"5.2 percent of the hospital’s liver transplants during that time"
November 20, 2017 11:17 AM Subscribe
I perhaps should have included in the original post a link to this recent article on the ethics of such donations:
Liver Allocation to Non-U.S. Citizen Non-U.S. Residents: An Ethical Framework for a Last-in-Line Approach
The incidence of non-U.S. citizen non-U.S. resident patients coming to the United States specifically for deceased donor liver transplantation raises compelling ethical questions that require careful consideration. The inclusion of these often financially and/or socially privileged patients in the pool of potential candidates for an absolutely scarce and life-saving liver transplant may exacerbate disparities already existing in deceased donor liver allocation. In addition, their inclusion on organ transplant waiting lists conflicts with recognized ethical principles of justice and reciprocity. Moreover, preliminary data suggest that public awareness of this practice could discourage organ donation, thereby worsening an already profound supply–demand gulf. Finally, U.S. organ allocation policies and statutes are out of step with recently promulgated international transplant guidelines, which prioritize self-sufficiency of organ programs. This article analyzes each of these ethical conflicts within the context of deceased donor liver transplantation and recommends policy changes that align the United States with international practices that discourage this scenario.
posted by crazy with stars at 11:45 AM on November 20, 2017 [2 favorites]
Liver Allocation to Non-U.S. Citizen Non-U.S. Residents: An Ethical Framework for a Last-in-Line Approach
The incidence of non-U.S. citizen non-U.S. resident patients coming to the United States specifically for deceased donor liver transplantation raises compelling ethical questions that require careful consideration. The inclusion of these often financially and/or socially privileged patients in the pool of potential candidates for an absolutely scarce and life-saving liver transplant may exacerbate disparities already existing in deceased donor liver allocation. In addition, their inclusion on organ transplant waiting lists conflicts with recognized ethical principles of justice and reciprocity. Moreover, preliminary data suggest that public awareness of this practice could discourage organ donation, thereby worsening an already profound supply–demand gulf. Finally, U.S. organ allocation policies and statutes are out of step with recently promulgated international transplant guidelines, which prioritize self-sufficiency of organ programs. This article analyzes each of these ethical conflicts within the context of deceased donor liver transplantation and recommends policy changes that align the United States with international practices that discourage this scenario.
posted by crazy with stars at 11:45 AM on November 20, 2017 [2 favorites]
They can have this American's liver when they pry it from my bloated, cirrhotic corpse.
posted by Atom Eyes at 11:47 AM on November 20, 2017 [6 favorites]
posted by Atom Eyes at 11:47 AM on November 20, 2017 [6 favorites]
I totally understand that they are talking specifically about non-resident non-citizens, but I fear that any eventual solution could also end up excluding resident non-citizens, especially undocumented immigrants.
posted by ArbitraryAndCapricious at 11:49 AM on November 20, 2017 [12 favorites]
posted by ArbitraryAndCapricious at 11:49 AM on November 20, 2017 [12 favorites]
Buried way down far from the lede...
posted by Talez at 11:49 AM on November 20, 2017 [70 favorites]
To be sure, the proportion of available livers that go to foreigners is tiny — slightly less than 1 percent of liver transplants nationwide from 2013 to 16. The figure appears to be dropping further in 2017. Even if all recipients were Americans, wait times would still be substantial. Moreover, foreigners queue up on the waitlist like everybody else — although it may be easier for them, since they aren’t rooted in any particular state, to choose a hospital in an area with a shorter wait, such as Ochsner. And some Americans discouraged by the lengthy wait in this country have gone abroad for transplants.We now return you to your regularly scheduled tribalism.
posted by Talez at 11:49 AM on November 20, 2017 [70 favorites]
“When you take people from other parts of the world and provide an organ transplant to them rather than someone who’s here, there’s a real cost, there’s a real life that’s lost,” said Jane Hartsock, a visiting assistant professor of medical humanities and health studies at the Indiana University School of Liberal Arts. Hartsock and her colleagues wrote a journal article published last year saying foreigners should be last in line for a transplant.
When you deny people from other parts of the world an organ transplant in order to give it to someone in the U.S., there's a real life that's lost as well. Hartsack's article reports that organ recipients who travel to the U.S. specifically to obtain a transplant benefit from the same factors that give more affluent Americans improved chances of receiving a donor organ compared to patients who are less wealthy.
If you're interested in addressing this inequality based on the cost of medical care, it seems better to do that directly. The solution Harstock is proposing seems to be to be as repugnant as other forms of nativism. That's especially true because she counts as one of the negative effects of providing this treatment to patients from outside the U.S. is that Americans might be less willing to donate organs if they knew foreigners might receive them. It's striking to me that catering to the feelings of bigots is characterized as an ethical response to prejudice.
posted by layceepee at 11:51 AM on November 20, 2017 [9 favorites]
When you deny people from other parts of the world an organ transplant in order to give it to someone in the U.S., there's a real life that's lost as well. Hartsack's article reports that organ recipients who travel to the U.S. specifically to obtain a transplant benefit from the same factors that give more affluent Americans improved chances of receiving a donor organ compared to patients who are less wealthy.
