The 72-year-old recipient, Lawrence Kelly of Pennsylvania, had been declared brain dead. His family donated his body for the study, which aimed to investigate how well the modified pig heart worked in the body of a dead human. After Kelly’s transplant in June, the research team repeated the procedure with another deceased recipient, 64-year-old Alva Capuano of New York, in early July. Dr. Robert Montgomery, director of NYU’s Langone Transplant Institute, said the procedures allowed for a more in-depth study of how well recipient bodies tolerated the pig hearts. “We can do much more frequent monitoring and really understand the biology and fill in all the unknowns,” he said. He added that their study was unique because they tried to mimic real-world conditions, for example, by not using experimental devices and drugs. The researchers are working to publish further details of the study.

“He came out a hero”

The researchers traveled out of state to procure the heart, which had genetic modifications aimed at several factors, including regulating the organ’s growth and reducing the chance that the recipient’s immune system would reject it. The flight meant the team could replicate the conditions of a typical heart transplant, said Dr. Nader Moazami, surgical director of heart transplants at NYU Langone Health. “It was about an hour and 15 minute flight from New York, which is typical of the distance we take hearts for clinical transplant,” said Moazami, who performed the transplant. The heart went out to Kelly, a Navy veteran who was declared brain dead after a car accident. Kelly’s fiancee, Alice Michael, agreed to donate his body for research.
“They were going to take his liver and they couldn’t find a recipient. And then New York University called me with this research topic. And I automatically said yes, because I know he would want to do it. He loved to help people “, he said. “When they asked me, I didn’t have to think twice. I just automatically said yes, because I knew it was groundbreaking research and I know he would want it. It was hard because I had to wait to be buried. But in the long run, maybe it can help a lot of people. “He was a hero in life and he came out a hero,” Michael said. After the transplant, researchers ran tests for three days to monitor how well the heart was accepted while the recipient’s body was kept alive using machines, including ventilation. “No signs of premature rejection were observed and the heart functioned normally with standard post-transplant medications and without additional mechanical support,” the medical center said in a news release. In addition, the researchers said they found no signs of porcine cytomegalovirus (pCMV) infection, which experts worry could be a barrier to using pig organs in human recipients.

A new method for transplant research

Testing how well an organ transplant works using a deceased person’s donated body is a new method, Moazami said. The first use of this technique for research came in September, when a team at NYU Langone led by Montgomery transplanted a kidney from a genetically modified pig into a dead human. While the study represents a step forward, Moazami said, there is still work to be done before such a procedure is widely available outside of a research setting. “There’s still a long way to go from here to clinical transplantation to support a patient long-term,” he said. “There are still many, many, many questions that need to be answered.” A major limitation was the length of the study, he said. the organ and recipient were only evaluated for 72 hours after transplantation. Additionally, there could be significant differences in how dead human bodies respond to the process, compared to living people. More research will be needed to determine how transplant recipients would fare in the long term. “We thought that in 72 hours, we could learn all the things that we would learn if we extended it a little bit longer,” Moazami said, noting that the short time frame kept the cost of the study down and allowed the recipient’s body to be returned more quickly. in his family. “We thought 72 hours was a reasonable period for our short-term study, to understand all the things we needed — that three days versus five days versus seven days wouldn’t make a difference. It would be three days versus a month makes the difference? Yes, absolutely. But at this stage, it would be very, very difficult to achieve.” Transplanting animal organs into humans also raises a number of other ethical questions, such as whether the benefits of using a modified pig heart outweigh the risks a patient would face if they waited for a human organ to become available.

Personal connection and new frontiers

For Montgomery, the research has a personal side. He is a recipient of a human heart transplant and said the difficulty in securing a transplant is part of what motivates his work. “During my illness, it became clear to me that this paradigm doesn’t work. It’s a failed paradigm and that we need a renewable resource, an alternative source of organs, that doesn’t require someone to die in order to live,” he said. “My whole illness was about making me aware of reality and changing the way I think, not that it’s not important to keep doing what we’re doing, but we need to move it in a completely different direction. “ In general, the demand for organ transplants far exceeds the supply of donor organs available in the United States. As of July 7, there are 106,074 people on the organ transplant waiting list, with 3,442 on the heart waiting list. On average, 17 people die on the organ transplant waiting list every day. Moazami suggested that animal transplants may someday be useful in the pediatric setting, where patients may face even greater challenges getting a human organ transplant in time. Animal organs could be used as a “bridge”, buying time before a more optimal human organ becomes available. “Perhaps the best way to study this is to perhaps use it as a bridge to a human transplant, if you will, so that any patient who needs an organ can get that heart with the caveat that when a human heart becomes available, it matches with the recipient, we exchange it again,” Moazami said.