Transplants of the Future

since Tech Stuff in two thousand eight. That's going all the way back to the very beginning of Tech Stuff. That's when we were doing fifteen minute long episodes. I love all of how stuff works podcasts. And to keep this email short, I recently saw news of a head transplant that is expected to be performed in a couple of months. I can't recall a podcast specifically about head transplants, not off the top of my head. Wink wink. This sounds like a spooky subject, but very interesting. Keep up

amazing tech at Futuristic Podcast. I wouldn't know what to do about you, guys at work. So Camillo's referring to a news item about a proposed head transplant that would not be taking place in a couple of months, unless you guys are listening to this in two thousand seventeen, because that is when it would the proposed surgery would actually take place, right, and the technology necessary for this feat is not quite so far along as the popular media has perhaps made it sound ye that the story

okay is this? Back in July of one, doctor Sergio Carnavero of the Turn Advanced Neuromodulation Group or TANG in Italy announced his project to make head transplants possible. The project is called heaven Gemini, which is an acronym for something I do not know what. It sounds like, a like a robot in a video game. I know, right, we'll get there. Yeah. But so this February in he announced that the project's coming along well and that he thinks he'll be ready to conduct a head transplant surgery

within the next two years. Yeah. Then it started making more headlines because in April he got a volunteer with a medical necessity, one Valerie spird Nov. Now Spritanov has Type one spinal muscular atrophy a k A worden ing Hoffman disease. Uh kinda vera has also being contacted by the way by transgender people. But the procedure is so risky that, you know, even he would not want to try it, you know, with a healthy body, even if

that healthy body is is not the one that you want. Right. So, in other words, he would want only to perform the surgery for someone who is already at risk of dying or or whose quality of life is such that it would be considered a worthwhile risk. Right. And along those lines, let's take a second to talk about worden ing Hoffman. Sure,

this is an inherited trait. The trait is an autosomal recessive trait, and it's a disease that's caused by disruptions or mutations in the s m IN one or survival motor neuron one gene, which is located on chromosome five. And it's also known as infantile spinal muscular atrophy and characterized by the degeneration of nerve cells within the lower

brain stem and certain motor neurons in the spinal cord. Now, this leads to muscle weakness, generally beginning in the extremities and eventually leading to other areas including muscles involved in chewing, swallowing, and breathing. Uh. And tragically, a large percentage of infants who developed this pass away before reaching the age of two. So you can see why somebody suffering from this condition might be a candidate for something like a head transplant,

if that were possible. Yeah, and Sprintanov himself has said, you know, he has lived beyond what most people had expected he would be able to to. You know, most people thought he would have passed away by now, most of the doctors he had been consulting through out his entire life. And so his his position on the matter is that he he is experiencing a difficult life. He's not expected to have a very long lifespan, and so for him, this is a risk that's worth taking. Sure. Sure.

And you know, if if these headlines about the possibility of a head transplant have sounded kind of incredible to you, you're not the only one that the medical community has has kind of been an agreement about that, and that's been kind Yeah, and that's partially because a successful organ transplants have really only been happening for the past fifty years or so. So before we go into the specifics about this head transplant surgery and the controversy surrounding it.

I want to take a look at the history of the medical technology surrounding transplantation. Sure, I actually didn't know that this was such a recent phenomenon. I imagined it would be one of those things that had been done in a dirt, an unpleasant way for hundreds of years. Well, there were certainly lots of early attempts that almost always resulted in the immediate death of the patient. If not that,

then it resulted in the eventual death of the patient. Right, We've we've actually only had the technology, or rather than the methods to perform vascular anastomoses that that's joining up to blood vessels since the very beginning of the twentieth century. And it wasn't until then that people could really start to attempt real organ transplants. And I'm sure that there were a few unfortunate cases earlier than that where people kind of like stuck an organ in a thing and went, oh, nope,

that's not working. But there well, I know there are a lot of cases in like mythology, and you don't know to what extent that might have been based on some horrific ancient experiment. Yeah, yeah, absolutely, um So. One of the researchers who was working on on the methodology of joining blood vessels together began attempting organ transplants in

nineteen o six. Uh He He was trying to put a goat or pig kidneys into human patients who were experiencing renal failure, which, to be fair at that time was was a mortal organ failure. There was no coming back from that one. Um It obviously did not work out, but it did get the field started. In the meanwhile, another technology was in kind of co development in the medical community, and that's artificial respiration and circulation, and by nineteen fifty three, the heart lung machine or or the

pump as we know it today had been created. That's something that can artificially circulate a patient's blood and an oxygen during a surgery. It was it was used for the first successful open heart surgery in and the next year in we get the very first successful human organ transplant, which was a kidney transplant. The doctor uh ended up transplanting a kidney from one identical twin to another identical twin. And the benefit of that is there was no risk

of oregon rejection. In fact, that's the only case apart from using someone's own tissue, where you don't have to worry about the the rejection of tissue that you would in other transplant surgeries, right, Right, And I'm not sure whether people knew at that specific time that that was why it was successful. Yeah, I'm not entirely sure either, because there was a lot of unsuccessful transplants after that, right,

