many other countries, you
(45:57):
can choose to donate your organs at fath or if
you're a very nice person or you care about somebody
very much, you can donate something like a kidney while
you're still alive, Like you can continue living with just
one kidney. Somebody else might have renal failure and they
need a kidney, and you can give them one of yours, UM,
but you can't sell it to them. Regally, you're not
supposed to sell your organs, but some people have argued
(46:21):
that it would be a good idea to move to
a general, open market for organ donation, where you could
be paid a market determined price, for example, a kidney.
And of course their arguments for and against UM. The
most obvious and pressing argument for is that thousands of
people die every year on the waiting list for kidneys.
(46:43):
Oh yeah, there's a crazy shortage of organs of all
kinds in the market. Yeah. So in the United States,
according to the National Kidney Foundation, in four thousand, four
hundred and fifty three patients died while waiting on a
kidney transplant. There on the waiting list. There, I assume
they're probably on dialysis waiting to get a kidney, and
they did not get one in time and they died
(47:06):
from Yeah. On average, they say twelve people die every
day waiting for a kidney. On top of that, there's
simply the problem of waiting. So let's say you're waiting
four years to get a kidney and you eventually get one,
and that allows you to extend your you know, your
lifespan and to go on living. But that time while
(47:29):
you're waiting, you're having to undergo dialysis. It's just going
to be a major blow to your quality of life
and your ability to do things. And you don't recapture
those four years. Yeah, and so in economic terms, this
is a situation where demand has greatly outpaced supply. There
is way more demand for kidneys than there are kidneys
(47:50):
to go around. So some economists have proposed a very
economic sounding solution. Uh. One example of people making this
argument is in January, economist Gary Becker and Julio Elias
authored a peace in the Wall Street Journal where they
recommended this path. It was called cash for Kidneys, the
(48:11):
Case for a Market for Organs, and they support compensation
for live kidney donation in a model where family members
can be compensated when when they choose to give up
the healthy organs of a dead relative, right, because that
can be one of the blocks placed in organ donation
is when even if a person has selected to be
(48:34):
an organ donor, you need the acquiescence of their surviving
relatives in order to go ahead with the organ donation. Right.
So somebody might if you have a relative who's just
passed away, they might have a healthy heart and somebody
else needs that heart. But you could say no, no, no,
but the yeah, yeah, the the understandably upset family members
(48:55):
might not want that. Right. So, even if it is
your wish as an organ donor to have of your
organs donated, it's possible for your next of kin to
say no, I don't want that to happen, and the
medical professional the medical professionals will back away. They won't
they won't continue. Yeah, And so this is understandably a
very controversial proposal. Um, And I'm not sure where I
(49:18):
stand on it. I can see the arguments on both sides.
On one hand, I I would probably if I were
myself someone who needed a kidney I would think like, well, yeah,
if there's some way I could, you know, can motivate
people to do more donations, then yes, please do it
any anyway you can, of course. Yeah. But then of
course there are arguments against it. Uh. The the economists
(49:40):
in this piece who were who were for it, that
they did try to offer some of the objections and
encounter them. Oh and one they proposed made sense to me.
They said, well, people who are going to be offering
to sell their kidneys, or people who very often are
people who are in a desperate situation. Somebody's like I
need money, now what you know, what can I do
(50:02):
while I can sell a kidney? And then that you
you might sort of be in a way forced to
make that decision by financial circumstances, and then later in
life come to really regret that decision. It'll end up
disproportionately affecting a specific democrats. Yes, specifically people who are
in who are in bad economic circumstances. Um and I
(50:24):
can totally see that being true. That yeah, it would
be sort of like a thing that you won't imagine
that many wealthy, well off people saying I could really
use the ten thousand or fifteen thousand bucks from a kidney.
Of course, then again they proposed sort of countermeasures to that. Well,
one thing you could do is you could put a
(50:44):
waiting period in place, so you like you'd be forced
to undergo counseling. You can't just say like, no, take
my kidney today. You know, there would be like a
three month period, and that seems like that could come
into play. They also pointed out that in their opinion,
I don't know to what extent this is true, but
they claimed that it also would be mainly to the
benefit of people who are more economically disadvantaged, because if
(51:06):
you're rich, you can typically more easily find a way
to get an organ if you need one, you can
you can travel to another country, or you can pay
for workarounds. Yeah. So in general, I think this is
a really interesting and difficult question. I don't know what
the right answer to that is. Yeah, I mean it
sounds like kind of like a like an ethical problem
of putting a price tag upon human bodies. Yeah, I mean,
(51:29):
they're there's certainly, and obviously this would also lead people
to say, now you're going to make that urban legend
come to life, the one about you know called the doctor,
you wake up in a bathtub full of ice, one
would hope there would be measures put in place to
avoid you being able to sell someone else's kid. Yeah,
it's like like when I went to donate blood and
(51:51):
then was disappointed to find out it had to be mine.
I don't know where I stand on this either. It's
one of those things that's really difficult to kind of
put my finger on. On the one hand, I definitely
don't want there to be thousands of people who are
are waiting and hoping and dying because they don't have
the access to organs that they need. On the other hand,
(52:13):
I don't like the I don't necessarily love the idea
of people electing to get a surgery that they otherwise
never would because they need the cash. I mean, they're
the now. On the on the the brightest side of
things that we can point out is that if everything
works well, this will hopefully be a transitional period where
(52:37):
we will end with the ability to create the organs
that are based off the patient themselves, and the need
for donors will be eliminated entirely. But that's the future
we may not ever arrive at. We can hope, but
we don't necessarily know that's going to happen. Yeah, this
is one of those situations. I feel like it comes
up fairly often on this show where there's a there's
(52:58):
a solution inside that would be the correct, the right solution,
but we're not quite there yet, and there is something
vision Yeah, and there on the way there there's a
there's a really unpleasant kind of transitional period. Yeah. Yeah, no,
that's that's entirely accurate, I would say. So, I'm curious
(53:19):
what our listeners think about this? What are your opinions?
