Episode Transcript
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Speaker 1 (00:00):
We've got a very special guest joining us.
Speaker 2 (00:02):
Doctor Robert Montgomery, directs the Transplant Institute at the NYU
Langone Medical Center. Right, both my parents went to NYU
Medical School, and so did my so did my sister.
U Bob, But anyway, UH, I was reading some some
fascinating stuff about the use of organs from pigs and
(00:26):
particularly genetically modified pigs to uh to allow the availability
of organs for transplant into humans when there is a
shortage of whatever.
Speaker 1 (00:37):
The particular organ is for humans.
Speaker 2 (00:38):
Which is probably most of them for people who need transplants.
Speaker 1 (00:42):
So, Bob Montgomery, welcome to Kaway. It's very good to
have you here. Thanks for doing this.
Speaker 3 (00:49):
Thanks Ross, thanks for having me. It's a pleasure. So,
and you're exactly right.
Speaker 1 (00:54):
Go ahead, go ahead.
Speaker 4 (00:56):
Yeah, there's a there's a terrible shortage of of all
human organs. And in fact, only about four percent of
the people who have organ failure receive a transplant each year,
and only about ten percent of the people who could
(01:20):
benefit from a transplant ever make it onto the list,
and only one third of the people who make it
onto the list ever actually receive a transplant, and the
others either die waiting or get too sick to benefit
from a transplant. So we have a terrible crisis in
organ availability. And that's really what this work is about.
(01:44):
It's about addressing the shortage of organs worldwide. It's the
same story in other countries.
Speaker 2 (01:53):
This isn't a very important question, but I'm going to
ask you anyway as somebody who knows nothing about this,
but just thinking of transplants, I can imagine heart, liver, kidney, lung,
which which are the ones that where the shortage is
causing the most deaths.
Speaker 4 (02:17):
Yeah, well, just based on numbers alone, it's kidney disease
and kidney transplantation that is, you know, in highest demand.
And so just to give you an example, you know,
the waiting list right now has over one hundred thousand people,
oh my gosh, and about you know, ninety percent of
(02:39):
those people who are waiting or waiting for a kidney.
Speaker 3 (02:42):
So, just based on numbers alone, you.
Speaker 4 (02:44):
Know, the the folks who have kidney disease are at
greatest risk. But we do have a replacement, you know,
for the kidneys. It's called dialysis. You're probably every all
your listeners know somebody who on dialysis. But it's not
a very good replacement. And in fact, if you receive
(03:05):
a kidney transplant, on average, you'll live twice as long
as if you have to stay on dialysis. So you know,
it works, and it's also cheaper for the healthcare system
to transplant somebody then keeping them on dialysis. But you know,
you can imagine something like the liver that really doesn't
(03:26):
have the equivalent of dialysis, that if you have liver
disease and you don't receive a liver transplant, you know,
in a certain period of time, you're at high risk
for dying because there's no other choice.
Speaker 2 (03:42):
Okay, one more question before we get to the pigs,
and let's stick with kidney now for a moment of
the let's say ninety thousand people who are on the
list to get a kidney, how many of them or
what percentage of them will ever get kidney? And maybe
this is another version of at least a similar question,
(04:03):
how many kidneys become available for transplant in the United
States over the course of a given year.
Speaker 4 (04:09):
Yeah, so we do about you know, thirty thousand kidney transplants,
so about you know, a third of the list.
Speaker 3 (04:19):
But you know, because of the way that.
Speaker 4 (04:24):
You know that people accumulate on the list, and because
you know, people who are quite ill, you know, are
on the list and have been waiting a long time.
When you look at it, over a period of time,
only about a third of the patients will receive an
(04:45):
organ because people, remember are dying or becoming too sick
and getting delisted all the time, and new people are
being added to the list. So if you just take
a snapshot, it's a bit deceiving, you know. If I
tell you that roughly, you know, we transplant roughly a
third of the people on the list each year, that
(05:05):
sounds like, well, okay, I only have to wait three years.
But it's not like that because all all long, you know,
people are falling off the list, either because of death
or because they get too ill.