There were quite a few. So Dr Joseph Murray was the one who performed the procedure and was eventually awarded the Nobel Prize for this work. Yeah, and the recipient of the kidney lived for eight years after the transplant surgery, so that was considered a success. It led to other

surgeries that were not as successful. Yeah. If you look at the history of transplantation other than this, which the person lived for eight years afterwards, very often you see like, well they lived for seven days after d or twenty days, and that has a lot to do with the rejection of tissue that I was talking about. And then even after we started to develop drugs to help prevent that, the drugs themselves could lead to complications that could lead

to fatalities. So it all depends upon the the technology and the drugs and the processes at the time. So nineteen fifty four is the first Oregon transplant. We moved to nineteen sixty three and we get the first lung transplant surgery, performed by Dr James Hardy. The recipient was actually a patient who was serving a life sentence in prison. The patient had lung cancer which had resulted in a collapsed, long and recurrent pneumonia. So Dr Hardy performs the lung transplant.

It's considered to be a success. The patient begins breathing almost immediately, uh, without any problems. However, the patients subsequently suffered progressive kidney failure and died eighteen days after the transplant. Goodness, yeah, so the autopsy didn't show any signs of organ rejection. But other procedures that followed in the next few decades,

and there weren't a whole lot. It wasn't like there were hundreds, but you know, the next several decades saw similar problems, with patients dying within a few months of the procedure, and the first truly successful lung transplant one where the patient would go on to live a normal

lifestyle after the procedure was done. That didn't happen until nineteen eighty three, so two decades after the first one was when you had the first truly successful one um and that just kind of tells you that, you know, this is really complicated stuff. The first heart transplant took place in nineteen sixty seven, that was performed by Dr Christianne Barnard, and the patient passed away eighteen days after

the procedure due to pneumonia. And this is where we see that the the anti rejection drugs, those are immunosuppressive drugs, because when you get somebody else's organ in planted in you, unless it's just the right one, like from your twin or something, typically your immune system regards that organ as something that shouldn't be in there and goes to work attacking it. Exactly, so, your own immune system is attacking your new oregon and that is obviously going to be

a true complication. So that's why these immunosuppressive drugs have been administered in order to reduce that. But that also opens up the doorway to other potential uh, you know, pathogens, other potential illnesses, and you need your immune system. Yeah,

it's it's pretty good to have around. Um. But advances started being made to those drugs in the nineteen seventies, right, Yes, that's when the chemists began to the chemists, that's when chemists in general began developing the anti rejection drug cyclosporing, which worked much better than earlier anti rejection drugs. Wouldn't be until nineteen eighty three that the FDA would give

it clearance to be used in transplant surgeries. And like we were just saying a second ago, these immunosuppressant drugs, well, I mean in general, they interfere with either the creation or the activities of your your body's T cells, which are these specific types of white blood cells that that remember and attacks stuff that they identify as dangerous in

your body. Um. And and this drug, cyclosporing is particularly useful because it, uh, it's the way in which it messes with your ear T cells is a little bit gentler that that some of the previous drugs, which were a little bit more of a nuke it from orbit kind of option, right. Uh. And yeah, So so being able to to mediate T cells response means that you can prevent them from attacking stuff that you want in your body, like a new heart or like your joints.

The drug is also used in a rheumatoid arthritis care for example. Yeah, it's interesting. I mean we when we talk about our immune systems, they are incredibly important, but way they can cause some big problems right when you you least need those big problems, and things like allergies. See yeah, cats, dumb body. Yeah, I want to hug the cats. Yeah, we can have a whole discussion about my allergies and how I'm not very pleased with them,

but at any rate, UH immune systems. Clearly we'd be much worse off without them, but we do have to take them into account with something as traumatic as a transplant surgery. UH. Now, when we move on with some more kind of cool updates to transplant technology, we start looking at UH synthetic and regenerative medicine approaches, which are

really awesome. This is the idea where we don't necessarily have to rely upon a donor to get the organ that we need in order to perform the transplant, and the earliest examples of this are actually UH in skin grafting products. So like a not like an internal organ but rather an external Yeah. So the first one would be an apple graph, which was a skin grafting product that the FDA approved, and in two thousand one the

FDA approved Dermographed, another kind of skin graph product. So this would allow doctors to grow the skin externally, you know, not attached to the patient, and then grafted onto the patient without having to remove a patch of skin from one part of the body and transplant to another part of the body. Right, it's really useful for stuff like like ulcers that are not healing under their own power. And these things are all basically fake skin that contain

real human cells. And and by fake skin, it might be a collagen that's been composed of of of cow cells or something like that. But but at any rate, it's it's a bio structure that that you can put on a patient and it will grow into the patient and his body and attached to the patient's own skin. So that is so gross and amazing. At the same time, I started thinking about the dark Man series, one of those and you don't go out in the sun because otherwise it all just end up bubbling off of you.

