Life Advocate Magazine - September/october, 1999 Volume Xiii Number 8

Whose body is it anyway?

Got Organs?

The debate over organ transplantation and research demonstrate that "My Body, My Choice" is empty rhetoric in more ways than one. Almost as meaningless are traditional terms like "death" and "donation." This month, Life Advocate takes a look at a fast-growing industry that has everyone bending the rules, morally and legally, for a profit.

• Language of the transplant industry
• Attitudes about donation
• The age of "Already Dead"
• The Wholesalers

A general history

Interested in talking about organ transplant politics and ethics?

The odds are that you aren�t. Most Americans give little thought to what is fast becoming a highly networked industry. Organ harvesting and transplantation is viewed by some as a blessing; by many as a necessary evil; and by a small but increasing number of people as evil without qualification.

Organ �procurement��some agencies disdain the term �harvesting��has a long history according to apologists who see inferences at every corner.

�Didn�t Jesus do an autograft [using a patient�s own tissue] by reattaching a wounded soldier's ear?� they ask.

Such an interpretation leads to the suggestion that the Son of God sought to ratify an Old Testament reference to transplantation.

�A new heart also I will give you, and a new spirit put within you.�

A verse out of the book of Ezekiel is referred to by some as proof-positive that organ transplants have always been part of God�s grand plan. Serious Bible scholars scoff at such a tortured use of Scripture, but less wary individuals embrace God�s promise of spiritual renewal as though it were a pledge intended for such a time as this, the age of organ transplant technology.

These abuses abound among champions who debate the benefits of using body parts. Warping Scripture out of context is not the only resource for such shallow ethical thinking either.

Surgeon and would-be Rabbi Richard Pauli make the case that the Gemara�a commentary on the Talmud�discusses organ donation by way of reference to the history of King David�s army. He cites a Halacha & Medicine conference in Jerusalem �a number of years ago,� in which it was brought up that �runners in David�s army had the pancreas removed� for an unspecified reason. Scripture does not support this theory, but then there are many eyelash-splitting rules and references in the Gemara that lack anything more than the substance of an opinion.

Mythological gods were known as chimeras�part man and part animal�are pointed to as evidence that ancient cultures outside of the Judeo-Christian faith have historically foreseen and embraced the sharing of tissue and organs from one body with another. Cross-species researchers hint that these mythical gods are hard evidence of the ancients pointing the way toward advanced science and technology. They, in turn, endeavor to grow pig hearts for use in human cardiac patients in a process called xenografting. The process alternately �shows promise� or has resulted in �failed research,� depending upon the source of information and the degree of financial or philosophical investment in the experimentation.

But apart from Bible verses pulled out of context and a stubborn insistence on transplantation technology as merely part of an ancient continuum, there is at least a small amount of documentation to suggest that transplantation is neither new nor just recently a source of conflict.

As far back as the second century B.C., an Indian surgeon, Sushruta, pioneered a skin grafting procedure for rhinoplasty, i.e. plastic surgery whereby the patient�s own skin is used to do a reconstruction of the nose. In those days, the cutting of noses was a common practice to punish criminal offenders who might later seek a sort of cosmetic remedy. Dueling battles separated many a man from his nose and necessitated surgical repair. What made Sushruta successful was that he restricted himself to what is called autografts, using only tissue from the patient.

On the other hand, allografts, where the tissue was taken from another and used to transplant onto a patient�s body, consistently failed. Slaves became a ready resource for skin transplant donations during a time before concepts like �informed consent� had been hammered out to protect unwitting and unwilling subjects.

The result of allografting tissue from one person to another was an increase in infection and even dismemberment and death for both patient and �donor.� Such abuse of one man to benefit another was soundly criticized by Renaissance writers like Voltaire and Samuel Butler.

Italian surgeon and anatomist, Gaspare Tagliacozzi, lamented the failure of allografts stating in his 1596 treatise De Curtorum Chirurgia per Insitionem, that, �The singular character of the individual entirely dissuades us from attempting this work on another person. For such is the force and power of individuality, that if anyone should believe that he could achieve even the least part of the operation, we consider him plainly superstitious and badly grounded in physical science.� Science and medicine had a wealth of information yet to uncover before organ and tissue sharing could be conceived as anything other than blind experimentation at a patient�s expense. Xenotransplants, grafting tissue from different species, was reported to have been somewhat successful around the turn of the 19th century when an Englishman, John Hunter, reported the successful transplant of human teeth into the comb of a cock, and a cock testes into a hen. Hunter�s chimeras seemed to have little value other than to prove that living substances�even though unrelated�might have a tendency to unite if transplant conditions could be controlled to eliminate problems. His research report was followed by accounts from others like G. Baronio of Italy, Claude Bernard, and Paul Bert, both of Paris, France.

