Creating organs for transplants is necessary, but it shouldn't have ethical costs

Creating organs for transplants is necessary, but it shouldn't have ethical costs
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There is a big health crisis in the U.S. that receives too little attention — the shortage of organs for transplant. As of January 2019, there were more than 113,000 people waiting on the organ transplant list, yet only 36,528 transplants were performed in 2018.  Moreover, 20 people die in this country every day while awaiting an organ. 

What to do? Urging people to donate organs is one strategy. The Center for Organ Recovery and Education, the American Transplant Foundation and Donate Life are important organizations that are deeply involved in trying to help. 

In the meantime, scientists all over the world are trying to increase options for useable organs. One idea that shows promise is three-dimensional printing. This technology produces artificial organs by using real tissue scaffolding.

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This idea is receiving a lot of attention and will likely prove to be a useful alternative or bridge for those awaiting transplants. 

Another idea with far-reaching potential is genetically engineered organs derived from other species, like pigs. This process renders them more compatible with humans and helps to overcome immunological differences so that the body doesn’t reject the organ.

Dr. Jef Boeke at NYU Langone Health is conducting groundbreaking research in this area. 

Unfortunately, a spotlight on the shortage of organs to transplant often opens the door for grandstanders who raise money to bend the rules and conduct rogue science by press release. Then there are some scientists and researchers who engage in highly controversial, or sometimes even questionable, research projects.

Dr. Juan Carlos Izpisua Belmonte has traveled from the esteemed Salk Institute in California to China where, apparently without the kind of rigorous regulation typically required in the U.S., he and his team reportedly were able to make a "chimera" — a hybrid organism, comprised of the cells of two or more species — by combining a monkey embryo and embryonic stem cells from humans. 

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The stated goal of using monkeys as a host for prospective organs is pointless, Arthur Caplan, professor of bioethics at NYU Langone Health, told me in an interview. “They are too small for human transplant sources."

Dr. Caplan added that, in his view, going to China to conduct such research is a matter of “simply ducking reasonable oversight. The whole dismal effort will do nothing for serious efforts at xenografting pigs, not primates.” Xenografting is the process of surgically grafting tissue from one species to that of another, different species.

In fact, Dr. Caplan went so far as to dismiss the whole undertaking: “There is no real risk of 'monkey people.' Too many incompatibilities; I don’t think chimeras are in our future any time in this century.”

Still, as technology and genetic editing develop further, and more synthesized embryos become possible, Izpisua Belmonte’s work appears to be lacking in ethical considerations, according to many of his critics. There is a reason that, in Greek mythology, a chimera is a fire-breathing monster with a lion’s head, a goat’s body and a serpent’s tail. 

According to these critics and other researchers, the future of transplant science is in the genetic engineering of organs for transplant, the way Boeke is doing, not using embryos and embryonic stem cells to build dying chimeras. The fact that Dr. Izpisua Belmonte is killing these hybrid embryos — after just a few days, before the organs can even start to develop — hardly exonerates him, according to those who oppose his research.

Previously, Izpisua Belmonte’s research has included a successful rat/mouse hybrid, and pig/human chimeras which did not succeed, in part, because the immunological barrier between the two species was too difficult to overcome. And Caplan says that the future of transplant science involves “humanizing pig organs. Not pigs!"

Izpisua Belmonte’s latest research not only brings to mind science-fiction movies, where yesterday’s fantasy becomes tomorrow’s problematic reality, but also the crucial problem of a lack of uniform international standards when it comes to scientific efforts. Creating organs for transplant is a crucial and pressing need, but it should not have any ethical costs.

There needs to be a governing body that endorses standards that governments must be under pressure to apply, whether in China, the United States or other countries. 

In the meantime, the Salk Institute should consider reviewing Izpisua Belmonte's research before allowing him to resume his work there.

Marc Siegel M.D. is a professor of medicine and medical director at Doctor Radio at NYU Langone Health. He is a Fox News Medical Correspondent. Follow him on Twitter: @drmarcsiegel.