It's only in dark Man, though not this stuff. Dark Man, the one that had a certain set of skills. Well he he later proved to a certain set of skills. Yes, yes, yes, many things were taken from dark Man. In two thousand and eight, a patient received an airway transplant that was regenerated airway, so the airways scaffold came from a donor.

That part was remained like a traditional transplant, but the doctors had removed the donor's cells from the scaffold, the various cells that were attached to the scaffolding, so it's just kind of a raw structure at that point. They Yeah, they added bone marrow cells from the patient, and the bone cells are essentially kind of like stem cells subset of stem cells, if you think of it that way.

They used the bone marrow which would ended up creating the the tissue for the airway, and then they transplant that into the patient and this helped reduce the possibility of an oregon rejection because it was the patient's own tissue, right right. The thing about bone marrow is that all of your T cells are grown there. So if you have some some bone marrow cells creating T cells, then yeah, yeah, it's already saying hey, Uh, we're all on the same

team essentially. Then we saw the first full face transplant. Uh, you know, bone bones and all like like cheekbones, jaw, nose, teeth, all the muscles and eyelids and all of that stuff. Uh. And it's so hard to not make a face off reference here, but man, that movie is really terrible and this surgery is really incredible. Uh. And this was basically made possible, I mean because we had all of the all of the elements of that, all of the bone afting and and uh and muscle connection and all of

that stuff. But but anti rejection medication was really what allowed the surgery to be a success. Um. The the patient went through two phases of rejection and was saved successfully both times. Wow. Uh. In two thousand eleven, that's when a patient received the first regenerated airway transplant that used a synthetic scaffold rather than one from a donor, so in this case, there was no need for any

kind of donation. They were able to build it from the ground up essentially, and in the first successful regenerated trachea transplant takes place, as well as a successful regenerated trachea with synthetic scaffold transplant in a child man. So now we're getting to that point where we'll talk more

about this in a little bit. But the idea of being able to build these synthetic structures and then incorporate the patient's tissue into those synthetic structures to create new versions of the patient's own organs, that's where we're headed. But we'll talk more about that in a little bit. Um As for head transplants, to get back to the topic at hand, Uh, well, we've seen some experiments, some

pretty crazy mad science style experiments involved. Well we can certainly recall those Russian experiments with like dogs taking the head off of a dog and putting it on another dog or well I think they were also just experimenting with if they could keep a dog's head living not attached to the dog body, so they attached it to like a circulatory Uh yeah, and you can see videos of this if you believe that no special effects were

involved in creating them. At the time. They would like do incredibly disturbing things like pound a hammer on the table where the severed dog's head was, and the dog's head would seem to sort of react react to it. Yeah. Um, yeah, we talked about that in our episode about Frankenstein. Yes we did. I cannot, I cannot ever watch those again.

Once was enough. It was truly disturbing. Yeah. But in the nineteen fifties and sixties and even into the seventies, there were some experiments, largely in Russia but in other places as well, with head transplants with dogs and monkeys. Um. There was one monkey head transplant that was successful for eight days. The monkey was able to continue eating and breathing, but had was essentially paralyzed from the neck down and died eight days after tissue rejection. But it did kind

of work that the spinal cord never fused back. That was one of the things we'll talk about too. Well. That seems like a pretty major issue, a huge issue obviously. But anyway, these these were these were um experiments, but none of them were like, uh, you know, a ground the foundation for further work, right. No one looked at

them and said, you know, this is a great plan. Yeah, Okay, Well I think we should look at where the science of transplantation rests today, like what are we good at doing and what are the things that that are still presenting problems for us. Well, guys, we are so good at cutting. We are terrific at cutting stuff like seriously.

And this is important because, uh you know, as you have perhaps seen in your own kitchen, if your knives are getting a little bit dull, a less than sharp edge, what will damage the tissue that you're cutting and and invite an immune response, which is what you do not want. Right Cutting with a dull knife tends to sort of

do some ripping and crushing exactly. Um. So with it, with advances in material science necessary to create very sharp blades, and with the advent of laser systems that can be used in surgery, we are able to keep both the organs and the patients much healthier. Uh. We've also developed ways of keeping organs viable while waiting for to perform transplant surgery. Typically this involves bathing the organs in a

cold salt water solution or saline uh. And it well usually let the organs last several hours, depending upon the organ. So for kidneys it could be forty eight hours, for livers it's about twenty four hours. For all heart only five to ten hours, So it's very dependent upon the type of organ. Obviously, with something like a person's head, you've got a lot more to consider, you know, keeping

the brain oxygenated and everything. So, but the the whole idea here is that by lowering the temperature, you lower the amount of energy the cells need to exert in order to survive, and that prolongs their viability so that you can get them to where they need to be in the surgery can be performed, but it is a matter of hours, right. This isn't something where you can just you know, you've got a freezer full of organs and you can just go and pull one out whenever