In Ireland, Samuel Bigger successfully transplanted a full cornea into the blind eye of a pet gazelle.

All of these researchers used animal studies to test the potential for transferring one type of tissue or another to a completely separate animal.

A breakthrough in human transplant technology took place in 1869 when a Swiss-born scientist by the name of Jacques Louis Reverdin successfully transplanted skin across a granulated wound surface. His accomplishment was followed only a few years later by another researcher, Thiers, who reported great success in grafting skin from one patient to another. But �great success� must be qualified. None of their research resulted in long-term graft survival.

An exception to the dismal long-term acceptance of allografts might be found in Sir Winston Churchill. It was reported that he donated a bit of flesh to a fellow officer for skin grafting purposes during the Sudanese war of 1898.

Churchill later wrote that what was used was, "A piece of skin and some flesh about the size of a shilling from the inside of my arm. This precious fragment was grafted to my friend�s wound. It remains there to this day and did him lasting good in many ways. I for my part keep the scar as a souvenir.� Beginning with the turn of the century, the nineteenth to the twentieth, human transplantation experiments sprang up all around the globe. Dr. Edward Zim was the first to succeed at a corneal transplant in 1906. The procedure enjoyed such a high rate of success that within short years corneal transplants became part of the standard medical procedure when dealing with blinding ailments of the eye. Such transplant technology has allowed the blind to see and restored fading vision in hundreds of thousands who would otherwise have lost sight.

In France and Ukraine, surgeons transplanted pig and goat kidneys into dying human subjects in a last-ditch effort for survival. Advances in suturing, including the production of very fine suture materials, meant that small vessels could be connected, their output controlled, and bold, even highly unethical experiments ensued to test the transfer of larger organs.

Alexis Carrell perfected the vascular anastomosis technique leading to all kinds of experimental transplants including the grafting of a dog�s head onto the neck of another dog. All these allogeneic and xenogeneic transplants were invariably unsuccessful as was the first human cadaveric kidney transplant performed in 1933 by the Ukrainian surgeon Voronoi.

The 1930s saw a decline in transplantation-related research. Surgeons concluded that, except for corneal grafting, all attempts at skin and organ transplants would ultimately fail due to rejection. Immunosuppression techniques were in a state of infancy and often, like X-irradiation, turned out to be impractical. The next twenty years would be noteworthy for an accumulation of information concerning the body�s immunologic characteristics as researchers noted the proliferation of lymphocytes�white blood cells�and another exudate around transplant sites. But at the same time, the immunity hypothesis of rejection�the idea that individual cell factors were responsible for tissue rejection�was largely discarded.

Eventually, though, the growing mountain of data on immunobiology set the stage for transplant technology to take off in 1954.

Doctors Joseph Murray and John Harrison made history with the first successful live kidney transplant. The donor and recipient were identical twins, organ compatibility was at its optimum, and the surgery was a huge triumph.

What follows is a small listing of transplant milestones:

• 1960 First kidney transplant at Stanford University Medical Center.
• 1963 First lung transplant done by Dr. James Hardy, of the University of Mississippi.
• 1963 First liver transplant done by Dr. Thomas Starzlof the University of Colorado.
• 1967 First heart transplant done by Dr. Christian Bernaard, of South Africa.
• 1968 First U.S. heart transplant done by Dr. Norman Shumway, of Stanford University.
• 1982 Barney Clark receives the first permanent artificial heart at the University of Utah Medical Center.
• 1984 Baby Fae receives a walnut-sized baboon heart in an operation at Loma Linda University Medical Center. The first infant to receive an animal organ, she lived for 21 days.
• 1986 The first successful double lung transplant is done by Dr. Joel Cooper, Toronto General Hospital.
• 1991 First successful small intestine transplant.
• 1996 U.S. surgeons at Barnes Hospital in St. Louis, University of California, San Francisco, and Stanford University Hospital perform split-liver transplants, a procedure that has been attempted fewer than 100 times worldwide with mixed results. Surgeons work with blood vessels and bile ducts so small that the suture material used to reattach them barely is visible to the naked eye.