You know, Camillo wrote in I wonder what what opinions
Camilo has about this? Because this is this is tricky stuff,
and uh, you know, we want to be we want
to see the greatest benefit for the most number of
people without it becoming like this weird question of ethics
(53:40):
that no one's comfortable with. But you know, this is
real life, and in real life they are there are
often a lack of easy answers. Another thing that I
think would be worth considering. And I'm not even sure
what their position would be, but what doctors think about this? Yeah,
because I bet that they have they might have our
mints for against this that we haven't even thought of
(54:02):
just like a procedural or medical yeah sure, or even
just of their personal experience of of working with patients
and with families, and you know that the kind of
stuff that we can read about and and sympathize with,
but not truly empathize with. Oh yeah, I mean there,
we haven't even touched any of the psychological effects that
that patients can experience when undergoing transplant surgery. And I
(54:25):
mean that's an entirely different field that is complex, fascinating
and and a little bit terrifying. Yeah, and certainly I
am not qualified to address it. It's but it is
something that I'm fascinated by. Uh Well, at any rate,
I am very curious to hear from other listeners like Camilla.
Thank you so much writing in Yes, Yes always. This
(54:46):
was a really interesting topic to look at, and we
want to continue that. We want to have people right
in and ask us questions. We really enjoy addressing these
listener requests, and if you have a topic that you
would like us to talk about in the future, let
us know. Send us an email the addresses FW thinking
at how stuff Works dot com, or drop us a
(55:07):
line on Twitter, Google Plus, or Facebook, at Twitter and
Google Plus, we are FW thinking. Just search FW thinking
and Facebook. We'll pop right up. Leave us a message
and we'll talk to you again really soon. For more
on this topic in the future of technology, visit forward
Thinking dot com h brought to you by Toyota. Let's
(55:38):
Go Places,
Brought to you by Toyota. Let's go places. Welcome to
Forward Thinking. Hey, they're in love in the Forward Thinking,
the podcast that looks at the future and typically makes
a reference to a song lyric, which I'm not doing today,
and I'll explain why in a second. But I'm Jonathan
Strickland and I'm Joe McCormick, and today we're gonna be
(00:24):
looking into a very special listener request. Yeah. Camillo wrote
in and said, hello, guys, I'm a long time listener
since Tech Stuff in two thousand eight. That's going all
the way back to the very beginning of Tech Stuff.
That's when we were doing fifteen minute long episodes. I
love all of how stuff works podcasts. And to keep
this email short, I recently saw news of a head
transplant that is expected to be performed in a couple
(00:46):
of months. I can't recall a podcast specifically about head transplants,
not off the top of my head. Wink wink. This
sounds like a spooky subject, but very interesting. Keep up
amazing tech at Futuristic Podcast. I wouldn't know what to
do about you, guys at work. So Camillo's referring to
a news item about a proposed head transplant that would
(01:09):
not be taking place in a couple of months, unless
you guys are listening to this in two thousand seventeen,
because that is when it would the proposed surgery would
actually take place, right, and the technology necessary for this
feat is not quite so far along as the popular
media has perhaps made it sound ye that the story
okay is this? Back in July of one, doctor Sergio
(01:30):
Carnavero of the Turn Advanced Neuromodulation Group or TANG in
Italy announced his project to make head transplants possible. The
project is called heaven Gemini, which is an acronym for
something I do not know what. It sounds like, a
like a robot in a video game. I know, right,
we'll get there. Yeah. But so this February in he
(01:54):
announced that the project's coming along well and that he
thinks he'll be ready to conduct a head transplant surgery
within the next two years. Yeah. Then it started making
more headlines because in April he got a volunteer with
a medical necessity, one Valerie spird Nov. Now Spritanov has
Type one spinal muscular atrophy a k A worden ing
(02:17):
Hoffman disease. Uh kinda vera has also being contacted by
the way by transgender people. But the procedure is so
risky that, you know, even he would not want to
try it, you know, with a healthy body, even if
that healthy body is is not the one that you want. Right. So,
in other words, he would want only to perform the
(02:37):
surgery for someone who is already at risk of dying
or or whose quality of life is such that it
would be considered a worthwhile risk. Right. And along those lines,
let's take a second to talk about worden ing Hoffman. Sure,
this is an inherited trait. The trait is an autosomal
recessive trait, and it's a disease that's caused by disruptions
(03:00):
or mutations in the s m IN one or survival
motor neuron one gene, which is located on chromosome five.
And it's also known as infantile spinal muscular atrophy and
characterized by the degeneration of nerve cells within the lower
brain stem and certain motor neurons in the spinal cord. Now,
this leads to muscle weakness, generally beginning in the extremities
(03:24):
and eventually leading to other areas including muscles involved in chewing, swallowing,
and breathing. Uh. And tragically, a large percentage of infants
who developed this pass away before reaching the age of two.
So you can see why somebody suffering from this condition
might be a candidate for something like a head transplant,
if that were possible. Yeah, and Sprintanov himself has said,
(03:46):
you know, he has lived beyond what most people had
expected he would be able to to. You know, most
people thought he would have passed away by now, most
of the doctors he had been consulting through out his
entire life. And so his his position on the matter
is that he he is experiencing a difficult life. He's
(04:10):
not expected to have a very long lifespan, and so
for him, this is a risk that's worth taking. Sure. Sure.
And you know, if if these headlines about the possibility
of a head transplant have sounded kind of incredible to you,
you're not the only one that the medical community has
has kind of been an agreement about that, and that's
(04:32):
been kind Yeah, and that's partially because a successful organ
transplants have really only been happening for the past fifty
years or so. So before we go into the specifics
about this head transplant surgery and the controversy surrounding it.
I want to take a look at the history of
the medical technology surrounding transplantation. Sure, I actually didn't know
(04:53):
that this was such a recent phenomenon. I imagined it
would be one of those things that had been done
in a dirt, an unpleasant way for hundreds of years. Well,
there were certainly lots of early attempts that almost always
resulted in the immediate death of the patient. If not that,
then it resulted in the eventual death of the patient. Right,
(05:16):
We've we've actually only had the technology, or rather than
the methods to perform vascular anastomoses that that's joining up
to blood vessels since the very beginning of the twentieth century.
And it wasn't until then that people could really start
to attempt real organ transplants. And I'm sure that there
were a few unfortunate cases earlier than that where people
(05:36):
kind of like stuck an organ in a thing and went, oh, nope,
that's not working. But there well, I know there are
a lot of cases in like mythology, and you don't
know to what extent that might have been based on
some horrific ancient experiment. Yeah, yeah, absolutely, um So. One
of the researchers who was working on on the methodology
of joining blood vessels together began attempting organ transplants in
(05:58):
nineteen o six. Uh He He was trying to put
a goat or pig kidneys into human patients who were
experiencing renal failure, which, to be fair at that time
was was a mortal organ failure. There was no coming
back from that one. Um It obviously did not work out,
but it did get the field started. In the meanwhile,
(06:20):
another technology was in kind of co development in the
medical community, and that's artificial respiration and circulation, and by
nineteen fifty three, the heart lung machine or or the
pump as we know it today had been created. That's
something that can artificially circulate a patient's blood and an
(06:42):
oxygen during a surgery. It was it was used for
the first successful open heart surgery in and the next
year in we get the very first successful human organ transplant,
which was a kidney transplant. The doctor uh ended up
transplanting a kidney from one identical twin to another identical twin.