you need it. It's it's one of the things that makes this such a delicate and difficult um field of medicine. Here's another thing that I think is fascinating, which is the ability to keep a patient alive while you're sort of like moving around or removing or inserting organs that we normally think of as absolutely critical to survival. How

do you actually do a heart transplant? Uh, you hook someone up to one of those artificial heart lung machines and kind of let it go and you you also one of the advances that we've seen since the nineteen fifties, was the capacity to do that with artificially cooled blood, which helps the rest of the patient's body. Oh, I'm sorry, literally chill out. It just kind of it preserves the

rest of the organs while the transplant is going on. Yeah, we talked a little bit about that when we were talking about the possibility of suspended animation in a previous episode. How this is something that's apt hypothermia. I don't know if this would technically qualifies that, but at least it's

a similar principle. Keeping temperature is low to prevent tissue degeneration. Yeah. So, and even in that episode, if you recall, it was really all about keeping a patient alive in order to address a medical issue immediately, as opposed to perpetually keeping that patient alive until you can thaw them out, like a hundred years from now. That's not what That's not

where the technology is right now. Um. Then, of course we've got the immunosuppressive drugs, the anti rejection drugs we're talking right, So the early ones were pretty pretty damaging to a person. Even if they were working as they were intended, they could cause other consequences. For example, because in general killing stuff in your body, like like we all know from an example for for chemotherapy, Yeah, kill

stuff in your body. Yeah stuff, the good and the bad. Right, So the newer drugs have lower toxicity with fewer side effects like side effects like raising your blood pressure or your coless role or even uh, giving you diabetes that could be one of the side effects of these older immuno suppressive drugs and still a risk with the current ones. Um, even with those advances, there are a lot of things

you have to take into consideration. They can be toxic, toxic to kidneys, they can cause they may cause cancer and uh. And the thing about them is that most patients who have to start taking them due to a transplant have to take them for the rest of their lives. Yeah. So one of the things that people are really looking into our ways of performing surgeries that would not require

immunosuppressive drugs. So in other words, these were generative medical approaches where you're using the tissue from the patient him or herself, then you don't need to worry about using the immunist suppressive drugs for the rest of their lives. That because they're getting a transplant of their own tissue um. Obviously that would be a huge benefit. All right, well, let's bring it back to the discussion of the head transplant,

because that's what everybody's got to know. Can I get my head put on a more attractive body or maybe like a dinosaur body? Right? Well, I'm sorry to sound like a tale from the crypto. I'm sorry, No, that that was in bad taste. I shouldn't make light of it. Actually, you know, can you if you have a dise he is affecting your body? Yeah? Can you? Can you actually get a head transplant? So let's let's look at Canavero's proposal.

It's pretty it's pretty intense. Yeah, he's estimating that it will require the coordinated efforts of a hundred surgeons working for a grand total of thirty six hours, although the surgery itself would be very short. Yeah, we'll talk about that in a second. So your head disconnected for thirty six hours. No, that would be bad, um because for one thing, a head can't remain viable on its own. It would have to be kept alive throughout the procedure,

which would be pretty tricky. Yeah, you can't. You can't put it in a a saline solution like you could with a liver or a heart, you would have to have, you know, some form of circulation going with that head the entire time. Plus the head is home to lots of stuff like it's not an oregan like a heart, right you're talking about. You have your eyes, you have your nose, your um, your ears, you've got skin, you've got glands that are very important um all located in

that area, and of course you have the brain. So if you decapitate ahead, which obviously would be one of the steps of this surgery, you immediately have a decrease in blood pressure in the head. No big surprise there, there's no way of pumping blood continuously there. But that also means that you have a you start to deprive the brain of oxygen, so then the patient would go

into a coma, which would be shortly followed by death. Right, You'd start to have that cell death throughout the brain, which is exactly what you don't want to happen because we generally consider that your river postables is damage to

the brain that's going to kill you. So Canavero has based the the idea that it needs to the procedure of actually hooking up the head from the patient to the donor body would need to happen in less than one hour based upon previous surgeries, including the one I was referring to earlier about the the monkey head that had been transplanted and lived for eight days. Uh, that

was all based on those earlier experiments. And so the actual point where you separate the patient's head from the patient's body and then attach it to the donor body would have to take less than an hour out of that full thirty six hours we were talking about previously. Um, you would have to have that connection there so that the the brain could remain viable. However, when you're actually doing the the transplant, both bodies, the patient and the

donor body would have to be in cardiac arrest. And then you could start the heart of the donor body afterward once the the head has been attached, but until then they would both be in cardiac arrest. And then, assuming that the surgery is in fact a success, any signs of rejection would have to be handled immediately. And the head is home to so many systems like the eyes and the brain and all of this that the risks of rejection would be much greater than if it

