“This would not have been allowed in Spain.”

Experts consulted by EL ESPAÑOL believe that Alternatives could be proposed to an experimental procedure whose results we would hardly know,

“I think in Spain it would have been transplanted from a deceased donor without any problems,” he explains. Beatriz Dominguez-Gil, Director of the National Organization for Transplantation (ONT). “And, of course, I had the option of dialysis.”

Our country is the world leader in organ transplantation and the world first in kidney transplantation with 3,688 procedures in 2023. ONT is a pioneer in efficient organization of transplant resources and has been emulated in many countries.

“What was said to justify this transplant was that there was no living donor and the expectation was that the waiting list for a deceased donor would take a long time, so, there was a risk of death,” he explains. “I, personally, am not so clear.”

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On March 16, Slayman, 62, became the first patient to receive a pig kidney transplant as a solution to his chronic kidney disease. He was previously given a human kidney but it failed and he returned to dialysis in 2023.

for this Other problems like high blood pressure, type 2 diabetes and heart problems also added, His condition was critical and doctors at Massachusetts General Hospital suggested the possibility of receiving a xenotransplant, that is, a transplant of a non-human organ.

Until now, trials had only been conducted with pig organs – hearts and kidneys – from people with terminal disease or brain death.

These organs were genetically modified to improve compatibility with the human body, and experiments showed that there was no acute rejection, which was the main fear of doctors. But there was still a lot left to know.

“From the first moment it seemed careless to me,” he says. Rafael Matesanz, founder and former director of ONT. “I don’t think it would be a morally acceptable possibility if it were raised in Spain.”

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Matesanj raises many questions. First, the fact that it was not an important organLike the heart, in which case it may be more appropriate.

Second, because the problem of rejection has been solved quite well, but “rejection is not everything” and many other issues also have to be faced; The issues, in fact, today we don’t even fully know what they are and have to be discovered through ‘trial and error’.

In fact, although Massachusetts General Hospital says there is no evidence linking the cause of death to the transplant, Mattesanz believes it is very subtle.

Third, and essential, is the selection of the ideal candidate for xenotransplantation. “The crux of the issue, especially in people with non-vital transplants, is the lack of clear definition of what criteria a patient must meet to access this type of therapy,” he explains.

Rick Slayman “had vascular access problems and was not in good shape, but I could be on dialysis for a while“, He says.

“Obviously, this is an experiment with tremendous, very valuable implications, but how can you ask a patient to trade an option with a life prognosis of years for another that is unknown today?”

The investigation is not going to stop

Matesanz recalls that, in 1954, in the first successful transplantation of a human kidney, the recipient, “so to speak, ideally, it was a very young person. The subjects of xenotransplantation are not going to be ‘sweet experts,’ that was obvious. Is, and that’s going to affect the outcomes: If you don’t die from rejection, you can die from any number of underlying things, like infection, heart attack, etc.”

Neither he nor Dominguez-Gil believe that the death of the first xenotransplant patient with a pig kidney will slow research in this area. In fact, Already several companies are producing genetically modified pigs adapted to humans,

“I don’t think this is going to stop,” the ONT director stressed, “but, obviously, this leads to reflection and a very detailed analysis of the case and what happened.”

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A month after this first transplant, doctors at New York University’s Langone Transplant Institute, a pioneer in the field, performed a second transplant of a pig kidney.

This time it was a woman, 54-year-old Lisa Pisano, who lived in New Jersey and had kidney disease exacerbated by heart failure. It was April 24 and the operation was not easy: his heart and kidneys had failed several times and he had to be resuscitated several times. There has been no update on his health condition.

However, the xenotransplant route is just one of many being investigated in a field that is in full swing. Impairment in asystole – followed by cardiorespiratory failure – is increasingly common.Various forms of immunological tolerance and transplantation without immunosuppression are being tested and significant advances have been made in organ preservation techniques.

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“This should allow us to further improve transplant outcomes as we imagine today,” says Domínguez-Gil.

Additionally, the creation of artificial and bioprostheses is being investigated, “using the matrix of discarded organs for transplantation and filling them with stem cells,” 3d organ printing “And even with the patient’s own cells, with which we could do the transplant with minimal immunosuppression.”

The aim of all these technologies will be to demonstrate in clinical trials whether they provide similar results to standard implants.

“We envision a future in which all of these options will exist alongside each other and we will have to find the right patient niche for each of the therapeutic options available.”