Speaker 2 (05:20):
Okay, So now let's get to this fascinating work.
Speaker 1 (05:23):
That you're doing regarding pigs.
Speaker 2 (05:26):
So I'm guessing that the reason the pig seems interesting
is that the organ function would be very similar to ours,
and then there's something you can do to minimize the
chance of rejection.
Speaker 4 (05:36):
Yeah, so you know, there there have been other species
that were considered, as you know, a replacement for human organs.
And you know, back in the nineteen seventies and eighties,
we did some transplants using primate organs baboon hearts for instance.
(05:59):
Meant many of your listeners will remember baby Fay. And
the problem with that is that primates are scarce, and
so their organs are scarce like human organs.
Speaker 3 (06:12):
So you don't want to, you.
Speaker 4 (06:13):
Know, try to solve a problem of scarcity by introducing
an equally scarce source of organs. So pigs are plentiful,
believe it or not. We consume one point three billion
pigs a year as a food source. They breed three
times a year, they have big litters, they you know,
(06:34):
are pretty easily genetically modified, and their organs are about
the same size as human organs. And so for all
of those reasons, it turned out they were the best replacement.
Speaker 3 (06:49):
And that's what we've been moving forward with.
Speaker 2 (06:53):
Talk to me a little bit about the genetic modification
and any other thing you do to minimize the chance
of rejection. Because we hear all the time, so and
so needs a kidney, but you know, can't find a match.
People can live with one kidney with no problem, right,
So if you could find a loved one or a
relative or the best friend in the world, and you're
a match, you could have it. But if you're not
(07:14):
a match, you can't have it. And it's not that
easy to make a match, I guess. So how do
you how do you maximize the chance of the pig
kidney not being rejected by the human recipient.
Speaker 4 (07:26):
Well, first of all, we can breathe the pigs, so
they're all blood type. Oh, so they're universal donors, so
they can give to anybody, so there's no blood typing compatibility,
whereas there's a thirty five percent chance that any two
individuals would be blood typing compatible. So you lose a
lot of your potential donors, particularly living donors.
Speaker 3 (07:45):
So that's the first thing.
Speaker 4 (07:47):
And then we can make them more compatible by two
types two strategies in genetic engineering. One is to knock
out a gene and the other is to replace a
pig gene with a human gene. That's what we call
that a knock in. So in certain instances like this
most recent transplant we just did, it was a ten
(08:09):
gene edited pig, and four of the genes were knockouts
and six were human copies of genes, where the pig copy.
Speaker 3 (08:20):
Doesn't really interact that well.
Speaker 4 (08:22):
With the human system, and so we put the human
copy in so that the pigs are bread that way,
and now we've got a human to human sort of interaction.
Speaker 3 (08:32):
So that's that's what these things do.
Speaker 4 (08:34):
And that makes it less likely that they're going to
be rejected, and it makes certain important pathways more likely
to function efficiently and well, because again you've got two
human proteins that are interacting.
Speaker 2 (08:47):
Tell us a little bit about any patient who you're
allowed to talk about right now.
Speaker 4 (08:55):
Yeah, Well, our most recent transplant, I can, and I
can give you you know, what would normally be privileged
information because she has become very has been very public about,
you know, her transplant and why she did it and
that sort of thing. And so her name is Tijuana Tauana,
and she comes from Alabama, and she had heard, you know,
(09:18):
about this revolution and in using peg organs, and she
had been on the waiting list for nine years. She
had been on dialysis, and believe it or not, she's
one of this very very small number of patients who
(09:39):
who donated an oregon. She donated one of her kidneys
to her mother and then developed renal failure. Many years later,
and she developed that renal failure because she had a
disease called pre eclampsia during her pregnancy, so she was
quite young when she donated her kidney to her mom,
(10:03):
and as a result of her pregnancies, then she developed
these harmful antibodies it's called sensitization, which made it almost
impossible to match her. So we knew that she would
continue to wait on the list and really have no
chance of finding a human organ because she was so
hard to match, and she was starting to lose the
(10:26):
ability to get dialysis because it requires access to blood vessels,
and she was losing some of those blood vessels. So
we knew that if if we didn't do something, she
would die. But she was in pretty good She's in
pretty good shape, so you know, we knew that she
could withstand them suppression and had the potential to do
(10:48):
really well. So we did that transplant on November twenty fifth,
and she's doing great. She's still here in New York.