If you're interested in addressing this inequality based on the cost of medical care, it seems better to do that directly. The solution Harstock is proposing seems to be to be as repugnant as other forms of nativism. That's especially true because she counts as one of the negative effects of providing this treatment to patients from outside the U.S. is that Americans might be less willing to donate organs if they knew foreigners might receive them. It's striking to me that catering to the feelings of bigots is characterized as an ethical response to prejudice.
posted by layceepee at 11:51 AM on November 20, 2017 [9 favorites]
Normal people just get on one transplant waiting list -- the one for whatever big transplant center is closest. Rich people (from any country) get on every transplant waiting list, including different regions within the US and different countries. I don't think the conflict here is American/foreigner, it's non-rich/rich.
posted by miyabo at 11:52 AM on November 20, 2017 [91 favorites]
posted by miyabo at 11:52 AM on November 20, 2017 [91 favorites]
Even beyond the realm of health care, some are questioning whether foreigners should be able to access limited spots that might otherwise be available to U.S. citizens.
There are at least 13 million legal foreign residents in the United States.
So this "foreigners" versus "citizens" framing is garbage.
posted by srboisvert at 11:55 AM on November 20, 2017 [2 favorites]
There are at least 13 million legal foreign residents in the United States.
So this "foreigners" versus "citizens" framing is garbage.
posted by srboisvert at 11:55 AM on November 20, 2017 [2 favorites]
Flagged Talez' comment as fantastic, and adding that there is a shortage of donated organs, for everyone, period. Declining violent and traffic deaths among young people mean fewer cadaver donors, and not enough people opt-in to being living donors when they acquire or renew their driver's licenses.
Rich people - foreigners or not doesn't matter - can afford to game the system by being able to fly to wherever transplant center has the shortest waiting list, and ordinary people cannot.
posted by Rosie M. Banks at 11:55 AM on November 20, 2017 [7 favorites]
Rich people - foreigners or not doesn't matter - can afford to game the system by being able to fly to wherever transplant center has the shortest waiting list, and ordinary people cannot.
posted by Rosie M. Banks at 11:55 AM on November 20, 2017 [7 favorites]
There are about at least 13 million legal foreign residents in the United States.The ProPublica article directly addresses this: it claims that those people should be eligible to be transplanted in the US, because there's a reciprocity issue, and their organs would be part of the US donation pool if they died here. But of course, people are eligible to receive donated organs even if they had previously indicated an unwillingness to be donors, so reciprocity doesn't really seem to be a defining factor.
I don't know. I guess that I think the way to address long waiting lists is to increase education about organ donation, so that potential donors and their next-of-kin opt in, and hopefully eventually to provide alternative treatments so that fewer people ultimately need donated organs.
posted by ArbitraryAndCapricious at 12:01 PM on November 20, 2017 [1 favorite]
The "Liver Allocation" article in the comments adds some useful discussion points. One, that some foreign transplant recipients might be returning to an area without appropriate post-care, which might impact their outcomes. This could be considered as a potential factor in determining how likely someone is to get the liver. Also that some countries (Japan is mentioned) have specific beliefs and funeral practices that are at odds with a transplant system; what might be most beneficial is to try to do work with these countries to help them develop their own systems.
My spouse is currently in the process of being put on the waiting list for a liver, albeit (thankfully) for a condition where he might stay on the low MELD score side for his entire life and not need the transplant. We're also in an area (southeast) that tends to have a higher number for the need. But I understand being protective of that scarce resource; I agree with several people above, though, that the issue of wealth and access is more pressing than foreign status.
Incidentally, one of the things we covered at one of the group meetings involved how to create a GoFundMe so your family and friends could help out. That aspect of our health care system grosses me out way more than the specific recipients of the livers.
posted by bizzyb at 12:06 PM on November 20, 2017 [4 favorites]
My spouse is currently in the process of being put on the waiting list for a liver, albeit (thankfully) for a condition where he might stay on the low MELD score side for his entire life and not need the transplant. We're also in an area (southeast) that tends to have a higher number for the need. But I understand being protective of that scarce resource; I agree with several people above, though, that the issue of wealth and access is more pressing than foreign status.
Incidentally, one of the things we covered at one of the group meetings involved how to create a GoFundMe so your family and friends could help out. That aspect of our health care system grosses me out way more than the specific recipients of the livers.
posted by bizzyb at 12:06 PM on November 20, 2017 [4 favorites]
Normal people just get on one transplant waiting list -- the one for whatever big transplant center is closest. Rich people (from any country) get on every transplant waiting list, including different regions within the US and different countries. I don't think the conflict here is American/foreigner, it's non-rich/rich.
