TV: Organ Farm
Authors: P. A Andrews
Journal: BMJ (2001)

ITV, 10 June at 11 05 pm, 13 June at 11.30 pm, and 17 June at 11.15 pm

 

We have come a long way from the earliest days of organ transplantation, whether renal transplantation by Murray in 1954, heart transplantation by Barnard in 1967, or more recent neural transplants for Parkinson's disease. Preservation, surgical, and immunosuppressive techniques have evolved, and both short and long-term outcomes continue to improve. Yet there is a crisis in transplantation. The unmet need grows each year, waiting lists for surgery lengthen, and patients continue to die.

To many, a more radical approach is required. Organ Farm was a series of three one-hour documentaries examining the current status of xenotransplantation, or cross-species transplantation. As ever in such programmes, it used a number of heartrending stories to tie together the narrative, together with an unnecessary amount of intrusive new age background music. Unusually, however, it offered a largely balanced perspective on a fascinating and complex area that has not received the media attention that might have been expected.

Xenotransplantation is big business. One estimate is that a successful programme would generate an annual market of $6bn (£4.3bn). Thousands of lives might be saved, but there remain many unanswered questions. To date, even using genetically modified pig donors, no trans-species kidney or heart transplant has lasted even for 90 days. Can the problems of hyperacute and second set rejection be overcome, and at what morbidity? Who would be offered transplantation, and at what cost? Even if transplanted organs survived, would their physiological function be appropriate to that of their human hosts? These questions were only minimally addressed.

Greater emphasis was given to the problem of porcine endogenous retroviruses (PERVs). Although preliminary work has shown no evidence of pathogenic transmission of these pig viruses to man, we have little idea how they might behave in the context of solid organ transplantation into a heavily immunosuppressed recipient, particularly when the donor tissue has been genetically “humanised” and might have lost some of its antigenicity. Of concern is that viral infection has already crossed the species barrier into immune deficient mice, with uncertain consequences. The chance of a future HIV-style pandemic appears remote, but not one expert in the field felt able to wholly deny the possibility. Although this risk of infection may appear irrelevant to a dying man awaiting a transplant, the wider community requires a higher level of reassurance. Are the risks of transmission acceptable—and what role has the public to play in this decision? 

The programme makers received unprecedented cooperation from scientists in the field, some of whom have good reason to be wary of the press and attendant publicity. They made articulate and convincing arguments for their cause. Several stated that they believed that clinical xenotransplantation was imminent, with the first solid organ transplants occurring within the next two to five years. The debate thus seems to be moving on from the technical issue of “can we” to the much more difficult issue of “should we.” However, no matter how impressive the examples shown, we should examine the evidence critically. A young woman received a pig neural cell infusion to the right side of her brain following a severe stroke, and appeared to make an excellent response. Later, it emerged that the only controlled study of pig neural cell infusion in neurological disease with a sham infusion arm had a “disappointing” result. To quote a legal maxim, “bad cases make bad law.”

Genetically modified food makes headlines, but we are all eating it; the boundaries of in vitro fertilisation are pushed back yearly; the spectre of BSE (bovine spongiform encephalopathy) casts its cloud over the eating habits of much of Europe; and abortion has moved from a medically indicated need to a freely prescribed social tool—in such a world, we need to be wary of the creeping deregulation of our health and the environment. No matter how well meaning, experience to date of the toothless tigers that pass for our regulatory bodies does not augur well for effective control of the vast commercial interests that drive much of the current scientific agenda. A wide ranging public debate is required before the practice of xenotransplantation is allowed to progress. How it will be facilitated by an 11.30 pm slot in the television schedule remains to be explained; it is unfortunate that one opportunity appears to have been lost.