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."
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!
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'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).
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?
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.