Mary Miller-Duffy was dazed and sad. Her brother collapsed suddenly and was brain dead a few days later. Now she faces a thorny question: Will she donate his body for research?
And so, the body of Maurice “Mo” Miller began its journey to a sunny corner of the intensive care unit at NYU Langone Health and became the culmination of efforts seeking to one day alleviate the nation’s animal organ transplant shortage. part.
“He always wanted to help people,” said Miller-Duffy, who struggled with the choice but was proud of her brother’s final act. “This tragic death, this quick and short death — some good has come out of it.”
Surgeons replace Miller’s kidney On July 14, he collaborated with a genetically modified pig. Doctors and nurses then cared for the dead as well as the living, while anxiously going through each day.
Remarkably, after just over a month, the new organ began to perform all the bodily functions of a healthy kidney — the longest time a pig kidney has ever worked in a human. Now the countdown is on to see if the kidney can last until September, the second month.
The AP gives insight into the challenges of conducting experiments on the dead, which may help bring animal to human transplantation closer to reality.
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There is little hope for an organ transplant these days. There are more than 100,000 people on the national waiting list, most of whom need a kidney. Thousands of people died while waiting. There are thousands more who might benefit that haven’t even been added to the list.
“I went through seven cardiac arrests before I was sick enough to qualify for a new heart,” said Dr. Robert Montgomery, director of NYU Langone Transplant Institute. He is a kidney transplant surgeon and was lucky enough to receive his own heart transplant in 2018.
He firmly believes that filling this gap will require the use of animal parts.
After decades of failed attempts, pigs are now genetically modified to make their organs more human-like, rekindling interest in so-called xenotransplantation. last year, Surgeon at University of Maryland Trying to save a dying man with a pig’s heart – he survived for two months.
Montgomery is doing more practice with the dead before venturing out on living patients.NYU and some previous experiments at NYU University of Alabama at Birmingham Making pig kidneys and hearts work in donated cadavers for days to a week avoids the immediate rejection that doomed many earlier attempts.
But the most common type of organ rejection lasts more than a month. The pig heart in Maryland worked fine for nearly 50 days until it suddenly failed. Observing how pig kidneys reach these time points in donated cadavers can provide important lessons — but how soon can Montgomery expect a family to surrender their loved one?
“I’m in awe of someone being able to make that decision in one of the worst moments of their life and really think about … humanity,” he said.
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In Newburgh, N.Y., Miller was taken by ambulance to the hospital after he passed out and developed a mass on his brain. He never woke up during the biopsy and was brain dead at the young age of 57. The next move depends on his sister, his closest relative.
Miller-Duffy asked if he would donate his organs, but he was not eligible. A biopsy found cancer.
Only then did organ agencies offer whole-body donations. Miller-Duffy wasn’t familiar with it, but the goal of improving kidney transplants “resonated.” Another brother died of kidney disease in early childhood. Other relatives suffered from diseases that damaged the kidneys and even died from dialysis.
Flipping through family photos, Miller-Duffy recalled how her brother adopted animals and once cared for a terminally ill friend. Still, she has questions.
During the video call, Montgomery explained the pig transplant and why it made a difference to Miller Duffy and her wife, Sue Duffy. Montgomery’s sympathy won them over.
“You know, his body wasn’t injured,” Duffy said. “It’s just an incubation of research that is about to be done.”
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The experiment was a rehearsal for a one-day operation on live patients. As a helicopter flew to the hospital’s riverside tarmac, Montgomery had Miller’s own kidney removed. PhD. NYU surgeons Jeffrey Stern and Adam Griesemer competed on kidneys taken from pigs raised at Revivicor in Blacksburg, Virginia.
Sewing a pig kidney into a donated body is not much different from a conventional transplant, Stern said. Postoperative immunosuppressive drugs are also standard drugs.
One twist: The pigs’ kidneys have a thymus, a gland that trains immune cells, glued to them, so it may help protect the organ.
There are many extra steps before and after surgery.
First, what pigs to use: Some pigs have as many as 10 genetic changes, but Montgomery bets that one will suffice—removing a single pig gene, triggering an immediate immune attack.
While the pigs were being raised in sterile facilities, the researchers performed additional tests for any hidden infections. Everyone in the operating room must have certain vaccinations and undergo their own blood tests.
After the surgery, doctors wheeled Miller’s body to the same intensive care unit where Montgomery was recovering from a heart transplant five years earlier.
What follows is more rigorous testing than a living patient can endure. Every week, doctors biopsy the kidney, placing the sample under a microscope to look for any signs of rejection. The blood will be continuously monitored, the spleen will be observed, and nurses will be watching to see if the body is being properly maintained on the ventilator.
During the first few weeks, Griesemer checked lab test results and vital signs multiple times a day: “You’d think, well, hope it’s okay — but is this the day things start to turn around?”
They are shipping biopsy samples to research partners across the country and even as far away as France.
“Our staff doesn’t get much sleep,” said Elaina Weldon, a nurse who oversees the transplant study. But as time passed, “everyone now faces the question: What else can we do? How far can we go?”
She has firsthand knowledge of the enormous interest: NYU asked community groups and religious leaders before it began using donated cadavers for research, which might sound “more on the science fiction side.”
Instead, many wonder how soon in vivo studies can begin, which the FDA will have to decide. Dozens of people have written to Montgomery eager to get involved.
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Montgomery called Miller-Duffy and her wife regularly with updates and invited them to come to NYU to meet with the team. As the deadline for the first month of the study looms, he asks another question: If everything goes well, can they keep her brother’s body for a second month?
That meant further delays to plans for the memorial service, but Miller-Duffy agreed. Her request: When her brother finally came off the ventilator, she had to be there.
Whatever happened next, the experiment changed Sue Duffy’s mind about organ donation.
“Maybe I don’t need all my organs when I go to heaven,” she said. “Before I was a hard person to say no to. … Now I’m hard to accept.”
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The Associated Press Health and Science Division is supported by the Howard Hughes Medical Institute’s Science and Educational Media Group. The Associated Press is solely responsible for all content.
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