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Heart transplantation from genetically modified pigs could be the answer to organ shortage: Dr. Sandeep Attawar

Dr. Sandeep Attavar, KIMS Hospital Pic
Heart transplantation from genetically modified pigs could be those answer to organ shortages for those suffering from end-stage medically refractory heart failure: Dr. Sandeep Attawar, KIMS Hospitals

Hyderabad: Doctors at the University of Maryland School of Medicine, successfully performed the world’s first-ever pig-to-human heart transplant surgery. This is a seminal advance in the history of modern medicine. According to medical updates from the center last received, the heart now beats normally and unassisted in the body of a 57-year-old recipient.

This paves a way for the future

Dr. Sandeep Attawar, Chair & Program Director, KIMS Heart & Lung Transplant Institute, a division of KIMS Hospitals, one of the leading healthcare providers in the country, believes this transplant procedure is the conclusion of years of research that will emerge as a shining cornerstone and paves a way for the future of transplant surgeries, in an era of organ shortage. Each year, millions of people suffer organ failures and many of them die due to the non-availability of a suitable organ donor. Deceased organ donation from a suitable matching donor is the final solution for end-stage organ failure.

According to available numbers, at least 50,000  individuals suffering from end-stage heart failure in the United States require a heart transplant. Current conventional sources are brain-dead but beating heart organ donors, only 4000 such organs are available according to the current census. This leads to a search for alternative viable sources of living organs. Extrapolating this data to India expands the number is at least five to six times based on population census and disease burden estimates. The current donation rates in our country are a dismal 1000 donations annually.

If we address the cumulative burden of patients who are suffering due to end-stage ailments of kidneys /liver /lungs and pancreas; and need such viable transplantable organ sources, the demand is huge. With no viable alternative in sight, this paradigm seems to be the answer to our dilemma.

Timely organ transplantation enhances the quality of life

Single organ damage leads to numerous and incalculable after-effects on other organ systems in the body, thereby affecting the quality of life and survival.  Timely intervention with an organ transplant prevents not just incremental damage to secondary life-sustaining organ systems, greatly enhances the quality of life, and controls excessive medical expenditure incurred by repeated hospitalization. Hence, the timely replacement of these damaged organs is crucial to the patient, family, and society at large. Our current scientific, ethical, social, and religious limitations make it imperative, that we explore alternate sources.

Chimpanzees, baboons could have possibly been an ideal source, but there are ethical, medical, and scientific reasons to disallow exploring this alternative. The option of hygienically bred, genetically modified pigs is a major step in this direction. Lab modified, multiple genes knock out, PERV free ( porcine retrovirus )piglets with human transgene modifications can be reared.  Using special breeding and feeding methods, we can ensure the elimination of exogenous (external) viruses (PERV). While endogenous (internal) PERV are eliminated utilizing CRISPR -Cas 9 gene-editing technology and nuclear editing of the embryo.

With time, scientists could develop 3D printed hearts that are fully biocompatible and avoid Immux Sx noupression completely. This can be the ideal solution and completely worthwhile. However this is a work in progress, has been scientifically proven to be a  viable alternative but, cannot be performed on a large scale given the enormous costs and time it takes to build one fully functional organ.  Till that time,  this intriguing possibility preserves the essence of human life. This groundbreaking and the latest development is a major milestone in medical science, it is worth celebrating, preserving, and nurturing.

(In his very diverse experience of treating a variety of congenital. acquired heart and lung diseases, spanning  close to three decades, Dr. Sandeep Attawar has done a total of 332 organ transplants including 203 lung transplants, 92 heart transplants and 37 lung and heart transplants together.)