She's going to be here for a total of three
months and then she'll go back to her home in
Alabama and be followed there.
Speaker 1 (11:02):
Wow, we're talking with doctor Robert Montgomery.
Speaker 2 (11:05):
He heads the Transplant Institute at the NYU Langone Medical Center.
Speaker 1 (11:11):
So in that situation, and especially.
Speaker 2 (11:15):
With a patient who has that much sensitization, will that
person need to be on anti rejection drugs for the
rest of her life or is it just a temporary.
Speaker 1 (11:24):
Thing till the body kind of quote unquote gets used
to it.
Speaker 4 (11:28):
Now, I mean, everyone who you know has a transplant
has to remain on those drugs unless they're one of
a very small group of people who are in some
innovative trials where we try to achieve tolerance and be
able to remove the drugs. But there's only about fifty
of those people walking around now. I don't know if
(11:50):
you know this, but I've had a transplant myself. I
had a heart transplant six years ago, which really, you know,
brought to when I was waiting and very ill. I
had seven cardiac arrests. I thought there was no way
I was going to get an organ, and believe it
or not, even with those cardiac arrests, I wasn't sick
(12:11):
enough really to even be listed. Because that's how, you know,
we only list people that we think we are going
to get allocated organs, and the allocation system is based
on severity of illness. So you have to be so
sick in order to qualify for an organ that that's
why many people die.
Speaker 3 (12:30):
And so I was.
Speaker 4 (12:32):
I went through that gauntlet, and this is when it
became so clear to me that we had to change
the paradigm. We had to find another source of organs.
I didn't want other people to have to go through
what I went through. But I bring this up because
of what you asked about the you know, suppression and
the drugs. I'm on those drugs and I'll have to
be on those drugs the rest of my life to
(12:53):
suppress the immune system and prevent the rejection of the
organ because that organ will always be different, you know
from the standpoint of my immune system.
Speaker 2 (13:03):
Wow, congratulations on still being here. That's a remarkable story.
Speaker 3 (13:09):
Yeah, six years year, six years out.
Speaker 1 (13:12):
Yeah, and it must have been.
Speaker 2 (13:14):
I hope there's some good video of the of the transplant,
because you could be one of the only people who's
ever done his own heart transplant. I don't know how
the anesthesia works on that. He had someone holding a
mirror up over your face so you could get in
there and you know, ask for the hemostat and so on.
Speaker 1 (13:30):
But that must have been pretty impressive.
Speaker 4 (13:32):
If it was possible, I would have done that. But
this the second best thing is I hired the guy
who did my heart transplant. Well, so you know, I
knew I was in good hands.
Speaker 2 (13:47):
So one one more question for you. Oh here, hold
on listener listener question. A couple of listener questions. I
have a cousin who recently passed from liver cancer. I'm
curious if pig livers could be trans planted into humans
who have liver cancer.
Speaker 4 (14:03):
Yeah, so, you know, it's an interesting, interesting question because
normally we don't think about doing a transplant for cancer,
but liver cancer is actually an exception to that, where
people can actually get a benefit, you know, in their
longevity if they have certain types of liver cancer from
a transplant, you know, rather than cancer surgery. So we
(14:28):
do liver transplants for certain types of liver cancer. And yes,
you know, I'm optimistic that, you know, in the future
that people will be able to get a pig liver,
genetically edited pig liver to you know, survive and do
well with liver cancer.
Speaker 1 (14:48):
How about pancreas for diabetics.
Speaker 4 (14:52):
So we probably wouldn't do the entire pancreast. But you
know the part of the pancreas that makes in Slynn
it is you you can isolate that from the rest
of the pancreas which helps digest.