were a single oregan. You have a lot of potential points of failure. In other words, and uh, during this time after the surgery, that the patient would have to be kept unconscious. Uh, you know, not just immediately, but for like three to four weeks in order to allow the spinal cord to grow new connections, and and medically induced coma has come with other risks on top of the ones we've already talked about, including things like blood clots, infection,

and reduced brain activities. So that would be another thing to keep your ion, assuming that the surgery itself had gone well. Oh sure, Although as we were mentioning earlier that that spinal cord severance might be the real problem in getting the surgery to be effective, because you know, muscles and blood vessels can be cut and then sutured back together, or or not sutured but reattached in the

zany medical ways that they do. I do not actually understand the process, so I'm not going to talk about it. But spinal cord severing and and fusion would have to be so sharp and clean and uh kind of Ourrow says that the chemicals he mentioned polyethylene glycol and cheetahs on um. It's kind of essentially like a biologically uh created glue, is what these tend to be sure, he

claims that those could encourage fusion. Um electrodes would be implanted, and while the patient was kept unconscious after the surgery, that the team would be a dyeing electrical stimulation via the electrodes in order to help boost new nerve connections. So, in other words, it's it's not enough to have everything plugged in properly. You also have to have these signals passing through in order for the body to recognize that their actual impulses passing along the spine, right, in order

to recognize, hey, we're brain tissue, your brain tissue. Let's make brain happen. Yeah. Well, and it's not just in our sort of non expert point of view that this sounds like a very very ambitious proposal. Well, especially when you take into account what Cannaverro has said that assuming that everything goes well, what the patient will be capable of doing after the surgery, Ah yeah, I mean, so they'd be down for about a month while their spinal

cord is reconnected. But then he claims that a patient would be able to walk within a year after the surgery. Yeah, that's I mean, so if you think that we are a little skeptical, you're right, because they're just so many different hurdles to overcome in order for this to even remotely work. But yeah, we're not the only ones to express skepticism. The medical community at large has expressed everything

from cautious skepticism to outright disbelief. Like there aren't a whole lot of people coming out and saying, yeah, I think this is gonna work. In fact, most of the reports I've read have said, uh that they were they were very skeptical. Some of them even went further to suggest that kind of Vera's idea is crazy, like that's I've seen that word being yeah, uh, and it could in fact be crazy for a reason. Yeah. So this was something I came across while I was researching the story.

And let's just prevace it by saying that this is a kind of like sort of con spiratorial allegation. But yeah, it this this falls. This can fall under the category

of conspiracy theory. There's a lot of circumstantial evidence that that seems to support it, but it's circumstantial evidence, right, And why we're dancing around this is because there are now allegations that perhaps the timing of these announcements has coincided with the promotion of a certain video game, that video game being Metal Gear Solid five, the Phantom Pain. In other words, that this entire thing about head transplantation

is a marketing stunt. Yeah. Now that now there's some who say that Canavero seems actually sincere about head transplants, but perhaps the timing of this particular discussion is in fact more of a collaboration, and that right right right, in other words, saying like, this is something I want to do sometime in the future, but I'm gonna say I'm gonna do it now because oh it's being it's part of this other grander stunt of promoting a video game.

So so what's the deal with the promotion? Alright? So here here's the circumstantial evidence that has come about, Um, the game Metal Gear Solid five has there's been images leaked of are not even leaked, I mean promoted of. There's a character in the game. There's a doctor who looks I wrote eerily similar to Cannavero. But if you look at the pictures, they look like it's looks like it's the same guy, right, Like on casual glance, you wouldn't even be able to tell. We're looking at a

pair of photos in our notes right now. The top photo in our notes is a picture of Canavero. The bottom photo is a picture of the character in the game, and the bottom photo looks like it's just another picture of Canavero. It's a little uncanny. Yeah, yeah, so so there's that. Then there are a couple of other pieces of against circumstantial evidence. Not so not this, No, this

is oaking gun. The patient of Valerie Spirridanov is also a CG artist in game development supervisor, So some have said that maybe that Spiritanov is in on this as well, and it's not a sincere attempt at this surgery. Again it this is just an allegation. Cannavero has published work about Phantom Pain in the past, and the subtitle of the game is The Phantom Pain. There are several acronyms used by Cannavero, you know, things like heaven that are

also used in the Metal Gear Solid game. So there's some terminology that is seems to be shared between the publications written by Canavero and the stuff within the game which came first, don't know. Uh. Hideo Kojima, who was one of the creators of the game, tweeted back in two thousand ten that he had found an quote ally to help address a huge taboo. He planned the game to have this enormous taboo incorporated in it, and did

not give any more details. So people looking at this now are retroactively looking back at all the tweets and stuff and saying, maybe Kennevero is this ally someone who would support an idea like a head transplant, which supposedly happens within the course of Metal Gear Solid five. So, in fact, there are some promotional images of Metal Gear Solid five which show this this scientist character uh holding some form of device to a decapitated head on a platter. Um,

