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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
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.
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 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.
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.