Speaker 3 (15:06):
Food, and those are called islets.
Speaker 4 (15:09):
And so there's really encouraging work going on transplanting pig
islets into people with with.
Speaker 3 (15:18):
With diabetes, particularly type one diabetes.
Speaker 2 (15:21):
Yeah, you know, I think maybe Marty McCarey is working
on that islet stuff. I don't know if he's don't
know if he's a friend of yours, but I think he's.
Speaker 4 (15:29):
I think he's he is a friend of mine. He
is a friend of mine. We're both at Hopkins together.
So before you know, I came to n y U
nine years ago, I was at Hopkins and he's you're right,
he's a pancreas does mostly cancer work.
Speaker 2 (15:46):
I bet I'm the only radio host you will talk
to who will bring that up. Let's see a couple
other listener questions and then we'll and then we'll call
it a day. It is the are the pigs that
you use a very particular type of pig and it's
so wid.
Speaker 4 (16:03):
Yeah, so we have some you know, we have different options.
There are a couple of different pig companies. Some of
them have like what are what are called genetically inbred pigs,
so they're essentially you know, you could you could transplant
between the two pigs and they wouldn't reject the organs,
so they're almost like identical twins.
Speaker 3 (16:21):
So that's one option. But most of the other.
Speaker 4 (16:23):
Pigs are what we call outbred pigs, so they're they're
more you know, typical of you know, they're just a
particular species of pigs. But the important thing is that
they have to be kept in a pathogen free facility
where there's no infections, no risk of infection. So that's
(16:44):
the that's the that's what makes them really special is
the way that they're you know, genetically engineered and and
the way they're they're housed and and taken care of.
Speaker 2 (16:56):
This is probably my favorite question so far. Could an
orthodox to Jew take an organ from a pig?
Speaker 3 (17:04):
Yes, so.
Speaker 4 (17:06):
If you if you talk to your rabbi, you know,
and this this is true for Muslims as well. There
there's really you know, if it's a life saving situation,
most I think religious leaders would say that's okay. And
(17:27):
of course we've been using pig valves to replace human
heart valves, and.
Speaker 3 (17:35):
You probably have.
Speaker 4 (17:36):
Some Jewish friends who are walking around with pig valves,
so that is an acceptable thing.
Speaker 2 (17:42):
And I'll just note to listeners, in Jewish law, you
can do almost anything, right. You can you can eat
on yom kipor you can do almost anything that you
wouldn't otherwise be allowed to do if it's to save
a life.
Speaker 1 (17:55):
So I think this would go into that, all right,
So we.
Speaker 2 (17:58):
Got about one minute left and one more listener question
that I.
Speaker 1 (18:01):
Think is quite interesting.
Speaker 2 (18:03):
Since pigs generally don't live as long as humans do,
would you expect the pig organ to kind of reduce
what you might otherwise expect a human lifespan to be
if you got a human organ instead.
Speaker 4 (18:20):
We don't really know the answer to that question. You know,
pigs usually live into their twenties. You know, the the
average time for a kidney transplant to survive is somewhere
between ten and twenty years anyway, And we'd also don't
know that if you take an organ that has a
(18:42):
different life expectancy and you put it into someone who
has a longer life expectancy, will it receive certain cues and.
Speaker 3 (18:53):
You know, will will it actually increase the longevity of
the organ, And.
Speaker 4 (18:57):
That's something that I think, you know, in our lifetime,
we're going to be able to answer those questions.
Speaker 2 (19:03):
Doctor Robert Montgomery is the director of the NYU Lango
and Medical Centers Transplant Institute, on the leading edge of
using organs from genetically modified pigs to increase the supply
of organ availability for humans who need transplants. It's incredibly
important and fascinating work. And Bob, I thank you so much.
I know you're a very busy guy. I thank you
(19:24):
so much for making time for us today.
Speaker 3 (19:26):
Well, thank you Ross for having me on your program.
Speaker 1 (19:28):
Yeah, glad to have a questions. I thoroughly enjoyed it.
Thanks Bob. We'll keep in touch.