(07:03):
And the benefit of that is there was no risk
of oregon rejection. In fact, that's the only case apart
from using someone's own tissue, where you don't have to
worry about the the rejection of tissue that you would
in other transplant surgeries, right, Right, And I'm not sure
whether people knew at that specific time that that was
(07:25):
why it was successful. Yeah, I'm not entirely sure either,
because there was a lot of unsuccessful transplants after that, right,
There were quite a few. So Dr Joseph Murray was
the one who performed the procedure and was eventually awarded
the Nobel Prize for this work. Yeah, and the recipient
of the kidney lived for eight years after the transplant surgery,
so that was considered a success. It led to other
(07:49):
surgeries that were not as successful. Yeah. If you look
at the history of transplantation other than this, which the
person lived for eight years afterwards, very often you see like,
well they lived for seven days after d or twenty days,
and that has a lot to do with the rejection
of tissue that I was talking about. And then even
after we started to develop drugs to help prevent that,
(08:12):
the drugs themselves could lead to complications that could lead
to fatalities. So it all depends upon the the technology
and the drugs and the processes at the time. So
nineteen fifty four is the first Oregon transplant. We moved
to nineteen sixty three and we get the first lung
transplant surgery, performed by Dr James Hardy. The recipient was
(08:36):
actually a patient who was serving a life sentence in prison.
The patient had lung cancer which had resulted in a collapsed,
long and recurrent pneumonia. So Dr Hardy performs the lung transplant.
It's considered to be a success. The patient begins breathing
almost immediately, uh, without any problems. However, the patients subsequently
suffered progressive kidney failure and died eighteen days after the transplant. Goodness, yeah,
(09:00):
so the autopsy didn't show any signs of organ rejection.
But other procedures that followed in the next few decades,
and there weren't a whole lot. It wasn't like there
were hundreds, but you know, the next several decades saw
similar problems, with patients dying within a few months of
the procedure, and the first truly successful lung transplant one
(09:21):
where the patient would go on to live a normal
lifestyle after the procedure was done. That didn't happen until
nineteen eighty three, so two decades after the first one
was when you had the first truly successful one um
and that just kind of tells you that, you know,
this is really complicated stuff. The first heart transplant took
place in nineteen sixty seven, that was performed by Dr
(09:44):
Christianne Barnard, and the patient passed away eighteen days after
the procedure due to pneumonia. And this is where we
see that the the anti rejection drugs, those are immunosuppressive drugs,
because when you get somebody else's organ in planted in you,
unless it's just the right one, like from your twin
or something, typically your immune system regards that organ as
(10:08):
something that shouldn't be in there and goes to work
attacking it. Exactly, so, your own immune system is attacking
your new oregon and that is obviously going to be
a true complication. So that's why these immunosuppressive drugs have
been administered in order to reduce that. But that also
opens up the doorway to other potential uh, you know, pathogens,
(10:30):
other potential illnesses, and you need your immune system. Yeah,
it's it's pretty good to have around. Um. But advances
started being made to those drugs in the nineteen seventies, right, Yes,
that's when the chemists began to the chemists, that's when
chemists in general began developing the anti rejection drug cyclosporing,
which worked much better than earlier anti rejection drugs. Wouldn't
(10:54):
be until nineteen eighty three that the FDA would give
it clearance to be used in transplant surgeries. And like
we were just saying a second ago, these immunosuppressant drugs, well,
I mean in general, they interfere with either the creation
or the activities of your your body's T cells, which
are these specific types of white blood cells that that
(11:14):
remember and attacks stuff that they identify as dangerous in
your body. Um. And and this drug, cyclosporing is particularly
useful because it, uh, it's the way in which it
messes with your ear T cells is a little bit
gentler that that some of the previous drugs, which were
(11:36):
a little bit more of a nuke it from orbit
kind of option, right. Uh. And yeah, So so being
able to to mediate T cells response means that you
can prevent them from attacking stuff that you want in
your body, like a new heart or like your joints.
The drug is also used in a rheumatoid arthritis care
for example. Yeah, it's interesting. I mean we when we
(11:56):
talk about our immune systems, they are incredibly important, but
way they can cause some big problems right when you
you least need those big problems, and things like allergies.
See yeah, cats, dumb body. Yeah, I want to hug
the cats. Yeah, we can have a whole discussion about
(12:17):
my allergies and how I'm not very pleased with them,
but at any rate, UH immune systems. Clearly we'd be
much worse off without them, but we do have to
take them into account with something as traumatic as a
transplant surgery. UH. Now, when we move on with some
more kind of cool updates to transplant technology, we start
(12:38):
looking at UH synthetic and regenerative medicine approaches, which are
really awesome. This is the idea where we don't necessarily
have to rely upon a donor to get the organ
that we need in order to perform the transplant, and
the earliest examples of this are actually UH in skin
grafting products. So like a not like an internal organ
(13:02):
but rather an external Yeah. So the first one would
be an apple graph, which was a skin grafting product
that the FDA approved, and in two thousand one the
FDA approved Dermographed, another kind of skin graph product. So
this would allow doctors to grow the skin externally, you know,
(13:23):
not attached to the patient, and then grafted onto the
patient without having to remove a patch of skin from
one part of the body and transplant to another part
of the body. Right, it's really useful for stuff like
like ulcers that are not healing under their own power.
And these things are all basically fake skin that contain
real human cells. And and by fake skin, it might
(13:46):
be a collagen that's been composed of of of cow
cells or something like that. But but at any rate,
it's it's a bio structure that that you can put
on a patient and it will grow into the patient
and his body and attached to the patient's own skin.
So that is so gross and amazing. At the same time,
(14:07):
I started thinking about the dark Man series, one of
those and you don't go out in the sun because
otherwise it all just end up bubbling off of you.
It's only in dark Man, though not this stuff. Dark Man,
the one that had a certain set of skills. Well
he he later proved to a certain set of skills. Yes, yes, yes,
many things were taken from dark Man. In two thousand
(14:29):
and eight, a patient received an airway transplant that was
regenerated airway, so the airways scaffold came from a donor.
