Transplant surgeon Dr. Joshua Mezrich writes in his recently published book, When Death Becomes Life (Harper), about his experience with organ transplants, highlighting the selfless humanitarian gift whereby a healthy person undergoes surgery to donate a kidney to one suffering from kidney disease.
He writes in the voice of the donor, “Together we will fight through this. I will take the same leap of faith you are taking. Let me join you in your suffering. Let me bear some of your risk with you.”
Dr. Thomas Starzl writes in his transplant memoir, The Puzzle People, that “the patients are the real heroes.”
The brave act of kidney donation humbles me even after more than thirty-five years in the practice of nephrology.
Now, because of gene-editing technology, pigs are being evaluated as a potential source of kidneys for humans suffering from this cruel disease. Dr. Mezrich writes in an op-ed of the loss of the special human relationship if pigs, rather than people, become donors. Gone will be the solace to a grieving family of having their deceased loved one donate, thus giving life to another human being and so live on.
Dr. Mezrich writes, “It will deprive us of some beautiful and important things: the heroism of our donors and their families and the connection they establish with recipients, relationships that represent, to my mind, the best of our humanity.”
On a sentimental level I recognize the loss of this pinnacle of humanitarian behavior, but on a professional level I see the value of non-human donors. I am a rescue dog (dogs) owner and am sensitive to animal rights advocates, but if given the choice, I would prefer not to put a human donor in jeopardy. It just makes sense.
Furthermore, I am not certain that the precious gift is valued as it once was, except to those immediately involved.
Recently one of my patients with a transplant of twenty-five years came for a routine visit. The gift of donation was never lost on the patient or me. The patient had enjoyed robust health, become a parent, and now a grandparent.
This January I renewed the patient’s immunosuppressive medication, and this began a romp through the twisted web of prior authorization and low-level bureaucrats who don’t care about miracles and the humanity of kidney transplantation or, it seems, the humanity of anything.
Here is what transpired.
In early January I gave the patient a prescription for his medications. It was denied because he needed a prior authorization. (What changed?)
- I called for the prior authorization and it was denied.
- I was told to resend the script.
- I sent the script but they sent it back, saying I had to put the patient’s address and phone number on the script. Okay, I did that, but they denied it once again.
- I called and was told I had to fill out an information sheet and fax it back.
- This I did and was denied once again. Our office kept sending faxes, and we received a fax telling us to quit sending faxes.
- We were denied once again because we did not indicate whether it was for a living related or cadaveric kidney transplant.
- We sent all the old kidney transplant data, and it was once again denied.
- I requested a “peer-to peer” review with a “peer” who never saw the patient. No luck.
The patient contacted the insurance company.
We received a letter saying Medicare part D was not responsible for the drugs but that Medicare part B was responsible. When the pharmacist ran it through part B, it was denied.
The patient’s insurance company informed the patient that their pharmaceutical branch no longer had the contract for Medicare specialty drugs.
Finally they told the patient that he had to go to a drugstore chain that now had the contract.
The script was finally filled. It took three weeks.
It would appear that the humanitarian act of transplantation has been discounted. The selfless gift from one human to another may have become too routine. Familiarity breeds contempt.
I could not imagine that happening with the first kidney transplant in 1954.
So if pig kidneys could provide an unlimited supply, it is a good thing, albeit not very romantic or emotionally satisfying.
My final issue in favor of pig kidneys comes from another recent op-ed titled “The Nightmare of Human Organ Harvesting in China” (WSJ, Feb. 2019). The author, Mr. Benedict Rogers, alleges the murder of political prisoners for organ transplantation. I researched further and discovered allegations that were similarly disturbing. In 2016 Nobel Peace Prize nominees David Matas, an international human rights lawyer, and David Kilgour stated, “The Chinese Communist Party had engaged the state in the mass killings of innocents, primarily practitioners of the spiritually based set of exercises Falun Gong, but also Uyghur Muslims, Tibetan Buddhists and select House Christians, in order to obtain organs for transplant.”
China denies these allegations. It remains unproven.
An independent tribunal investigating forced organ harvesting in China concluded: “The Tribunal’s members are all certain—unanimously and sure beyond reasonable doubt—that in China forced organ harvesting from prisoners of conscience has been practiced for a substantial period of time involving a very substantial number of victims.”
It was alleged that during the Beijing Olympics, such harvesting was put on hold until the international spotlight faded. This is reminiscent of the halt of persecutions during the 1936 Berlin Olympics. What happened after 1936 began as allegations.
The Chinese “Real Bodies” display may have come from political prisoners as well. Once again these are allegations, but it is chillingly reminiscent of the Nazi-commissioned Pernkopf’s Atlas of Topographical and Applied Human Anatomy. Concentration camp inmates and Nazi political prisoners were used for this “scientific and artistic masterpiece.”
Presently intellectual exchanges involving some of our most prestigious medical institutions are underway with China. This is not right. Intellectual intercourse should come to an abrupt halt until these allegations are investigated and proved false. It would be in the best interest of all parties.
It brings to mind the Tuskegee syphilis study. The study was published in august medical journals and was well known in academe for decades. Sadly, for almost fifty years there was no protest and no outrage. In 1964 Dr. Irwin Schatz of Detroit’s Henry Ford Hospital wrote an oped in the Archives of Internal Medicine protesting the Tuskegee study (credit to my Motor City). The study was reviewed by the NIH in 1969, and it was thought that it should continue. It was eventually stopped by popular, non-professional outrage in 1973.
The use of pigs to supply organs for transplantation would cause the bottom to fall out of the alleged Chinese transplant atrocity and end alleged “organ tourism.”
Dr. Mezrich states that his biggest fear is harm to the healthy donor (me too), volunteer or otherwise.
Ethics and transplantation are interlinked by its concept and origin and mandates that those of us who take care of transplant patients and their donors must insist on patient safety. This is fundamental to the practice and cannot be compromised, regardless of personal or professional jeopardy. After all, we are asking healthy individuals to be put at risk.
It will be a while before pigs replace humans, so don’t invest in pork belly futures just yet. Despite the risks, I would donate to a family member in need. But the change in the attitude toward transplants and what allegedly is going on in China makes me think that the future belongs to the pigs—the four-legged ones.
References
Mezrich, Joshua D. When Death Becomes Life. Harper Collins, 2019.
Starzl, Thomas E. The Puzzle People. University of Pittsburgh Press, 1992.
Rogers, Benedict. “The Nightmare of Human Organ Harvesting in China.” WSJ, Feb. 5, 2019.
Mezrich, Joshua D. “Losing the Humanity of Transplants.” WSJ, Jan. 19-20, 2019.
Ochab, Ewelina U. “How Chinese Doctors Who Harvest Organs Get Away with Murder.” Forbes, Jan. 8, 2019.
Gutman, Ethan. The Slaughter. Prometheus Books/Penguin Random House LLC, 2014.
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Olaf Kroneman graduated from the Michigan State University College of Human Medicine with an MD. He interned at the Mayo Clinic in Rochester, Minnesota, then attended the University of Virginia to complete a residency in internal medicine. Upon completion of his residency, he participated in a fellowship in nephrology at Massachusetts General Hospital and Harvard Medical School. He entered private practice in 1983. His interaction with patients and other healthcare professionals prompted me to write.
Photo: Christopher Carson