it doesn't like a scene of violence. It looks like a scene of mad science in that case at any rate, So that more circumstantial evidence. Uh. And Kajima is um kind of a well certainly a well known figure in the video games circles about Yeah, and he recently made headlines when he when he left Konami, who he had

been collaborating with for for a very long time. Um. His most recent project economy was Silent Hills, which is that Greadmo del Toro Norman ritas Silent Hill new Silent Hill game that it was making so many waves a few months ago, I just got canceled, and that has been very upsetting. I mean, you the big news from like a year ago was when uh Konami released PT and didn't say what PT was for, and PT ended up being a playable trailer for Silent Hills. You didn't

know that while you're playing it. It was only after you had completed the trailer, which by the way, was incredibly creepy. Oh yeah, yeah, it's very effective. I watched a playthrough of it and it's very yeah, very unsettling. So this was one of those things where, you know, Kojima has been known for going through elaborate setups to promote video games in non traditional and and very media savvy ways. Well, I have to say, if this is a promotional stunt for a video game, it is a

bizarre one in very bad taste. Yeah, I mean there's certainly there have been plenty of of ways of marketing games that were not directly tied back to the games, at least not initially. Like like alternate reality games, there are quite a few that started off that no one was even sure what it was trying to promote at the beginning, so it's possible that this was promotion. However, Canavero, for his part, denies involvement, and Coginia also denied that

Cannavera's likeness was used. So Cannivera had come out and said, I didn't give permission for my likeness to be used. They shouldn't be using my my image without my permission, and Cogima said, oh, we weren't actually using him. It's just a coincidence. It's a coincidence. If it's a coincidence, it's a phenomenal coincidence, because this whole thing is a phenomenal coincidence. If it's all a coincidence, I mean, and strange things happen in the universe. Chaos theory, I get it.

Law law of truly large numbers says that even things that would seem impossible sometimes happen. But yeah, it's it's one of those where the circumstantial evidence is such that if there's nothing there, it's really, it almost seems more weird that there'll be nothing there then that this is all about a promotion for a video game. So we will see, I suppose, eventually how all of this shakes out,

and whether whether it's a clever ruse or not. But at any rate, I'm glad that the headlines popped up for it because we got to do this research into transplantation and and all of the amazing research it's going into it. Yeah. Well, whether or not we can transplant ahead, we are going to be forging some new territory and transplantation soon, and I think we should talk about future

of medical transplantation. Sure, uh yeah, yeah. One thing that researchers are looking at doing is keeping organs alive longer, because, as as we said earlier, you know, the the expiry date on organs from a donor is really short, a matter of hours or two days at most for kidneys. In August, though, the FDA approved a device that uh preserves one particular organ, the lungs, for long enough to determine whether they're a really good match for a transplant,

about four extra hours on top of the normal time. Lungs, by the way, are really particularly tricky. About eighty percent of donated lungs are deemed unfit for transplant. Yeah, and the creators of the machine, which is called the x vivo Profusion system, um, they're they're hoping that eventually their their system will allow for the storage of lungs for up to two or three days. That's pretty cool. Yeah. I gotta say though, x vivo profusion system sounds like

something I would see in a spay. Just step into our x vivo perfusion system and you will come out a new person. Another thing that we're seeing advances in our going back to the the regenerative medicine approach and the synthetic scaffolding for things like airways, it's three D printing and transplants. Um. So this is something that we've been talking about for a while and our three D printing episodes. I think we've referred to it once or twice.

But the idea of using tissue as essentially ink and being able to print upon first designing the scaffolding the structure of whatever organ you're making, and then printing the tissue directly onto that scaffolding. So yeah, so that you have a a healthy organ to transplant, and it's made from the patient's own tissue. So the yeah, you've got you've got a nice uh a nice heads up. You're able to get to a point where you can make this transplant surgery without the worry of the organ being

rejected the body reacting in negative way. However, you know that being said, it sounds like I'm making it sound way easier than it really is, because depending upon the organ, some of these organs are incredibly complex. You know you're talking about you know, it's not just a massive tissue. Obviously, it's important and has lots of different parts to it. So to be able to synthetically create a working version of that ourselves from the ground up is depending on

the organ, easier said than done. Actually, for all of the organs, it's easier said than done. We are not lumpy space people. Not just if we could just like have a massive tissue that's generally liver shaped and you're fine, it would be so much easier. But no, that's not the way it works. However, it is very promising and we're seeing more and more, um uh, you know, advances

in that. In March of this year, of a Russian company called three D bio Printing Solutions announced it had successfully printed a mouse by roid using these bioprinting techniques and they're planning on transplanting this printed organ into a mouse that suffers from hypothyroidism. And uh, the results have

not yet been published. They said that they will be presenting their results at a conference called the Second International Congress on Bioprinting, which will take place in Singapore in July. So in July they will announce how this experiment went, whether it was a success or not. Uh. And you know, a thyroid is relatively simple, so it was a good thing to target for this kind of procedure. And also