That part was remained like a traditional transplant, but the
doctors had removed the donor's cells from the scaffold, the
various cells that were attached to the scaffolding, so it's
(14:50):
just kind of a raw structure at that point. They Yeah,
they added bone marrow cells from the patient, and the
bone cells are essentially kind of like stem cells subset
of stem cells, if you think of it that way.
They used the bone marrow which would ended up creating
the the tissue for the airway, and then they transplant
(15:11):
that into the patient and this helped reduce the possibility
of an oregon rejection because it was the patient's own tissue,
right right. The thing about bone marrow is that all
of your T cells are grown there. So if you
have some some bone marrow cells creating T cells, then yeah, yeah,
it's already saying hey, Uh, we're all on the same
(15:32):
team essentially. Then we saw the first full face transplant. Uh,
you know, bone bones and all like like cheekbones, jaw, nose, teeth,
all the muscles and eyelids and all of that stuff. Uh.
And it's so hard to not make a face off
reference here, but man, that movie is really terrible and
this surgery is really incredible. Uh. And this was basically
(15:54):
made possible, I mean because we had all of the
all of the elements of that, all of the bone
afting and and uh and muscle connection and all of
that stuff. But but anti rejection medication was really what
allowed the surgery to be a success. Um. The the
patient went through two phases of rejection and was saved
successfully both times. Wow. Uh. In two thousand eleven, that's
(16:16):
when a patient received the first regenerated airway transplant that
used a synthetic scaffold rather than one from a donor,
so in this case, there was no need for any
kind of donation. They were able to build it from
the ground up essentially, and in the first successful regenerated
trachea transplant takes place, as well as a successful regenerated
(16:36):
trachea with synthetic scaffold transplant in a child man. So
now we're getting to that point where we'll talk more
about this in a little bit. But the idea of
being able to build these synthetic structures and then incorporate
the patient's tissue into those synthetic structures to create new
versions of the patient's own organs, that's where we're headed.
(16:59):
But we'll talk more about that in a little bit.
Um As for head transplants, to get back to the
topic at hand, Uh, well, we've seen some experiments, some
pretty crazy mad science style experiments involved. Well we can
certainly recall those Russian experiments with like dogs taking the
head off of a dog and putting it on another
(17:21):
dog or well I think they were also just experimenting
with if they could keep a dog's head living not
attached to the dog body, so they attached it to
like a circulatory Uh yeah, and you can see videos
of this if you believe that no special effects were
involved in creating them. At the time. They would like
(17:42):
do incredibly disturbing things like pound a hammer on the
table where the severed dog's head was, and the dog's
head would seem to sort of react react to it. Yeah. Um, yeah,
we talked about that in our episode about Frankenstein. Yes
we did. I cannot, I cannot ever watch those again.
Once was enough. It was truly disturbing. Yeah. But in
(18:04):
the nineteen fifties and sixties and even into the seventies,
there were some experiments, largely in Russia but in other
places as well, with head transplants with dogs and monkeys. Um.
There was one monkey head transplant that was successful for
eight days. The monkey was able to continue eating and breathing,
(18:25):
but had was essentially paralyzed from the neck down and
died eight days after tissue rejection. But it did kind
of work that the spinal cord never fused back. That
was one of the things we'll talk about too. Well.
That seems like a pretty major issue, a huge issue obviously.
But anyway, these these were these were um experiments, but
(18:45):
none of them were like, uh, you know, a ground
the foundation for further work, right. No one looked at
them and said, you know, this is a great plan. Yeah, Okay,
Well I think we should look at where the science
of transplantation rests today, like what are we good at
doing and what are the things that that are still
(19:06):
presenting problems for us. Well, guys, we are so good
at cutting. We are terrific at cutting stuff like seriously.
And this is important because, uh you know, as you
have perhaps seen in your own kitchen, if your knives
are getting a little bit dull, a less than sharp edge,
(19:27):
what will damage the tissue that you're cutting and and
invite an immune response, which is what you do not want.
Right Cutting with a dull knife tends to sort of
do some ripping and crushing exactly. Um. So with it,
with advances in material science necessary to create very sharp blades,
and with the advent of laser systems that can be
(19:48):
used in surgery, we are able to keep both the
organs and the patients much healthier. Uh. We've also developed
ways of keeping organs viable while waiting for to perform
transplant surgery. Typically this involves bathing the organs in a
cold salt water solution or saline uh. And it well
(20:12):
usually let the organs last several hours, depending upon the organ.
So for kidneys it could be forty eight hours, for
livers it's about twenty four hours. For all heart only
five to ten hours, So it's very dependent upon the
type of organ. Obviously, with something like a person's head,
you've got a lot more to consider, you know, keeping
the brain oxygenated and everything. So, but the the whole
(20:35):
idea here is that by lowering the temperature, you lower
the amount of energy the cells need to exert in
order to survive, and that prolongs their viability so that
you can get them to where they need to be
in the surgery can be performed, but it is a
matter of hours, right. This isn't something where you can
just you know, you've got a freezer full of organs
and you can just go and pull one out whenever
(20:56):
you need it. It's it's one of the things that
makes this such a delicate and difficult um field of medicine.
Here's another thing that I think is fascinating, which is
the ability to keep a patient alive while you're sort
of like moving around or removing or inserting organs that
(21:17):
we normally think of as absolutely critical to survival. How
do you actually do a heart transplant? Uh, you hook
someone up to one of those artificial heart lung machines
and kind of let it go and you you also
one of the advances that we've seen since the nineteen fifties,
was the capacity to do that with artificially cooled blood,
(21:39):
which helps the rest of the patient's body. Oh, I'm sorry,
literally chill out. It just kind of it preserves the
rest of the organs while the transplant is going on. Yeah,
we talked a little bit about that when we were
talking about the possibility of suspended animation in a previous episode.
