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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."
Do kids who get transplants this young need to be on anti rejection drugs for the rest of their lives? I know they're exceptional at healing & recovering from major surgery at extreme young ages, but don't know if there's an extra ability to 'adapt' to foreign tissue.
The same question could be asked about this baby :)
Of course we can't yet do brain transplants, so I guess one can say its the same person as long as its the same brain.
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Wanna play some word games?
> It must be a little odd to know that a growing plurality of your tissue used to be someone else's.
In rare cases, the cells of non-identical twins in the very early stages of development can merge into a single embryo, and develop into a normal "patchwork" adult, called a chimera.
IIRC this phenomenon was only discovered recently, when modern DNA testing revealed that these people have different DNA in different parts of their body.
Sheesh, evil *and* a jerk. -- Jade
And you thought that being told you were adopted was bad..... just wait until this starts making it into the common pool of things to be told while you are growing up.
...atleast the child was _alive_ when born. .. not for 8 minutes atleast. (having the umbellical cord wrapped around your neck and snapped will do that).I had also lost more then 90% of my blood. This kid has more ofa chance then medical science will ever give him.
I wasn't
good luck to the kid. O btw. the doctors said that I would turn out to be nothing more then a vegetable when I did survive, but last I checked vegetables don't score 127 on i.q test ( not that i think i.q test really measure intelligence).
I'm a med student working on the multi-organ transplant service in Toronto. I wonder what the real goal of these kinds of commmando surgeries are. The more organs transplanted, the greater are the hemodynamic derangements, the more compensation that has to be made for natural fluid balances and what not. The more organs, the more likely it is for her immune system to react and reject the foreign organs. I wonder what their plan is for the child's immune system. A 6 month old immune system is fairly weak, and in a normal infant it would gradually develop and become capable of defending the infant from your regular run of the mill pathogens. I'm not sure what would happen in this case; Alessia will certainly need lifelong suppression of her immune system with drugs like Tacrolimus (or steroids for bouts of acute rejection) which have their own side effects. The flip side is that a weak immune system predisposes you to develop systemic infections, sepsis and other nasty things. I know that in infants with HIV and other immunocompromising illnesses, they still get most of their vaccinations (except the live vaccines), so she may still be protected against those. It comes down to a dilemma not unknown to those who work in Neonatal Intensive Care Units. How far should we go to save these unfortunate children? I've seen in my time the so-called "Sick Kids Specials", children at our Hospital for Sick Children who were born incredibly premature (24 weeks versus 36-40 weeks for normal gestation) and sustained in increasingly advancing NICU's. These children rarely turn out normal, and in some cases, have up to 12 different major medical problems (kidney failure, cerebral palsy) etc. etc. What kind of future is in store for Alessia? I don't think a particularly long one; she will most certainly require re-transplantation of many of her organs (things like kidneys can last 10 years or so, small bowel transplants are so rare that I don't think there's that many studies of them). When you consider the cost, the mental anguish to both parents and to this increasingly developing child, and the cost to the public health system, I wonder if the right decision was made.
Think of the information that can be gained by all this -- the child gets a chance at life, and science gets to learn more, with each transplant, how to extend life, how to replace parts, how to improve the quality of life and lifespan of others.
Someone always has to be the first, right?
Those could've saved 8 people
Why are we so quick to judge a decision simply based on economic sense? I find it alarming that living, breathing and emotional beings could suggest that because of the lack of clarity on the prospect of the child's future quality of life, he should have been left to die. And to those darwinist, fitness is not only in physical ability. If that is the case, should a brilliant a person as Stephen Hawkins be left to die because of his physical disablity?
The problem as *I* see it is that these parents can doom this child for a very trobled future. I wonder how much the parents have reflected not over *their* feelings, but over the *childs* feelings. By doing what they are, they're saying: YES, you should have 8 organs replaced with all the implications this can cause, and YES, you should grow up on anti-rejection medicines, and YES you should have a high risk of dying in a near future. These decisions were all made by the parents before this child was even born, as the observations was made while she was in her womb.
Now, that can be pretty heartless to me.
Beware: In C++, your friends can see your privates!
