Slashdot Mirror
Six Months Old, Eight New Organs
AEton writes "According to the BBC, Dr. Andreas Tzakis has just successfully replaced six-month-old Alessia Di Matteo's liver, stomach, pancreas, small and large intestine, spleen, left kidney, and right kidney in a record-setting operation. The child is so far doing fine with a one-year-old baby's organs. Tzakis is no stranger to multiple-organ transplants; in 1997 he set the previous record of seven organs by replacing seven of a two-and-a-half-year-old's organs. It must be a little odd to know that a growing plurality of your tissue used to be someone else's."
1. The number of organs transplanted is NOT an indication of the pre-op condition/prognosis of the baby or an indicator of post-op "quality of life".
Her disorder is a single disease process that happens to affect most of her vital organs. All other things being equal, a baby born with several disorders, requiring fewer organs transplanted (even as little as 1 or 2), actually could be considered "sicker", have a much lesser chance of survival and be a greater "burden on society".
2. Of the eight organs transplanted, some might not have actually been "diseased" (more on this later).
3. The greater the number of organs transplanted is not proportional to the surgical difficulty.
Not to take away from Dr. Tzakis' great achievement, but technically the surgery might have been easier than transplanting a few non-contiguous organs. Here is why:
If you ask any transplant surgeon, the most difficult aspect of the surgery is doing the anastamoses (or "rejoinings"). Essentially taking the entire foregut and midgut en bloc significantly decreases the number of "rejoinings" one has to perform.
Tzakis likely only had to join this single unit of organs (the liver+stomach+pancreas+spleen+small bowel+large bowel) at two points (those being #1 the original esophagus-to-new stomach and #2 the new large bowel-to-original rectum) for complete continuity of the gastrointestinal tract and then probably about another 4 anastamoses for blood supply.
The entire blood supply for all the aforementioned organs (minus the kidneys) originate from only 2-3 arteries arising from the aorta. To leave the original pancreas and spleen (which are not significantly affected by her disorder) would have been several times more difficult than taking the "whole package" because the vascular supply for each organ would have to be dissected and reanastomed individually. This is more difficult because it's more vessels to join and the vessels are smaller i.e. more difficult to work with.
Transplanting even only 3 of these organs in non-continuity would have required 1-2 GI tract and 2+ vascular anastamoses for EACH organ. If you do the math you can quickly realize why it was probably easier to take all the organs, even if some were not diseased.
4. Transplanting both kidneys is NOT the transplant surgery standard of care. The baby would have done fine with one kidney and there has yet to be any studies proving that transplanting two kidneys vs. one improves a patient's post-op outcome. But if Tzakis did not take both kidneys he would be stuck at 7 and we wouldn't be talking about this whole topic right now (take it however you want).
So to make a long story short:
1. The baby was not as sick or doomed as one might think.
2. It's a great accomplishment but it wasn't "pushing the envelope".
3. The ethical issues raised are no different than those for any other medical procedure or treatment: should society help the inherently weak at the expense of the strong or should we fall into the Darwinian model of society were it's survival of the fittest? Or is there a middle-ground as to how much help we give the weak and who/what determines how much and what is too much help to give?
What your stating is based on a flawed (but common) misconception that the immune system 'learns what is dangerous' or attacks what is dangerous, which hasn't been shown by any real facts/supporting research.
In addition, a childs immune system is only 'immature' based upon the fact that it hasn't been exposed to as many antigens as an adult - which allow for a rapid secondary response when re-exposed to those antigens. An example is chicken pox - once you get it, your exposed to the antigens and your body can rapidly respond if exposed to it again so you only get the chicken pox once (most of the time.
Lastly, for the first few months alive, babies also have passive immunity that is gained from their mother. So, this would add an entire other level of complexity if the 'maternal' antibodies were to attack the new organs as well - though I have no idea if they would still be present at 6 months after birth. (As a side note, it also sometimes occurs that a mother's immune system will reject the baby and have to be treated with certain drugs to reduce/stop the killing of the fetus via the mothers immune reaction).
So, IMHO, yes, the child has to take the drugs for their entire life.
One last comment - very old people need more drugs because their bodies are failing because they are...OLD. Organs and cells do not have infinite lifespans. They simply can't deal with being sick at all - whereas a younger person can deal with the flu. Given the same level of immune response, the frail old person would die while a young healthy person would live.