We've got a very special guest joining us.
Speaker 2 (00:02):
Doctor Robert Montgomery, directs the Transplant Institute at the NYU
Langone Medical Center. Right, both my parents went to NYU
Medical School, and so did my so did my sister.
U Bob, But anyway, UH, I was reading some some
fascinating stuff about the use of organs from pigs and
(00:26):
particularly genetically modified pigs to uh to allow the availability
of organs for transplant into humans when there is a
shortage of whatever.
Speaker 1 (00:37):
The particular organ is for humans.
Speaker 2 (00:38):
Which is probably most of them for people who need transplants.
Speaker 1 (00:42):
So, Bob Montgomery, welcome to Kaway. It's very good to
have you here. Thanks for doing this.
Speaker 3 (00:49):
Thanks Ross, thanks for having me. It's a pleasure. So,
and you're exactly right.
Speaker 1 (00:54):
Go ahead, go ahead.
Speaker 4 (00:56):
Yeah, there's a there's a terrible shortage of of all
human organs. And in fact, only about four percent of
the people who have organ failure receive a transplant each year,
and only about ten percent of the people who could
(01:20):
benefit from a transplant ever make it onto the list,
and only one third of the people who make it
onto the list ever actually receive a transplant, and the
others either die waiting or get too sick to benefit
from a transplant. So we have a terrible crisis in
organ availability. And that's really what this work is about.
(01:44):
It's about addressing the shortage of organs worldwide. It's the
same story in other countries.
Speaker 2 (01:53):
This isn't a very important question, but I'm going to
ask you anyway as somebody who knows nothing about this,
but just thinking of transplants, I can imagine heart, liver, kidney, lung,
which which are the ones that where the shortage is
causing the most deaths.
Speaker 4 (02:17):
Yeah, well, just based on numbers alone, it's kidney disease
and kidney transplantation that is, you know, in highest demand.
And so just to give you an example, you know,
the waiting list right now has over one hundred thousand people,
oh my gosh, and about you know, ninety percent of
(02:39):
those people who are waiting or waiting for a kidney.
Speaker 3 (02:42):
So, just based on numbers alone, you.
Speaker 4 (02:44):
Know, the the folks who have kidney disease are at
greatest risk. But we do have a replacement, you know,
for the kidneys. It's called dialysis. You're probably every all
your listeners know somebody who on dialysis. But it's not
a very good replacement. And in fact, if you receive
(03:05):
a kidney transplant, on average, you'll live twice as long
as if you have to stay on dialysis. So you know,
it works, and it's also cheaper for the healthcare system
to transplant somebody then keeping them on dialysis. But you know,
you can imagine something like the liver that really doesn't
(03:26):
have the equivalent of dialysis, that if you have liver
disease and you don't receive a liver transplant, you know,
in a certain period of time, you're at high risk
for dying because there's no other choice.
Speaker 2 (03:42):
Okay, one more question before we get to the pigs,
and let's stick with kidney now for a moment of
the let's say ninety thousand people who are on the
list to get a kidney, how many of them or
what percentage of them will ever get kidney? And maybe
this is another version of at least a similar question,
(04:03):
how many kidneys become available for transplant in the United
States over the course of a given year.
Speaker 4 (04:09):
Yeah, so we do about you know, thirty thousand kidney transplants,
so about you know, a third of the list.
Speaker 3 (04:19):
But you know, because of the way that.
Speaker 4 (04:24):
You know that people accumulate on the list, and because
you know, people who are quite ill, you know, are
on the list and have been waiting a long time.
When you look at it, over a period of time,
only about a third of the patients will receive an
(04:45):
organ because people, remember are dying or becoming too sick
and getting delisted all the time, and new people are
being added to the list. So if you just take
a snapshot, it's a bit deceiving, you know. If I
tell you that roughly, you know, we transplant roughly a
third of the people on the list each year, that
(05:05):
sounds like, well, okay, I only have to wait three years.
But it's not like that because all all long, you know,
people are falling off the list, either because of death
or because they get too ill.