To add to your comment, there are current debates going on, at least in Australia, and I imagine in other Western nations on whether it is feasible to try to give the best medical treatment possible to everyone. Of course they are only talking about government funds here, not private treatment.
The points being raised is there is only X amount of dollars available in the government for health. Yet with the ever increasing sophistication of medical treatment, the cost of treatments is going up. People who before would have died rather rapidly are now hanging on with new treatments. Ailments that were not life threatening but affected quality of life are now curable or much more treatable. And of course everyone wants the best treatments available. Also people are living longer and of course elderly people require more treatments. Add to this the ever increasing imbalance between the elderly and working tax paying members of society and some people think that we could be heading to a budgetary catastrophe in the future.
This raises the question of whether every medical treatment should be available to everyone. Whether or not we should ration our public health dollars to give the best return ie. bumping up the queue those who have the best chance of survival, who require the least money to treat, treat working age citizens and reasonably healthy children before the elderly and those who are very sick etc.
This of course is a controversial topic. The idea of having a committee choose who will live or who will die or telling someone that they can't get treatment because they are too old and no longer working and therefore no longer useful to society or I guess in this case, telling parents their kid will die because those 7 organs could be used to treat and cure 7 kids rather than just one, is very emotive and raises a lot of uneasy feelings and questions about the criteria to be used not to mention the uncomfortable closeness to eugenics and euthanasia. However it might be possible that in the future, if the public health $$ starts running out, we may be forced into this type of system.
I have hemophilia, and I am not reproducing. Still, people around me seem to feel that I'm contributing substantially through my career and in my community.
When I was young, I'm sure everyone thought I'd die young from such a terrible disease. Now I have a normal lifespan and a relatively normal lifespan.
I have to say that issues around what the "right" thing to do are very complex, and distorted by health care financing, organ shortages, religious values, etc.
I recognize that I survive based on the generosity and altruism of blood donors. On the other hand, the medicine that makes my blood clot normally comes from paid plasma donors, some of whom donate in spite of having HIV, and the manufacturer accepting these donations accepts this.
You also have to consider that the picture is always different when looked at from an individual standpoint, in contrast to looking at it from public policy. It's been said that the cure for hemophilia is to let the bleeders die before they breed more bleeders. I have to say that this logic would have been an injustice to me, since I'm not reproducing (yes, I'm sure about that).
I would simply do as every other animal on the face of this earth, and try again. This is definitely going too far, and I will not praise the doctor for carrying out such a grand experiment on this unfortunate family.
Its not difficult to me. Unless she could never have another child, its elementary.
Yes its sad to see your loved ones die, but life is not always better than death. Are they thinking of the child or themselves. I question.
The use of medical technology to sustain those who might otherwise die and not pass on their genes isn't some kind of anti-evolution, where we make the population into a bunch of weak slobs who cannot survive, their bodies riddled with diseases. We're simply stopping, piece by piece, the natural selection that eliminates those with unfavorable combinations of genes. However, in many cases, those genes would still be present in the gene pool even if we were undergoing natural selection. The genes in question are recessive, and sometimes there can come some benefit to the species in the long run for those who have one copy each of the "normal" and "abnormal" genes. A great example of this is sickle cell anemia: the prevalence of SCA increases in areas where malaria is endemic, because to be a carrier of SCA protects you somewhat against the disease, even though to have two recessive sickle cell genes means you will die early. (Natural selection at work in our world)
So if we were to, say, eliminate the disease malaria, perhaps - or find a way to save sickle cell patients who would otherwise die young, what would happen. Well, we know that the sickle cell gene would not disappear completely - look at populations for whom malaria is not a problem. The gene still exists, preserving the genetic diversity that allows our species to respond to the demands of natural selection, if and when they impose themselves.
So to allow humans with diseases that would have killed them before reproducing to reproduce - even then it does not necessarily mean that their children will have that condition. For one thing, a number of these conditions render the bearer infertile. For another, it takes two parents to make a child. Perhaps we would see an increase in negative genes in the general population - but the prevalence of these genes is not high in the first place, and to require medical care to live is also not the most attractive lure to a potential mate.