it's important because thyroid cancer is a real thing. It can it affects around three thousand people, or rather three hundred thousand people are diagnosed with it every year. So being able to print a thyroid on an as needed basis could potentially save thousands of lives every year. So if this ends up being a success, it could be

it could be the getting of something truly transformational in medicine. Yeah. Yeah, other researchers are looking into entirely artificial organs and of course we do have some systems right now, that that will keep a patient alive until a real biological organ can be transplanted. But as our technology and also our our understanding of human biology improve, we might end up with some some medical cyborgs. There are research labs working

on artificial kidneys. Those are still in development, but with artificial hearts, which you know, replace a whole a whole

heart like ventricles and valves and all. Uh. Some artificial hearts have supported patients for up to four years before a transplant organ became available, right Yeah, And and I mean we could do an entire episode about about artificial organs and the development of those, because that's also a fascinating story, uh and and an amazing achievement in technology to have been able to create something that is medically safe to implant in a person and can keep them

alive until an actual organic uh replacement is available. And that Yeah, I'm excited to see that continue with other organs besides the heart and kidneys. Oh. Absolutely. Also on the immuno suppression front, there is a team out of Massachusetts General Hospital that's been conducting a clinical trial for

bone marrow transplants in addition to organ transplants. Kidney transplants specifically, so uh so, So the idea here is like, like we were saying, with the scaffolding, the throat scaffolding issue in some other patients. If you, uh, if you give someone a kidney transplant and also destroy some of the patient's native bone marrow and give them a transplant of some of the donor's bone marrow. Oh, I see. So the so in other words, the patients getting bone marrow

and an organ from the same donor. So that means that the bone marrow which is generating these T cells is already familiar with the tissue of up donated organ. So you wind up with these two bone marrow T cell creating systems working together to support the patient's original

tissue and the new organ. I see. So that would uh, that would at least hopefully cut down the incidence of organ rejection, because the patient's own systems would be generating the same native T cells as the tissue that was donated. Right right. We're still waiting for the results of these trials, but as of two thousand eight, four of the original five patients had gone for five years without having to

take immuno suppressive dress. That's pretty incredible. That's amazing. So obviously I think the ultimate future that we want to get to with organ transplantation is the ability to have these regenerative techniques where you sort of regrow organs with your own stem cells. They're based on your own biology. That seems like the ideal solution all around, but as you pointed out, that is a ways off, and there

are people who need organs to day. Right in the meantime, we have a need that is not going to just sit on hold for the decade or so it'll take for us to get that that technology to maturity. Right, So in the meantime, I wanted to talk about something else I read about, which is a more controversial sort of temporary solution in the meantime, and that would be open markets for organ donation. And by market I mean the exchange of money. You would a physical market, It

looks like a farmer's market. That would be a little No, that would be very that would be very unsafe. Would however, fit right into silent hills. Yes, but so so of course today you cannot purchase an organ for transplant. No, well, in most countries you can't. And so like you could maybe go to Iran and purchase a an organ for transplant.

But in the United States and many other countries, you can choose to donate your organs at fath or if you're a very nice person or you care about somebody very much, you can donate something like a kidney while you're still alive, Like you can continue living with just one kidney. Somebody else might have renal failure and they need a kidney, and you can give them one of yours, UM,

but you can't sell it to them. Regally, you're not supposed to sell your organs, but some people have argued that it would be a good idea to move to a general, open market for organ donation, where you could be paid a market determined price, for example, a kidney. And of course their arguments for and against UM. The most obvious and pressing argument for is that thousands of people die every year on the waiting list for kidneys. Oh yeah, there's a crazy shortage of organs of all

kinds in the market. Yeah. So in the United States, according to the National Kidney Foundation, in four thousand, four hundred and fifty three patients died while waiting on a kidney transplant. There on the waiting list. There, I assume they're probably on dialysis waiting to get a kidney, and they did not get one in time and they died from Yeah. On average, they say twelve people die every day waiting for a kidney. On top of that, there's

simply the problem of waiting. So let's say you're waiting four years to get a kidney and you eventually get one, and that allows you to extend your you know, your lifespan and to go on living. But that time while you're waiting, you're having to undergo dialysis. It's just going to be a major blow to your quality of life and your ability to do things. And you don't recapture those four years. Yeah, and so in economic terms, this

is a situation where demand has greatly outpaced supply. There is way more demand for kidneys than there are kidneys to go around. So some economists have proposed a very economic sounding solution. Uh. One example of people making this argument is in January, economist Gary Becker and Julio Elias authored a peace in the Wall Street Journal where they

recommended this path. It was called cash for Kidneys, the Case for a Market for Organs, and they support compensation for live kidney donation in a model where family members can be compensated when when they choose to give up the healthy organs of a dead relative, right, because that can be one of the blocks placed in organ donation is when even if a person has selected to be an organ donor, you need the acquiescence of their surviving