Speaker 2 (05:20):
Okay, So now let's get to this fascinating work.
Speaker 1 (05:23):
That you're doing regarding pigs.
Speaker 2 (05:26):
So I'm guessing that the reason the pig seems interesting
is that the organ function would be very similar to ours,
and then there's something you can do to minimize the
chance of rejection.
Speaker 4 (05:36):
Yeah, so you know, there there have been other species
that were considered, as you know, a replacement for human organs.
And you know, back in the nineteen seventies and eighties,
we did some transplants using primate organs baboon hearts for instance.
(05:59):
Meant many of your listeners will remember baby Fay. And
the problem with that is that primates are scarce, and
so their organs are scarce like human organs.
Speaker 3 (06:12):
So you don't want to, you.
Speaker 4 (06:13):
Know, try to solve a problem of scarcity by introducing
an equally scarce source of organs. So pigs are plentiful,
believe it or not. We consume one point three billion
pigs a year as a food source. They breed three
times a year, they have big litters, they you know,
(06:34):
are pretty easily genetically modified, and their organs are about
the same size as human organs. And so for all
of those reasons, it turned out they were the best replacement.
Speaker 3 (06:49):
And that's what we've been moving forward with.
Speaker 2 (06:53):
Talk to me a little bit about the genetic modification
and any other thing you do to minimize the chance
of rejection. Because we hear all the time, so and
so needs a kidney, but you know, can't find a match.
People can live with one kidney with no problem, right,
So if you could find a loved one or a
relative or the best friend in the world, and you're
a match, you could have it. But if you're not
(07:14):
a match, you can't have it. And it's not that
easy to make a match, I guess. So how do
you how do you maximize the chance of the pig
kidney not being rejected by the human recipient.
Speaker 4 (07:26):
Well, first of all, we can breathe the pigs, so
they're all blood type. Oh, so they're universal donors, so
they can give to anybody, so there's no blood typing compatibility,
whereas there's a thirty five percent chance that any two
individuals would be blood typing compatible. So you lose a
lot of your potential donors, particularly living donors.
Speaker 3 (07:45):
So that's the first thing.
Speaker 4 (07:47):
And then we can make them more compatible by two
types two strategies in genetic engineering. One is to knock
out a gene and the other is to replace a
pig gene with a human gene. That's what we call
that a knock in. So in certain instances like this
most recent transplant we just did, it was a ten
(08:09):
gene edited pig, and four of the genes were knockouts
and six were human copies of genes, where the pig copy.
Speaker 3 (08:20):
Doesn't really interact that well.
Speaker 4 (08:22):
With the human system, and so we put the human
copy in so that the pigs are bread that way,
and now we've got a human to human sort of interaction.
Speaker 3 (08:32):
So that's that's what these things do.
Speaker 4 (08:34):
And that makes it less likely that they're going to
be rejected, and it makes certain important pathways more likely
to function efficiently and well, because again you've got two
human proteins that are interacting.
Speaker 2 (08:47):
Tell us a little bit about any patient who you're
allowed to talk about right now.
Speaker 4 (08:55):
Yeah, Well, our most recent transplant, I can, and I
can give you you know, what would normally be privileged
information because she has become very has been very public about,
you know, her transplant and why she did it and
that sort of thing. And so her name is Tijuana Tauana,
and she comes from Alabama, and she had heard, you know,
(09:18):
about this revolution and in using peg organs, and she
had been on the waiting list for nine years. She
had been on dialysis, and believe it or not, she's
one of this very very small number of patients who
(09:39):
who donated an oregon. She donated one of her kidneys
to her mother and then developed renal failure. Many years later,
and she developed that renal failure because she had a
disease called pre eclampsia during her pregnancy, so she was
quite young when she donated her kidney to her mom,
(10:03):
and as a result of her pregnancies, then she developed
these harmful antibodies it's called sensitization, which made it almost
impossible to match her. So we knew that she would
continue to wait on the list and really have no
chance of finding a human organ because she was so
hard to match, and she was starting to lose the
(10:26):
ability to get dialysis because it requires access to blood vessels,
and she was losing some of those blood vessels. So
we knew that if if we didn't do something, she
would die. But she was in pretty good She's in
pretty good shape, so you know, we knew that she
could withstand them suppression and had the potential to do
(10:48):
really well. So we did that transplant on November twenty fifth,
and she's doing great. She's still here in New York.