How this is something that's apt hypothermia. I don't know
(22:00):
if this would technically qualifies that, but at least it's
a similar principle. Keeping temperature is low to prevent tissue degeneration. Yeah. So,
and even in that episode, if you recall, it was
really all about keeping a patient alive in order to
address a medical issue immediately, as opposed to perpetually keeping
(22:20):
that patient alive until you can thaw them out, like
a hundred years from now. That's not what That's not
where the technology is right now. Um. Then, of course
we've got the immunosuppressive drugs, the anti rejection drugs we're
talking right, So the early ones were pretty pretty damaging
to a person. Even if they were working as they
were intended, they could cause other consequences. For example, because
(22:42):
in general killing stuff in your body, like like we
all know from an example for for chemotherapy, Yeah, kill
stuff in your body. Yeah stuff, the good and the bad. Right,
So the newer drugs have lower toxicity with fewer side
effects like side effects like raising your blood pressure or
your coless role or even uh, giving you diabetes that
(23:04):
could be one of the side effects of these older
immuno suppressive drugs and still a risk with the current ones. Um,
even with those advances, there are a lot of things
you have to take into consideration. They can be toxic,
toxic to kidneys, they can cause they may cause cancer
and uh. And the thing about them is that most
(23:24):
patients who have to start taking them due to a
transplant have to take them for the rest of their lives. Yeah.
So one of the things that people are really looking
into our ways of performing surgeries that would not require
immunosuppressive drugs. So in other words, these were generative medical
approaches where you're using the tissue from the patient him
(23:46):
or herself, then you don't need to worry about using
the immunist suppressive drugs for the rest of their lives.
That because they're getting a transplant of their own tissue um.
Obviously that would be a huge benefit. All right, well,
let's bring it back to the discussion of the head transplant,
because that's what everybody's got to know. Can I get
(24:06):
my head put on a more attractive body or maybe
like a dinosaur body? Right? Well, I'm sorry to sound
like a tale from the crypto. I'm sorry, No, that
that was in bad taste. I shouldn't make light of it. Actually,
you know, can you if you have a dise he
is affecting your body? Yeah? Can you? Can you actually
get a head transplant? So let's let's look at Canavero's proposal.
(24:27):
It's pretty it's pretty intense. Yeah, he's estimating that it
will require the coordinated efforts of a hundred surgeons working
for a grand total of thirty six hours, although the
surgery itself would be very short. Yeah, we'll talk about
that in a second. So your head disconnected for thirty
six hours. No, that would be bad, um because for
(24:49):
one thing, a head can't remain viable on its own.
It would have to be kept alive throughout the procedure,
which would be pretty tricky. Yeah, you can't. You can't
put it in a a saline solution like you could
with a liver or a heart, you would have to have,
you know, some form of circulation going with that head
(25:10):
the entire time. Plus the head is home to lots
of stuff like it's not an oregan like a heart,
right you're talking about. You have your eyes, you have
your nose, your um, your ears, you've got skin, you've
got glands that are very important um all located in
that area, and of course you have the brain. So
if you decapitate ahead, which obviously would be one of
(25:32):
the steps of this surgery, you immediately have a decrease
in blood pressure in the head. No big surprise there,
there's no way of pumping blood continuously there. But that
also means that you have a you start to deprive
the brain of oxygen, so then the patient would go
into a coma, which would be shortly followed by death. Right,
(25:53):
You'd start to have that cell death throughout the brain,
which is exactly what you don't want to happen because
we generally consider that your river postables is damage to
the brain that's going to kill you. So Canavero has
based the the idea that it needs to the procedure
of actually hooking up the head from the patient to
the donor body would need to happen in less than
(26:15):
one hour based upon previous surgeries, including the one I
was referring to earlier about the the monkey head that
had been transplanted and lived for eight days. Uh, that
was all based on those earlier experiments. And so the
actual point where you separate the patient's head from the
patient's body and then attach it to the donor body
(26:37):
would have to take less than an hour out of
that full thirty six hours we were talking about previously. Um,
you would have to have that connection there so that
the the brain could remain viable. However, when you're actually
doing the the transplant, both bodies, the patient and the
(26:58):
donor body would have to be in cardiac arrest. And
then you could start the heart of the donor body
afterward once the the head has been attached, but until
then they would both be in cardiac arrest. And then,
assuming that the surgery is in fact a success, any
signs of rejection would have to be handled immediately. And
(27:19):
the head is home to so many systems like the
eyes and the brain and all of this that the
risks of rejection would be much greater than if it
were a single oregan. You have a lot of potential
points of failure. In other words, and uh, during this
time after the surgery, that the patient would have to
be kept unconscious. Uh, you know, not just immediately, but
(27:40):
for like three to four weeks in order to allow
the spinal cord to grow new connections, and and medically
induced coma has come with other risks on top of
the ones we've already talked about, including things like blood clots, infection,
and reduced brain activities. So that would be another thing
to keep your ion, assuming that the surgery itself had
(28:02):
gone well. Oh sure, Although as we were mentioning earlier
that that spinal cord severance might be the real problem
in getting the surgery to be effective, because you know,
muscles and blood vessels can be cut and then sutured
back together, or or not sutured but reattached in the
(28:22):
zany medical ways that they do. I do not actually
understand the process, so I'm not going to talk about it.
But spinal cord severing and and fusion would have to
be so sharp and clean and uh kind of Ourrow
says that the chemicals he mentioned polyethylene glycol and cheetahs
on um. It's kind of essentially like a biologically uh
(28:47):
created glue, is what these tend to be sure, he
claims that those could encourage fusion. Um electrodes would be implanted,
and while the patient was kept unconscious after the surgery,
that the team would be a dyeing electrical stimulation via
the electrodes in order to help boost new nerve connections. So,
in other words, it's it's not enough to have everything
(29:09):
plugged in properly. You also have to have these signals
passing through in order for the body to recognize that
their actual impulses passing along the spine, right, in order
to recognize, hey, we're brain tissue, your brain tissue. Let's
make brain happen. Yeah. Well, and it's not just in
our sort of non expert point of view that this
sounds like a very very ambitious proposal. Well, especially when
(29:33):
you take into account what Cannaverro has said that assuming
that everything goes well, what the patient will be capable
of doing after the surgery, Ah yeah, I mean, so
they'd be down for about a month while their spinal
cord is reconnected. But then he claims that a patient
would be able to walk within a year after the surgery. Yeah,
(29:55):
that's I mean, so if you think that we are
a little skeptical, you're right, because they're just so many
different hurdles to overcome in order for this to even
remotely work. But yeah, we're not the only ones to
express skepticism. The medical community at large has expressed everything
(30:16):
from cautious skepticism to outright disbelief. Like there aren't a
whole lot of people coming out and saying, yeah, I
think this is gonna work. In fact, most of the
reports I've read have said, uh that they were they
were very skeptical. Some of them even went further to
suggest that kind of Vera's idea is crazy, like that's
(30:39):
I've seen that word being yeah, uh, and it could
in fact be crazy for a reason. Yeah. So this
was something I came across while I was researching the story.