relatives in order to go ahead with the organ donation. Right. So somebody might if you have a relative who's just passed away, they might have a healthy heart and somebody else needs that heart. But you could say no, no, no, but the yeah, yeah, the the understandably upset family members might not want that. Right. So, even if it is your wish as an organ donor to have of your organs donated, it's possible for your next of kin to say no, I don't want that to happen, and the

medical professional the medical professionals will back away. They won't they won't continue. Yeah, And so this is understandably a very controversial proposal. Um, And I'm not sure where I stand on it. I can see the arguments on both sides. On one hand, I I would probably if I were myself someone who needed a kidney I would think like, well, yeah, if there's some way I could, you know, can motivate people to do more donations, then yes, please do it

any anyway you can, of course. Yeah. But then of course there are arguments against it. Uh. The the economists in this piece who were who were for it, that they did try to offer some of the objections and encounter them. Oh and one they proposed made sense to me. They said, well, people who are going to be offering to sell their kidneys, or people who very often are people who are in a desperate situation. Somebody's like I need money, now what you know, what can I do

while I can sell a kidney? And then that you you might sort of be in a way forced to make that decision by financial circumstances, and then later in life come to really regret that decision. It'll end up disproportionately affecting a specific democrats. Yes, specifically people who are in who are in bad economic circumstances. Um and I

can totally see that being true. That yeah, it would be sort of like a thing that you won't imagine that many wealthy, well off people saying I could really use the ten thousand or fifteen thousand bucks from a kidney. Of course, then again they proposed sort of countermeasures to that. Well, one thing you could do is you could put a waiting period in place, so you like you'd be forced to undergo counseling. You can't just say like, no, take

my kidney today. You know, there would be like a three month period, and that seems like that could come into play. They also pointed out that in their opinion, I don't know to what extent this is true, but they claimed that it also would be mainly to the benefit of people who are more economically disadvantaged, because if you're rich, you can typically more easily find a way to get an organ if you need one, you can you can travel to another country, or you can pay

for workarounds. Yeah. So in general, I think this is a really interesting and difficult question. I don't know what the right answer to that is. Yeah, I mean it sounds like kind of like a like an ethical problem

of putting a price tag upon human bodies. Yeah, I mean, they're there's certainly, and obviously this would also lead people to say, now you're going to make that urban legend come to life, the one about you know called the doctor, you wake up in a bathtub full of ice, one would hope there would be measures put in place to avoid you being able to sell someone else's kid. Yeah, it's like like when I went to donate blood and then was disappointed to find out it had to be mine.

I don't know where I stand on this either. It's one of those things that's really difficult to kind of put my finger on. On the one hand, I definitely don't want there to be thousands of people who are are waiting and hoping and dying because they don't have the access to organs that they need. On the other hand, I don't like the I don't necessarily love the idea of people electing to get a surgery that they otherwise never would because they need the cash. I mean, they're

the now. On the on the the brightest side of things that we can point out is that if everything works well, this will hopefully be a transitional period where we will end with the ability to create the organs that are based off the patient themselves, and the need for donors will be eliminated entirely. But that's the future we may not ever arrive at. We can hope, but we don't necessarily know that's going to happen. Yeah, this

is one of those situations. I feel like it comes up fairly often on this show where there's a there's a solution inside that would be the correct, the right solution, but we're not quite there yet, and there is something vision Yeah, and there on the way there there's a there's a really unpleasant kind of transitional period. Yeah. Yeah, no, that's that's entirely accurate, I would say. So, I'm curious what our listeners think about this? What are your opinions?

You know, Camillo wrote in I wonder what what opinions Camilo has about this? Because this is this is tricky stuff, and uh, you know, we want to be we want to see the greatest benefit for the most number of people without it becoming like this weird question of ethics that no one's comfortable with. But you know, this is real life, and in real life they are there are often a lack of easy answers. Another thing that I think would be worth considering. And I'm not even sure

what their position would be, but what doctors think about this? Yeah, because I bet that they have they might have our mints for against this that we haven't even thought of just like a procedural or medical yeah sure, or even just of their personal experience of of working with patients and with families, and you know that the kind of stuff that we can read about and and sympathize with,

but not truly empathize with. Oh yeah, I mean there, we haven't even touched any of the psychological effects that that patients can experience when undergoing transplant surgery. And I mean that's an entirely different field that is complex, fascinating and and a little bit terrifying. Yeah, and certainly I am not qualified to address it. It's but it is something that I'm fascinated by. Uh Well, at any rate, I am very curious to hear from other listeners like Camilla.

Thank you so much writing in Yes, Yes always. This was a really interesting topic to look at, and we want to continue that. We want to have people right in and ask us questions. We really enjoy addressing these listener requests, and if you have a topic that you would like us to talk about in the future, let us know. Send us an email the addresses FW thinking at how stuff Works dot com, or drop us a line on Twitter, Google Plus, or Facebook, at Twitter and

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