All of this does not take into account other aspects of life, such as whether we should strive to save the children of rich people (who we will then care for probably the rest of their lives) when we can help many poorer folk with simpler medical conditions. Honestly, I don't think I would have made the choice these parents did - but not because I'm sure it will spell the doom of our species. I'm confident that if and when our civilization crumbles and we are cast into the dark ages, natural selection will assert itself, and our gene pool will respond accordingly. But until then, perhaps continuing to save those who would otherwise not is only going to give them lives they might otherwise never have had.
ps: I can't tell from the details in the article, but many babies born with defects have those defects from developmental abnormalities, rather than genetic conditions - thus saving them doesn't change the gene pool.
She may only live another 6 months, 6 years, 30 years, whatever .. who knows ? Maybe she will fully recover in a few years time, and then get run over by a truck - who knows ? The world is an odd place indeed.
I met a girl not too long ago who by all rights should never have survived, and who's whole life could be seen as a drain of resources to the people around her.
But then again, she managed to write a way controversial film script, and convinced enough people to produce the film.
The film went into production, and made it to the Cannes film festival, where she was hauled up the steps and taken along the red carpet.
After the screening of the film, the stunned audience wiped away their tears and gave a standing ovation.
Her name was Heather Rose Slattery. ACPA Site Here
Or you can read my small contribution Here
RIP Heather .. Im sure you can read this where you are now.
So ever since meeting Heather, Ive learned that there is no relationship between someone's physical condition, and their productive value to the rest of society. Its all pretty random really.
A lot of people are saying "organs should have gone to different kids." While this may be true, this is also a test bed for future technologies.
Think about stem cell research. If in the future (as it looks like it will be), it woudl be possible to grow those organs from a slightly modified version of the child's stem cells (with the smooth muscle disorder corrected), then those would all have to be transplanted into the body. The same applies for adults who say may have stomach cancer. A new stomach and gastrointestinal tract, just to be safe, would be grown and then transplanted in.
I am not so jaded as to thing that this is a publicity stunt, especially considering they did not release the fact that it was taking place until well after the surgery.
To the "natural selection" people: why even bother with any sort of medicine then? Any influence that we have is not "natural." The same arguments can be made for such simple things as pacemakers, dialysis, and insulin therapy.
This is a perfect example of why people should become organ donors. Have it noted on your driver's license. Tell your family that you want all or some of your organs to be used if needed to save someone else. Ok, I can understand if you don't want your face to be altered for open-casket reasons (ie cornea donor). That does make sense. Remember though that morticians can replace your eyes with very life-like and nearly identical fake eyes and no one would be the wiser. The important thing is that you choose to be a donor. I'm sure this little girl will be very grateful in decades of her life yet to come.
I think there are some important exceptions to your ideas. There are cheetahs. All of them are nearly identical genetically, not that they are thriving tremendously. There are species that no longer have males. They have only females who produce only more females. That survival strategy is not conducive to diversity, but the species have made it this far.
The risk for death for each and every one of us is 100%.
I doubt that we can help or hurt evolution. Evolution is just what happens. It does not get better or worse. It's just a bunch of stuff that happens.