And let's just prevace it by saying that this is
a kind of like sort of con spiratorial allegation. But yeah,
(31:02):
it this this falls. This can fall under the category
of conspiracy theory. There's a lot of circumstantial evidence that
that seems to support it, but it's circumstantial evidence, right,
And why we're dancing around this is because there are
now allegations that perhaps the timing of these announcements has
(31:22):
coincided with the promotion of a certain video game, that
video game being Metal Gear Solid five, the Phantom Pain.
In other words, that this entire thing about head transplantation
is a marketing stunt. Yeah. Now that now there's some
who say that Canavero seems actually sincere about head transplants,
(31:44):
but perhaps the timing of this particular discussion is in
fact more of a collaboration, and that right right right,
in other words, saying like, this is something I want
to do sometime in the future, but I'm gonna say
I'm gonna do it now because oh it's being it's
part of this other grander stunt of promoting a video game.
(32:07):
So so what's the deal with the promotion? Alright? So
here here's the circumstantial evidence that has come about, Um,
the game Metal Gear Solid five has there's been images
leaked of are not even leaked, I mean promoted of.
There's a character in the game. There's a doctor who
looks I wrote eerily similar to Cannavero. But if you
(32:28):
look at the pictures, they look like it's looks like
it's the same guy, right, Like on casual glance, you
wouldn't even be able to tell. We're looking at a
pair of photos in our notes right now. The top
photo in our notes is a picture of Canavero. The
bottom photo is a picture of the character in the game,
and the bottom photo looks like it's just another picture
of Canavero. It's a little uncanny. Yeah, yeah, so so
(32:53):
there's that. Then there are a couple of other pieces
of against circumstantial evidence. Not so not this, No, this
is oaking gun. The patient of Valerie Spirridanov is also
a CG artist in game development supervisor, So some have
said that maybe that Spiritanov is in on this as well,
(33:13):
and it's not a sincere attempt at this surgery. Again
it this is just an allegation. Cannavero has published work
about Phantom Pain in the past, and the subtitle of
the game is The Phantom Pain. There are several acronyms
used by Cannavero, you know, things like heaven that are
(33:33):
also used in the Metal Gear Solid game. So there's
some terminology that is seems to be shared between the
publications written by Canavero and the stuff within the game
which came first, don't know. Uh. Hideo Kojima, who was
one of the creators of the game, tweeted back in
two thousand ten that he had found an quote ally
(33:57):
to help address a huge taboo. He planned the game
to have this enormous taboo incorporated in it, and did
not give any more details. So people looking at this
now are retroactively looking back at all the tweets and
stuff and saying, maybe Kennevero is this ally someone who
would support an idea like a head transplant, which supposedly
(34:20):
happens within the course of Metal Gear Solid five. So,
in fact, there are some promotional images of Metal Gear
Solid five which show this this scientist character uh holding
some form of device to a decapitated head on a platter. Um,
it doesn't like a scene of violence. It looks like
(34:42):
a scene of mad science in that case at any rate,
So that more circumstantial evidence. Uh. And Kajima is um
kind of a well certainly a well known figure in
the video games circles about Yeah, and he recently made
headlines when he when he left Konami, who he had
(35:03):
been collaborating with for for a very long time. Um.
His most recent project economy was Silent Hills, which is
that Greadmo del Toro Norman ritas Silent Hill new Silent
Hill game that it was making so many waves a
few months ago, I just got canceled, and that has
been very upsetting. I mean, you the big news from
(35:26):
like a year ago was when uh Konami released PT
and didn't say what PT was for, and PT ended
up being a playable trailer for Silent Hills. You didn't
know that while you're playing it. It was only after
you had completed the trailer, which by the way, was
incredibly creepy. Oh yeah, yeah, it's very effective. I watched
(35:46):
a playthrough of it and it's very yeah, very unsettling.
So this was one of those things where, you know,
Kojima has been known for going through elaborate setups to
promote video games in non traditional and and very media
savvy ways. Well, I have to say, if this is
a promotional stunt for a video game, it is a
(36:08):
bizarre one in very bad taste. Yeah, I mean there's
certainly there have been plenty of of ways of marketing
games that were not directly tied back to the games,
at least not initially. Like like alternate reality games, there
are quite a few that started off that no one
was even sure what it was trying to promote at
the beginning, so it's possible that this was promotion. However, Canavero,
(36:32):
for his part, denies involvement, and Coginia also denied that
Cannavera's likeness was used. So Cannivera had come out and said,
I didn't give permission for my likeness to be used.
They shouldn't be using my my image without my permission,
and Cogima said, oh, we weren't actually using him. It's
just a coincidence. It's a coincidence. If it's a coincidence,
(36:54):
it's a phenomenal coincidence, because this whole thing is a
phenomenal coincidence. If it's all a coincidence, I mean, and
strange things happen in the universe. Chaos theory, I get it.
Law law of truly large numbers says that even things
that would seem impossible sometimes happen. But yeah, it's it's
(37:15):
one of those where the circumstantial evidence is such that
if there's nothing there, it's really, it almost seems more
weird that there'll be nothing there then that this is
all about a promotion for a video game. So we
will see, I suppose, eventually how all of this shakes out,
and whether whether it's a clever ruse or not. But
(37:39):
at any rate, I'm glad that the headlines popped up
for it because we got to do this research into
transplantation and and all of the amazing research it's going
into it. Yeah. Well, whether or not we can transplant ahead,
we are going to be forging some new territory and
transplantation soon, and I think we should talk about future
(38:00):
of medical transplantation. Sure, uh yeah, yeah. One thing that
researchers are looking at doing is keeping organs alive longer, because,
as as we said earlier, you know, the the expiry
date on organs from a donor is really short, a
matter of hours or two days at most for kidneys.
In August, though, the FDA approved a device that uh
(38:22):
preserves one particular organ, the lungs, for long enough to
determine whether they're a really good match for a transplant,
about four extra hours on top of the normal time. Lungs,
by the way, are really particularly tricky. About eighty percent
of donated lungs are deemed unfit for transplant. Yeah, and
the creators of the machine, which is called the x
(38:43):
vivo Profusion system, um, they're they're hoping that eventually their
their system will allow for the storage of lungs for
up to two or three days. That's pretty cool. Yeah.