She's going to be here for a total of three
months and then she'll go back to her home in
Alabama and be followed there.
Speaker 1 (11:02):
Wow, we're talking with doctor Robert Montgomery.
Speaker 2 (11:05):
He heads the Transplant Institute at the NYU Langone Medical Center.
Speaker 1 (11:11):
So in that situation, and especially.
Speaker 2 (11:15):
With a patient who has that much sensitization, will that
person need to be on anti rejection drugs for the
rest of her life or is it just a temporary.
Speaker 1 (11:24):
Thing till the body kind of quote unquote gets used
to it.
Speaker 4 (11:28):
Now, I mean, everyone who you know has a transplant
has to remain on those drugs unless they're one of
a very small group of people who are in some
innovative trials where we try to achieve tolerance and be
able to remove the drugs. But there's only about fifty
of those people walking around now. I don't know if
(11:50):
you know this, but I've had a transplant myself. I
had a heart transplant six years ago, which really, you know,
brought to when I was waiting and very ill. I
had seven cardiac arrests. I thought there was no way
I was going to get an organ, and believe it
or not, even with those cardiac arrests, I wasn't sick
(12:11):
enough really to even be listed. Because that's how, you know,
we only list people that we think we are going
to get allocated organs, and the allocation system is based
on severity of illness. So you have to be so
sick in order to qualify for an organ that that's
why many people die.
Speaker 3 (12:30):
And so I was.
Speaker 4 (12:32):
I went through that gauntlet, and this is when it
became so clear to me that we had to change
the paradigm. We had to find another source of organs.
I didn't want other people to have to go through
what I went through. But I bring this up because
of what you asked about the you know, suppression and
the drugs. I'm on those drugs and I'll have to
be on those drugs the rest of my life to
(12:53):
suppress the immune system and prevent the rejection of the
organ because that organ will always be different, you know
from the standpoint of my immune system.
Speaker 2 (13:03):
Wow, congratulations on still being here. That's a remarkable story.
Speaker 3 (13:09):
Yeah, six years year, six years out.
Speaker 1 (13:12):
Yeah, and it must have been.
Speaker 2 (13:14):
I hope there's some good video of the of the transplant,
because you could be one of the only people who's
ever done his own heart transplant. I don't know how
the anesthesia works on that. He had someone holding a
mirror up over your face so you could get in
there and you know, ask for the hemostat and so on.
Speaker 1 (13:30):
But that must have been pretty impressive.
Speaker 4 (13:32):
If it was possible, I would have done that. But
this the second best thing is I hired the guy
who did my heart transplant. Well, so you know, I
knew I was in good hands.
Speaker 2 (13:47):
So one one more question for you. Oh here, hold
on listener listener question. A couple of listener questions. I
have a cousin who recently passed from liver cancer. I'm
curious if pig livers could be trans planted into humans
who have liver cancer.
Speaker 4 (14:03):
Yeah, so, you know, it's an interesting, interesting question because
normally we don't think about doing a transplant for cancer,
but liver cancer is actually an exception to that, where
people can actually get a benefit, you know, in their
longevity if they have certain types of liver cancer from
a transplant, you know, rather than cancer surgery. So we
(14:28):
do liver transplants for certain types of liver cancer. And yes,
you know, I'm optimistic that, you know, in the future
that people will be able to get a pig liver,
genetically edited pig liver to you know, survive and do
well with liver cancer.
Speaker 1 (14:48):
How about pancreas for diabetics.
Speaker 4 (14:52):
So we probably wouldn't do the entire pancreast. But you
know the part of the pancreas that makes in Slynn
it is you you can isolate that from the rest
of the pancreas which helps digest.
Speaker 3 (15:06):
Food, and those are called islets.
