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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.
--
Wanna play some word games?
The one-year-old baby is not doing so well.
I know this will sound harsh, but if your child is born with so many problems that they would die without eight organ replacements, one has to wonder what their long-term chances of survival realistically are.
I know we can work wonders with organ transplants these days, but how much is too much? What are this child's chances of having a reasonable quality of life after being born with so many potentially fatal problems?
It's sad to see your loved ones die, but I can't help wondering if the parents did the right thing under these circumstances.
No doubt my feelings on this would be much stronger if it was my own child in question, but it would seem we as a species very often let our emotions get in the way of rational thought, and I'm just not sure these parents made the right decision for their child.
This is most definitely a difficult issue - I could well be wrong, but I'm throwing my initial thoughts into the pot to see what others think.
Organic free-range music... yum!
My mother has a transplant - the organ is from a cadaver: a 30 some-odd year old woman who died in a traumatic way (likely auto accident, but we don't know).
Of course it is pretty disconcerting to know that someone has died, perhaps in a traumatic way. Especially a relatively young person who likely had a family that was grieving. Especially a person who died mere hours earlier.
But the donor didn't die because my mom was the recipient - my mom was the recipient because the donor died.
That's a pretty big difference.
My girlfriend at the time was "against" organ transplant due to a combination of religious beliefs and a lack of faith in the medical profession. In a nutshell, she claimed that someone was put to death so my mom could get a transplant.
Of course, that's a pretty dark and closed-minded way to think, and that's the primary reason why she is no longer my girlfriend.
Doctor: I'm sorry to say, but your baby was born with no arms...
Mother: Oh, doctor, I don't care, I'll still love him...
D: I'm afraid he doesn't have any legs either...
M: Never mind, he's still my son...
D: He doesn't have a trunk...
M: Ah...
D: And no head, either...
M: But, what does he has...
D: An ear...
(doctor brings the ear)
M: OH MY SON, MY BEAUTIFUL SON...
D: It's no use screaming, cause he's deaf...
how long until
> 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'd be pretty pissed if she died after 10 years. Think of how amazingly expensive this procedure probably was for their insurance company! That's money that you and I have to foot the bill for. At 6 months old, wouldn't it make a hell of a lot more sense to let her die and start over? If your computer is SO fucked up that you need a new motherboard, CPU, memory, hard drive, DVD-ROM, floppy drive, and there's a huge ass dent and scratch in your case and the plastic front is all cracked, wouldn't you just say fuck it and start from scratch? It may sound cruel and heartless, but this kind of surgery is just ludicrous for a baby. She's going to be fucked up for the rest of her life now whereas if they would've just let her die peacefully they could've started fresh.
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.
however as much as I wish to see this girl survive and live a healthy, happy life you have to wonder if those organs might have been better used saving multiple children with one major organ failing instead of someone who seems to have a body that seems to be almost completely non-functional. Think about what this girl's long term prospects are - considering her body's frail state. Hardly anything inside of her works. Will she live a year and die, taking the truckload of transplanted organs with her, while others with one or two problematic organs and much better chances to survive long-term post-transplant are forced to wait and quite possibly die?
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).
or incilin or any human advancements that have allowed people to live who would have otherwise died.
.
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Everyone who draws the line of what is too far, like you just did, conveniently places that line to exclude any kind of technological help their survival has depended on.
There are plenty of people living in dirt, eating trash to survive for what will probably be a pretty short life. Maybe until such people decide that THEIR quality of life is so low that they start drowning themselves and their children in muddy puddles, we can implement a "quality of life" policy and put those poor souls out of their misery if they fall below the definition of "liveable". Until then . . . I say you are playing God with out any of the usual minimal requisites to play the part.
If you are going to argue against this, please, oh please, say that the same money could have been better spent to save many more lives in some developing country.
But making judgement on someone's quality of life is all fun and games until someone looks at YOUR marginal existence and says, "man, we should really put YOU out of your misery."
Is this why the U.S. can bomb people and say it is saving those same people at the same time? Under a dictatorship their quality of life is so low that it is well worth risking their death in an attempt to raise their quality of life to a level worth living? How noble . .
I sympathize that you were merely trying to discuss the issue, but your assumptions reveal a value that has been the root of all types of exploitations of other people. The quality of life argument has been used to inslave, to kill, and to exterminate entire civilizations. And now, I fear it has been used to turn the U.S. into a tool to allows poorly educated politicians play God.
I fear God's retribution for such blasphemy . .
Sdelat' Ameriku velikoy Snova!