I gotta say though, x vivo profusion system sounds like
something I would see in a spay. Just step into
our x vivo perfusion system and you will come out
a new person. Another thing that we're seeing advances in
(39:07):
our going back to the the regenerative medicine approach and
the synthetic scaffolding for things like airways, it's three D
printing and transplants. Um. So this is something that we've
been talking about for a while and our three D
printing episodes. I think we've referred to it once or twice.
But the idea of using tissue as essentially ink and
(39:30):
being able to print upon first designing the scaffolding the
structure of whatever organ you're making, and then printing the
tissue directly onto that scaffolding. So yeah, so that you
have a a healthy organ to transplant, and it's made
from the patient's own tissue. So the yeah, you've got
you've got a nice uh a nice heads up. You're
(39:52):
able to get to a point where you can make
this transplant surgery without the worry of the organ being
rejected the body reacting in negative way. However, you know
that being said, it sounds like I'm making it sound
way easier than it really is, because depending upon the organ,
some of these organs are incredibly complex. You know you're
talking about you know, it's not just a massive tissue. Obviously,
(40:15):
it's important and has lots of different parts to it.
So to be able to synthetically create a working version
of that ourselves from the ground up is depending on
the organ, easier said than done. Actually, for all of
the organs, it's easier said than done. We are not
lumpy space people. Not just if we could just like
(40:35):
have a massive tissue that's generally liver shaped and you're fine,
it would be so much easier. But no, that's not
the way it works. However, it is very promising and
we're seeing more and more, um uh, you know, advances
in that. In March of this year, of a Russian
company called three D bio Printing Solutions announced it had
(40:57):
successfully printed a mouse by roid using these bioprinting techniques
and they're planning on transplanting this printed organ into a
mouse that suffers from hypothyroidism. And uh, the results have
not yet been published. They said that they will be
presenting their results at a conference called the Second International
(41:18):
Congress on Bioprinting, which will take place in Singapore in July.
So in July they will announce how this experiment went,
whether it was a success or not. Uh. And you know,
a thyroid is relatively simple, so it was a good
thing to target for this kind of procedure. And also
it's important because thyroid cancer is a real thing. It
(41:42):
can it affects around three thousand people, or rather three
hundred thousand people are diagnosed with it every year. So
being able to print a thyroid on an as needed
basis could potentially save thousands of lives every year. So
if this ends up being a success, it could be
it could be the getting of something truly transformational in medicine. Yeah. Yeah,
(42:05):
other researchers are looking into entirely artificial organs and of
course we do have some systems right now, that that
will keep a patient alive until a real biological organ
can be transplanted. But as our technology and also our
our understanding of human biology improve, we might end up
with some some medical cyborgs. There are research labs working
(42:27):
on artificial kidneys. Those are still in development, but with
artificial hearts, which you know, replace a whole a whole
heart like ventricles and valves and all. Uh. Some artificial
hearts have supported patients for up to four years before
a transplant organ became available, right Yeah, And and I
mean we could do an entire episode about about artificial
(42:47):
organs and the development of those, because that's also a
fascinating story, uh and and an amazing achievement in technology
to have been able to create something that is medically
safe to implant in a person and can keep them
alive until an actual organic uh replacement is available. And
that Yeah, I'm excited to see that continue with other
(43:09):
organs besides the heart and kidneys. Oh. Absolutely. Also on
the immuno suppression front, there is a team out of
Massachusetts General Hospital that's been conducting a clinical trial for
bone marrow transplants in addition to organ transplants. Kidney transplants specifically,
so uh so, So the idea here is like, like
(43:30):
we were saying, with the scaffolding, the throat scaffolding issue
in some other patients. If you, uh, if you give
someone a kidney transplant and also destroy some of the
patient's native bone marrow and give them a transplant of
some of the donor's bone marrow. Oh, I see. So
the so in other words, the patients getting bone marrow
(43:52):
and an organ from the same donor. So that means
that the bone marrow which is generating these T cells
is already familiar with the tissue of up donated organ.
So you wind up with these two bone marrow T
cell creating systems working together to support the patient's original
tissue and the new organ. I see. So that would uh,
(44:13):
that would at least hopefully cut down the incidence of
organ rejection, because the patient's own systems would be generating
the same native T cells as the tissue that was donated.
Right right. We're still waiting for the results of these trials,
but as of two thousand eight, four of the original
five patients had gone for five years without having to
(44:34):
take immuno suppressive dress. That's pretty incredible. That's amazing. So
obviously I think the ultimate future that we want to
get to with organ transplantation is the ability to have
these regenerative techniques where you sort of regrow organs with
your own stem cells. They're based on your own biology.
That seems like the ideal solution all around, but as
(44:55):
you pointed out, that is a ways off, and there
are people who need organs to day. Right in the meantime,
we have a need that is not going to just
sit on hold for the decade or so it'll take
for us to get that that technology to maturity. Right,
So in the meantime, I wanted to talk about something
else I read about, which is a more controversial sort
(45:17):
of temporary solution in the meantime, and that would be
open markets for organ donation. And by market I mean
the exchange of money. You would a physical market, It
looks like a farmer's market. That would be a little No,
that would be very that would be very unsafe. Would however,
(45:37):
fit right into silent hills. Yes, but so so of
course today you cannot purchase an organ for transplant. No, well,
in most countries you can't. And so like you could
maybe go to Iran and purchase a an organ for transplant.
But in the United States and many other countries, you
(45:57):
can choose to donate your organs at fath or if
you're a very nice person or you care about somebody
very much, you can donate something like a kidney while
you're still alive, Like you can continue living with just
one kidney. Somebody else might have renal failure and they
need a kidney, and you can give them one of yours, UM,
but you can't sell it to them. Regally, you're not
supposed to sell your organs, but some people have argued
(46:21):
that it would be a good idea to move to
a general, open market for organ donation, where you could
be paid a market determined price, for example, a kidney.
And of course their arguments for and against UM. The
most obvious and pressing argument for is that thousands of
people die every year on the waiting list for kidneys.