I used to think the same way too... 'till we ran to this case while doing rounds during my edical ethics class: A teenage girl was dying from heart failure (we were not told what this was caused by, since the this was an undergraduate ethics class) and required a heart transplant. Her cardiologist requested one from UNOS (United Network for Organ Sharing), and got one. The operation went reasonably well, but as I understand it, multiple clots eventually developed in her bloodstream post-surgery. Some lodged in her brain, causing multiple strokes of varying severity, rendering her comatose. Others lodged in varying organs, including her newly transplanted heart, causing it to slowly fail. Since her cardiologist was an attending physician at a large medical school, he had quite a lot of connections. He pulled some strings, and got the girl back on the heart transplant list. Second heart was found and flown in. (Second verse, same as the first, a little bit louder, a little bit worse...) After a few days... turns out it's incompatable. The girl starts rejecting the second heart, and it slowly begins to fail. Dr. Promenent Attending Physician with Connections pulls more strings (he's got a lot invested in this girl), and she's back up on the heart transplant list. Our professor, who was the pediatric neurologist called, assessed that the girl had no significant chance of recovering due to multiple strokes. And yet there she was, high up on the transplant list for her third heart! Morals of the story: 1) connections matter; if you're gonna get a transplant, go to a major teaching facility and get the attending physician to do it. 2) resource allocation of something as precious as a heart isn't as cut and dry as, say, deciding who gets a scholarship to college. You give away multiple grants to somebody, and everybody else who applied will scrape by and find another way to fund their education; you give away multiple organs to one person, and there's a good chance that many, many people will die waiting. Your argument presents a false dichotomy of either save the kid, or don't save the kid. (Who in their right minds would, without any other piece of information, say "don't save the kid"?) In reality, the case is this: Save the kid, or save a kid who needs a stomach, a kid who needs a liver, two kids who need kidneys, etc... Until the day that we are able to grow organs, scarcity will be an issue. And regardless of how "feel good" it is to perform heroic measures to save somebody, it is ethically remiss to give multiple transplants to the same person, whether it be in the form of three consecutive hearts, or a half dozen organs. Chosing one organ recipient over another because of their health, importance to society, etc., is an ethical gray area. But how anybody can claim that it's better to save a kid by giving her multiple organs, over saving eight separate kids each of whom needs one organ transplant, is beyond me.
Quality of life, cost, and expected return should all be involved in making decisions about medical treatment.
It's not a moral question, it's a social question. Can society justify expending X resources to save the life of one individual? Can those resources be more efficiently spent in other applications which may benefit/extend the lives of a greater number of individuals? In this case, the answer appears obvious to me.
Withholding extreme medical care is not the same as killing someone, morally, ethically, or physically, and the primary criteria for the greater good of society is the collective good of its members. If you wish to personally fund extreme medical intervention on this scale, feel free... but don't insinuate that it is just or rational for society to compel other individuals to support it.
Does your definition of "Playing God" include forcing other people to spend their lives doing what you think is right? Think about it.
"We have to go forth and crush every world view that doesn't believe in tolerance and free speech." - David Brin
In this book, Heinlein chronicles the 2000+ year life of Lazarus Long. The character has had every organ replaced, his skin, bone structure(can't remember if the brain was swapped out).
When reading the book, I got the impression that the character still had the sense that he was the same Lazarus who was born. Probably because he had the same spirit and consciousness. Myself I wasn't so sure because he had been almost entirely modified.
Great book for a weekend's reading.
BTW, that's a generic link to Amazon, not one of those 'sales' links that people around here post sometimes.
wbs.
Huh?
Bear with me here, I'm not Trolling, these are really my beliefs. It's a long rant but I feel strongly enough about it to comment.
I too am against organ transplants (and most other extraordinary life saving measures), but not for religious reasons. For me it's a cost/benefit issue. People say that you can not put a value on human life. I disagree. I put it at very close to zero, as all that is required is a male, a female and a will to procreate. All of recorded history seems to suggest that this is the case, as people have been ending each others lives on the flimsiest of pretexts for all of human existence.
If my life were to end today, my friends and family would be upset, however nothing else about the universe would change. Don't give me any existential/spiritual crap about my uniqueness. My company would replace me, my wife would grieve and move on. I am not claiming that life isn't worth living. It is very much so. My life is worth quite a lot to *me*. However, I don't expect it to be worth anything to anyone outside of my friends and family.
The cost associated with trying to keep people alive through modern medicine is open ended. You can spend nearly limitless amounts of money to keep a single person alive. Where do you draw the line?
My sister, though I love here dearly, is a good case in point. She is 36, has an advanced form of cancer, and a six year old daughter. She has undergone treatment for several years, at a cost of hundreds of thousands of dollars. She says I am heartless. I say she's going to die anyway, and she's just renting more time. Is it worth it? Perhaps to her daughter it is. Maybe to some of her friends.
However, how many people who use her insurance carrier have had their costs increase to pay for her care? Can they afford it? Because of our shared cost health insurance system in the US, with each medical advancement, the price of health care goes up for everyone. Affordable basic health care is out of reach for too many people. Is everyone here so egotistical to think that their life is actually worth that much? Do you have a right to live forever? I think that that money might be better spent providing basic health care to those that have none. Perhaps that sounds like socialized medicine. Maybe that's what I'm looking for, I'm not sure. As an American I can't comment on how well the EU and Canadian systems work. You want to spend your own money to keep yourself alive go right ahead. Are your medical problems someone else's fault? Make them pay for your care. If you can convince other people to pay for it out of their own pockets, that's ok too. Just don't use my money for your non-zero sum heath costs.