If a baby who is 6 months old needs 8 simulatneous organ transplants, then shouldn't the baby just be allowed to die naturally? I consider a single transplant or a tweak of an organ to justifiable, but isn't transplanting 8 organs in a 6 month old baby breaking some type of natural law?
I know it would be difficult for the parents to bear the sadness of watching their child die, but what if the organs are rejected in the future and they have to watch their child slowly wither away, while be connected to all sorts of tubes and wires? Could those 8 organs have been used to save 8 babies or young children? Could the money that was used to pay for this multiple transplant be used to save others' lives?
My wife is 8 month pregnant and I hope we never are in a situation similar to this. It would be difficult, but being faced with 8 organ transplants, I would think that some higher power might be telling me something about this baby.
Why did I lurk so long before registering for a Slashdot account? I could have had a Slashdot ID of less than 100000.
I thought that species with a DIVERSE genetic base had the best probability of survival.If, through technology, we are able to maintain an even MORE diverse code base, then is that not better?
.well, keeping in mind the progress of the last 100 years, can you call me crazy if I were to say that technology could cure all illness within the next thousand years? With that in mind, maybe your genetics gives you a disadvantage physically, but the mental advantages to your genetics is a far greater advantage to the human race. Or maybe just having your gene set to study will allow the human race to understand our code that much quicker. Technology is just so much faster than evolution that even if your contribution is very, very small (like teaching your kid to program OSS), it is enough to make up for any genetic deficiencies.
Good genes, bad genes . . . in the current environment it is easy for you to pass judgement, However, when the environment changes, so must your definitions of good and bad. Since change is uncertain, there is no way you can really know which genes are good or bad. Would it not be better to hold on to as many different genes as possible, just in case we need them later?
Besides, if your genes are really detrimental to your daily function, you will already have a disadvantage that will limit the spread of your genes compared to other "good" gened people. There's additional medical costs, social prejudice, and simply a higher risk of death for people with inferior genetic material. You may live a quite normal and happy life, but individuals with similar genetic material as you will automatically be limitted, relative to other "healthier" genes. Plus, you have to take in account how large and diverse our population is now. Evolution will continue whether you decide to help it or not. It is simply the way the world works, not a policy one should live their life by.
Finally, it really can be argued that evolution is no longer relevant to human survival. Evolution takes thousands and thousands of years to mold species. Technology, on the other hand . .
And maybe the environment will change and your son will be the only one left to impregnate an entire generation of women . . . nomatter how slight the possibilty, how could you rob such a possibility like THAT from ANYONE!
Sdelat' Ameriku velikoy Snova!
What always annoys me in such articles is that the journalists concentrate on the kid and ignore the medical science. Come on, who cares about Alissia? She is only 6 months old - a less than complete human being, and a defective one at that. Why isn't the public told about what medical achievements made it possible, what infrastructure was created in the hospitals in the past decade to make this possible, about the doctors, nurses, their training, education, about computers, about tools, etc., etc.? Why? Certainly all that is much more important than whether yet another human baby will live or die...
Call me heartless, but crap like that BBC article breeds stupidity among general public and teaches them it's ok to ignore how things happen in our world. And hence some of the readers will say the obligatory "wow" (if at all) and go back to opposing stem-cell research, genetics, budget extension for medical schools, and after that will send their kid to some quack or a faith-healing program after consulting with a professionally made horoscope, of course...
Future Wiki -- If you don't think about the future, you cannot have one.
Dib: You'll never... get away with this...
ZIM: You speak craziness, Earth boy. More organs means more human. It WILL work.
-- Invader ZIM, episode 7
If it's for-profit but free, you're not the customer -- you're the product (e.g., the Slashdot Beta's "audience").
I don't see how you can make that joke, and how people can think its funny. Someone obviously lost their child, which is a horrible thing to have happen. Just hope that you never lose anything with significant meaning, because only then will you even begin to comprehend the cruelty of your statement.
Are you joking or do you just have no idea what you're talking about? There are ENORMOUS waiting lists for organ transplants. It is VERY, VERY likely that there are other children waiting to get transplants.
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?
Why didn't they just make a new baby? It's fun, and cheao.
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I had similar thoughts when I saw this report on TV. I have to admit, if the baby were my child I probably would do all I could do to keep my child alive.
But are we just talking about the cost, or is there another issue that we have to consider. Technology is getting to the point where just about everyone lives to breeding age. This means that the defective genes these children have are passed on. Are we de-evolving as a species because we improve the chances of living to breeding age?