(46:43):
Oh yeah, there's a crazy shortage of organs of all
kinds in the market. Yeah. So in the United States,
according to the National Kidney Foundation, in four thousand, four
hundred and fifty three patients died while waiting on a
kidney transplant. There on the waiting list. There, I assume
they're probably on dialysis waiting to get a kidney, and
they did not get one in time and they died
(47:06):
from Yeah. On average, they say twelve people die every
day waiting for a kidney. On top of that, there's
simply the problem of waiting. So let's say you're waiting
four years to get a kidney and you eventually get one,
and that allows you to extend your you know, your
lifespan and to go on living. But that time while
(47:29):
you're waiting, you're having to undergo dialysis. It's just going
to be a major blow to your quality of life
and your ability to do things. And you don't recapture
those four years. Yeah, and so in economic terms, this
is a situation where demand has greatly outpaced supply. There
is way more demand for kidneys than there are kidneys
(47:50):
to go around. So some economists have proposed a very
economic sounding solution. Uh. One example of people making this
argument is in January, economist Gary Becker and Julio Elias
authored a peace in the Wall Street Journal where they
recommended this path. It was called cash for Kidneys, the
(48:11):
Case for a Market for Organs, and they support compensation
for live kidney donation in a model where family members
can be compensated when when they choose to give up
the healthy organs of a dead relative, right, because that
can be one of the blocks placed in organ donation
is when even if a person has selected to be
(48:34):
an organ donor, you need the acquiescence of their surviving
relatives in order to go ahead with the organ donation. Right.
So somebody might if you have a relative who's just
passed away, they might have a healthy heart and somebody
else needs that heart. But you could say no, no, no,
but the yeah, yeah, the the understandably upset family members
(48:55):
might not want that. Right. So, even if it is
your wish as an organ donor to have of your
organs donated, it's possible for your next of kin to
say no, I don't want that to happen, and the
medical professional the medical professionals will back away. They won't
they won't continue. Yeah, And so this is understandably a
very controversial proposal. Um, And I'm not sure where I
(49:18):
stand on it. I can see the arguments on both sides.
On one hand, I I would probably if I were
myself someone who needed a kidney I would think like, well, yeah,
if there's some way I could, you know, can motivate
people to do more donations, then yes, please do it
any anyway you can, of course. Yeah. But then of
course there are arguments against it. Uh. The the economists
(49:40):
in this piece who were who were for it, that
they did try to offer some of the objections and
encounter them. Oh and one they proposed made sense to me.
They said, well, people who are going to be offering
to sell their kidneys, or people who very often are
people who are in a desperate situation. Somebody's like I
need money, now what you know, what can I do
(50:02):
while I can sell a kidney? And then that you
you might sort of be in a way forced to
make that decision by financial circumstances, and then later in
life come to really regret that decision. It'll end up
disproportionately affecting a specific democrats. Yes, specifically people who are
in who are in bad economic circumstances. Um and I
(50:24):
can totally see that being true. That yeah, it would
be sort of like a thing that you won't imagine
that many wealthy, well off people saying I could really
use the ten thousand or fifteen thousand bucks from a kidney.
Of course, then again they proposed sort of countermeasures to that. Well,
one thing you could do is you could put a
(50:44):
waiting period in place, so you like you'd be forced
to undergo counseling. You can't just say like, no, take
my kidney today. You know, there would be like a
three month period, and that seems like that could come
into play. They also pointed out that in their opinion,
I don't know to what extent this is true, but
they claimed that it also would be mainly to the
benefit of people who are more economically disadvantaged, because if
(51:06):
you're rich, you can typically more easily find a way
to get an organ if you need one, you can
you can travel to another country, or you can pay
for workarounds. Yeah. So in general, I think this is
a really interesting and difficult question. I don't know what
the right answer to that is. Yeah, I mean it
sounds like kind of like a like an ethical problem
of putting a price tag upon human bodies. Yeah, I mean,
(51:29):
they're there's certainly, and obviously this would also lead people
to say, now you're going to make that urban legend
come to life, the one about you know called the doctor,
you wake up in a bathtub full of ice, one
would hope there would be measures put in place to
avoid you being able to sell someone else's kid. Yeah,
it's like like when I went to donate blood and
(51:51):
then was disappointed to find out it had to be mine.
I don't know where I stand on this either. It's
one of those things that's really difficult to kind of
put my finger on. On the one hand, I definitely
don't want there to be thousands of people who are
are waiting and hoping and dying because they don't have
the access to organs that they need. On the other hand,
(52:13):
I don't like the I don't necessarily love the idea
of people electing to get a surgery that they otherwise
never would because they need the cash. I mean, they're
the now. On the on the the brightest side of
things that we can point out is that if everything
works well, this will hopefully be a transitional period where
(52:37):
we will end with the ability to create the organs
that are based off the patient themselves, and the need
for donors will be eliminated entirely. But that's the future
we may not ever arrive at. We can hope, but
we don't necessarily know that's going to happen. Yeah, this
is one of those situations. I feel like it comes
up fairly often on this show where there's a there's
(52:58):
a solution inside that would be the correct, the right solution,
but we're not quite there yet, and there is something
vision Yeah, and there on the way there there's a
there's a really unpleasant kind of transitional period. Yeah. Yeah, no,
that's that's entirely accurate, I would say. So, I'm curious
(53:19):
what our listeners think about this? What are your opinions?
You know, Camillo wrote in I wonder what what opinions
Camilo has about this? Because this is this is tricky stuff,
and uh, you know, we want to be we want
to see the greatest benefit for the most number of
people without it becoming like this weird question of ethics
(53:40):
that no one's comfortable with. But you know, this is
real life, and in real life they are there are
often a lack of easy answers. Another thing that I
think would be worth considering. And I'm not even sure
what their position would be, but what doctors think about this? Yeah,
because I bet that they have they might have our
mints for against this that we haven't even thought of
(54:02):
just like a procedural or medical yeah sure, or even
just of their personal experience of of working with patients
and with families, and you know that the kind of
stuff that we can read about and and sympathize with,
but not truly empathize with. Oh yeah, I mean there,
we haven't even touched any of the psychological effects that
that patients can experience when undergoing transplant surgery. And I
(54:25):
mean that's an entirely different field that is complex, fascinating
and and a little bit terrifying. Yeah, and certainly I
am not qualified to address it. It's but it is
something that I'm fascinated by. Uh Well, at any rate,
I am very curious to hear from other listeners like Camilla.
Thank you so much writing in Yes, Yes always. This
(54:46):
was a really interesting topic to look at, and we
want to continue that. We want to have people right
in and ask us questions. We really enjoy addressing these
listener requests, and if you have a topic that you
would like us to talk about in the future, let
us know. Send us an email the addresses FW thinking
at how stuff Works dot com, or drop us a
(55:07):
line on Twitter, Google Plus, or Facebook, at Twitter and
Google Plus, we are FW thinking. Just search FW thinking
and Facebook. We'll pop right up. Leave us a message
and we'll talk to you again really soon. For more
on this topic in the future of technology, visit forward
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