I admit I am ignoring whole classes of problems with the US insurance, medical and pharmaceutical industries, but that is a rant for another day.
In the case of this 7 month old, just let it die. You may feel that the research value of this operation is worth it. I feel if it's that important to you, take money out of your own wallet and pay for it. Just remember that with each technique we perfect, medical care gets more expensive for everybody, not less, and that costs are already open ended. Some people were not meant to live. It is pure hubris to feel otherwise.
I have to say first of all that I fall right in line with the other posts from people who are parents. I'm very thankful that I was never called upon to make tough decisions regarding my own two, and my sincerest wish is that both of them will outlive me.
I was thinking, though, of a recent storm in my own community about a baby who was born with only the brain stem intact (anencephaly) and with a defect of the digestive system that made absorption of nutrients impossible. The doctors recommended providing fluids and painkillers only and allowing the child to die naturally rather than putting him through the suffering of an operation to repair the digestive tract. This caused a storm of protest in the larger community--the baby's life must be prolonged at all costs because, after all, "life is sacred." Never mind that the life would be no longer than a few weeks--the suffering that this small being would be put through was considered by many people to be worthwhile.
I've also witnessed the same thing at the other end of life. Frail, elderly people are put through the ordeal of being resucitated even though their lives are drawing to a natural close. It's rough; it's the equivalent of taking quite a beating. Why do it to a fragile body whose time to die has come? This was done to my grandmother some years ago. It bought her three additional days during which her dying process was marred by bruises and strains and other discomforts.
While I can't argue for "mercy killing" and am on the fence about suicide, I feel I can argue against needless human suffering. I truly hope that the child who has received these transplants has some expectation of a happy life. But I do have to wonder where and how we draw the line and who gets to draw it.
DUCT TAPE: The Election Supervisors' Secret Weapon
Once you have the Chicken Pox virus, the Varicella Zoster virus, you have it for life. Your immune system will eventually beat it back and the Chicken Pox symptoms will disappear, but the virus will hide out in the nerve roots around your spine for the rest of your life. If your immune system is weakened by age, chemotherapy etc. the virus can break out again, burning is way up the nerves, usually on one side of your body, until it reaches the skin and causes rash and blistering. This is known as Shingles and is very painful. Not something you are usually told when you get Chicken Pox as a kid.
Evolution is nowhere near the best way of making things better. It works, but it's slow, cruddy, and shortsighted. We have a new technique: intellegence. There's no reason to "weed out the weak" now that we can apply our mighty brains to the matter. Intellegent Design might not have been how we got here, but that doesn't mean we can't start doing some of it ourselves. Just because someone is not particuarly evolutionarily fit does not make them unvaluable to society.
Within a few generations, we'll be able to manipulate the genetic code directly. So whatever crap we might accumulate in these few generations isn't that big a deal in the long run.
"Never attribute to malice that which can be adequately explained by stupidity." -- Hanlon's Razor
There's a chicken pox vaccine... kids don't have to get chicken pox anymore. Hundreds of kids die of encephalitis due to chiken pox every year. There's also the school time lost, the scrring, and the eventual possibility of shingles.
Nonetheless, parents still "vaccinate" their kids by exposing them to other kids who have chicken pox at a convenient time, like summer vacation. Insanity.
I guess this is one of those "spay or neuter your pet" announcements. Get the issue out there.
I just talked to someone two minutes ago who says that the vaccine you're talking about doesn't actually keep you from getting the virus but rather just lessens the symptoms. If this is true, the vaccine wouldn't protect you from the possibility of Shingles as an adult. I would be interested to hear from anyone who knows more about the specifics of whether the vaccine does or doesn't actually keep you from acquiring the virus or keeping it in your system.
Very interesting thread. I can safely say until this point I had no idea what the root cause of Shingles was. (See grandparent post.)