The only way that I can think to balance this technological conundrum is via genetics. If we could identify and correct such issues in an embryo, or go to the level of the movie Gattaca and pre-select those embryos with the best genes, that would decrease the possiblity of such extreme surgeries. Of course, that then brings up a tremendous number of ethics issues, but none that cannot be worked through, or that some small country won't become a haven for.
Or, in a more cruel line, if you can't afford it, you can't have it. Is it really societies responsibility to make sure that every child has an equal chance at attaining adulthood? Or is it their parents.
The United States has been taking more and more of the responsibility of parenting away from the parent and to the state. Our children are currently taught moral values by state-run schools, sex ed for example. There are numerous examples of parents being brought up on charges for spanking(I'm not talking about beating, I'm talking about a swat on the rump that every American over the age of 40 has had at least two or three times in their lives) or denying health care due to personal or religeous beliefs. Where will it stop?
I don't have the answers, I don't think anyone does. I am of the opinion that if you can't afford it, all you get is basic health care to treat colds, broken bones, etc., and the more expensive health care that is needed for 6 organ transplants are not guarantees. If a family can raise the money or a hospital wants to waive fees so they can try new procedures, those options should always be available.
I rarely read replies, it's my opinion and if you thought about your opinion a little more, I'm OK with that.
I'm seeing some people here saying that this baby should have merely been allowed to die, and the parents encouraged to just "have another one". Obviously I can't say for sure, but I'd hazard a guess that most of these people aren't parents. If they were, they'd realize that most parents become deeply emotionally attached to their children very quickly, usually at an early stage in pregnancy, in fact, so it's not as though a six-month-old girl can simply be scrapped and replaced as though she were a defective car.
Here's a more pertinent point: once you start saying that some people are too "physically defective" to live, where would you draw the line? I, for example, am among the most physically health people around -- my mother always said I was "disgustingly healthy". Even so, had I lived in Nazi Germany, I would have been exterminated due to my "physical imperfections" (and no, I'm not Jewish).
Then, on a more personal level, there's my wonderful girlfriend, who's beautiful, incredibly intelligent (IQ in the mid 170s), who graduated from Berkeley with honors, and who spends her time rescuing homeless cats and advocating for social services for autistics (not to mention the ways she's brought joy into my life, in more ways than I can count). She was also born with severe birth defects that required eight or nine major operations over a number of years at a total cost of several million dollars. Was it worth it? I don't even have to wonder about that.
The simple fact of the matter is, you can't tell which human lives are going to be valuable and which ones aren't when the baby is so young. As to the argument of "quantity" -- that you could have saved more babies with those eight organs -- well, let's use your own calculus. Why is it so important to save the maximum number of lives possible, especially considering, as you point out, that making babies isn't exactly a huge challenge? It's not as though human beings are in short supply these days -- far from it. And it's also not as though most people even want babies, considering (for example) that one-third of all pregnancies in the United States end in abortion.
I realize this post is a bit meandering, but you'll have to excuse my lack of coherence. There are people responding to this article who are essentially saying that my girlfriend (a slashdotter whom I love with all my heart and plan to marry someday) should be dead because she's "too defective" and repairing those defects wasn't worth the cost or effort. It's hard to write clearly when your emotional response to such comments is interfering so much.
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.
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In short, your post is an extremely good argument for America's system of private health care. When we start deciding how our public health dollars are spent, it doesn't take long for the healthy to realize that they outnumber the sick. When people realize, for instance, the very large portion of medical expenditures targeted at the elderly--well, hey. They're not productive members any more. And let's not forget about the special ed kids in school: some kid drooling in a wheel chair is never going to hold down a job or pay taxes either. If we just stopped giving them medical services, they'd die--and stop costing us money. Right?
Years ago I attended an economics lecture given by Milton Friedman, the Nobel prize-winning economist. He described a situation much like this, and went on at great length about the "tyranny of democracy." What happens, he asked, when 51% of Congress votes to shoot the other 49? In much the same way, the tyranny of democracy is expressed when the young, the healthy, the tax-paying, the well-educated discover that they could pay a lot less in taxes if they just killed off the lame, the halt, and the feeble.
This isn't an abstract argument: a population phenomenon in the United States called the Baby Boom means that an abnormally large population of people was born between 1948 and 1960. The oldest Boomers are nearing retirement age--and when 2025 rolls around (when the youngest Boomers turn 65) a disproportionately large portion of U.S. citizens will be expecting retirement benefits. As we get closer and closer to that point, I fully expect to hear more people claiming to be "courageous" and "willing to take a stand" by demanding that we kill old people.
For now at least, we (collectively) have no say in whether or not an Italian baby can have a lot of organs transplanted. And I think that's a good thing.
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.