Speaker 4 (15:09):
And so there's really encouraging work going on transplanting pig
islets into people with with.
Speaker 3 (15:18):
With diabetes, particularly type one diabetes.
Speaker 2 (15:21):
Yeah, you know, I think maybe Marty McCarey is working
on that islet stuff. I don't know if he's don't
know if he's a friend of yours, but I think he's.
Speaker 4 (15:29):
I think he's he is a friend of mine. He
is a friend of mine. We're both at Hopkins together.
So before you know, I came to n y U
nine years ago, I was at Hopkins and he's you're right,
he's a pancreas does mostly cancer work.
Speaker 2 (15:46):
I bet I'm the only radio host you will talk
to who will bring that up. Let's see a couple
other listener questions and then we'll and then we'll call
it a day. It is the are the pigs that
you use a very particular type of pig and it's
so wid.
Speaker 4 (16:03):
Yeah, so we have some you know, we have different options.
There are a couple of different pig companies. Some of
them have like what are what are called genetically inbred pigs,
so they're essentially you know, you could you could transplant
between the two pigs and they wouldn't reject the organs,
so they're almost like identical twins.
Speaker 3 (16:21):
So that's one option. But most of the other.
Speaker 4 (16:23):
Pigs are what we call outbred pigs, so they're they're
more you know, typical of you know, they're just a
particular species of pigs. But the important thing is that
they have to be kept in a pathogen free facility
where there's no infections, no risk of infection. So that's
(16:44):
the that's the that's what makes them really special is
the way that they're you know, genetically engineered and and
the way they're they're housed and and taken care of.
Speaker 2 (16:56):
This is probably my favorite question so far. Could an
orthodox to Jew take an organ from a pig?
Speaker 3 (17:04):
Yes, so.
Speaker 4 (17:06):
If you if you talk to your rabbi, you know,
and this this is true for Muslims as well. There
there's really you know, if it's a life saving situation,
most I think religious leaders would say that's okay. And
(17:27):
of course we've been using pig valves to replace human
heart valves, and.
Speaker 3 (17:35):
You probably have.
Speaker 4 (17:36):
Some Jewish friends who are walking around with pig valves,
so that is an acceptable thing.
Speaker 2 (17:42):
And I'll just note to listeners, in Jewish law, you
can do almost anything, right. You can you can eat
on yom kipor you can do almost anything that you
wouldn't otherwise be allowed to do if it's to save
a life.
Speaker 1 (17:55):
So I think this would go into that, all right,
So we.
Speaker 2 (17:58):
Got about one minute left and one more listener question
that I.
Speaker 1 (18:01):
Think is quite interesting.
Speaker 2 (18:03):
Since pigs generally don't live as long as humans do,
would you expect the pig organ to kind of reduce
what you might otherwise expect a human lifespan to be
if you got a human organ instead.
Speaker 4 (18:20):
We don't really know the answer to that question. You know,
pigs usually live into their twenties. You know, the the
average time for a kidney transplant to survive is somewhere
between ten and twenty years anyway, And we'd also don't
know that if you take an organ that has a
(18:42):
different life expectancy and you put it into someone who
has a longer life expectancy, will it receive certain cues and.
Speaker 3 (18:53):
You know, will will it actually increase the longevity of
the organ, And.
Speaker 4 (18:57):
That's something that I think, you know, in our lifetime,
we're going to be able to answer those questions.
Speaker 2 (19:03):
Doctor Robert Montgomery is the director of the NYU Lango
and Medical Centers Transplant Institute, on the leading edge of
using organs from genetically modified pigs to increase the supply
of organ availability for humans who need transplants. It's incredibly
important and fascinating work. And Bob, I thank you so much.
I know you're a very busy guy. I thank you
(19:24):
so much for making time for us today.
Speaker 3 (19:26):
Well, thank you Ross for having me on your program.
Speaker 1 (19:28):
Yeah, glad to have a questions. I thoroughly enjoyed it.
Thanks Bob. We'll keep in touch.
The Ross Kaminsky Show News
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