I remember hearing recently that Steve Jobs got himself on the list for as many different places as possible and just kept a fully-crewed and gassed plane on standby for the entire time he was on the lists, I guess be able to claim the liver immediately if a compatible one came up.
posted by Copronymus at 12:09 PM on November 20, 2017 [9 favorites]
I remember hearing recently that Steve Jobs got himself on the list for as many different places as possible and just kept a fully-crewed and gassed plane on standby for the entire time he was on the lists, I guess be able to claim the liver immediately if a compatible one came up.
posted by Copronymus at 12:09 PM on November 20, 2017 [9 favorites]
This article is wrong-headed in almost every possible way. Being aghast that a few foreigners get rich enough to climb the walls the West has erected around itself to keep from sharing its wealth is pretty fucking ironic, and would be hilarious if it didn't make me so irritated.
posted by howfar at 12:18 PM on November 20, 2017 [7 favorites]
posted by howfar at 12:18 PM on November 20, 2017 [7 favorites]
Flagged Talez' comment as fantastic, and adding that there is a shortage of donated organs, for everyone, period. Declining violent and traffic deaths among young people mean fewer cadaver donors, and not enough people opt-in to being living donors when they acquire or renew their driver's licenses.
This is one of those areas where Nudge makes a lot of sense:
Sunstein and Thaler also propose a way to increase organ donation rates in the United States. They argue that a mandated choice program should be put in place, where, in order for someone to renew their drivers license, they must say whether or not they would like to be an organ donor. They also advocate the creation of websites which would suggest that the wider community supports organ donation in order to nudge people into becoming organ donors themselves.
I'd go farther and make it opt out instead of opt in.
posted by leotrotsky at 12:18 PM on November 20, 2017 [7 favorites]
This is one of those areas where Nudge makes a lot of sense:
Sunstein and Thaler also propose a way to increase organ donation rates in the United States. They argue that a mandated choice program should be put in place, where, in order for someone to renew their drivers license, they must say whether or not they would like to be an organ donor. They also advocate the creation of websites which would suggest that the wider community supports organ donation in order to nudge people into becoming organ donors themselves.
I'd go farther and make it opt out instead of opt in.
posted by leotrotsky at 12:18 PM on November 20, 2017 [7 favorites]
Bob Dylan said,"While money doesn't talk, it swears."
posted by Oyéah at 12:19 PM on November 20, 2017
posted by Oyéah at 12:19 PM on November 20, 2017
Yeah, I don’t mind foreigners getting livers, but I do mind the implication that hospitals deliberately seek out foreigners who can afford to pay higher prices to the hospital than Medicaid reimbursement.
posted by corb at 12:21 PM on November 20, 2017 [4 favorites]
posted by corb at 12:21 PM on November 20, 2017 [4 favorites]
Honestly, I would have never thought anybody would voluntarily choose to travel to the US to undergo any sort of medical procedure, thanks to the astronomical cost of doing so there. After all, the same or better standard of care is available elsewhere for less money. (Fun example: the default plan of our travel insurance provider in Finland covers "any country, except the United States", with a separate, more expensive plan offered for the US alone. My wife is traveling to a conference in LA next year, and some of the things she's having to consider and prepare for are as bad or worse than on previous trips to developing countries.)
But having read the article, I'm not at all surprised that priority access to organ transplants for the rich is a thing there, so it makes sense.
I'd go farther and make it opt out instead of opt in.
This was quite recently done here. A good system, IMO.
posted by jklaiho at 12:41 PM on November 20, 2017 [1 favorite]
But having read the article, I'm not at all surprised that priority access to organ transplants for the rich is a thing there, so it makes sense.
I'd go farther and make it opt out instead of opt in.
This was quite recently done here. A good system, IMO.
posted by jklaiho at 12:41 PM on November 20, 2017 [1 favorite]
People come to the US for treatment all the time. Some of them are rich people who can pay their own way, and some of them are people whose national health services pay for them to obtain treatment that isn't yet available in their own country. Top US hospitals have special offices for patients who are traveling internationally.
posted by ArbitraryAndCapricious at 12:54 PM on November 20, 2017 [5 favorites]
posted by ArbitraryAndCapricious at 12:54 PM on November 20, 2017 [5 favorites]
After all, the same or better standard of care is available elsewhere for less money.
Except if you are super rich, the less money thing doesn't even enter into the equation.
And while the overall standard of care may be better in other countries, in the US if you have a giant bag of cash you can pay (or at least have the perception of paying) for a medical care experience that is the best in the world (with regards to surgical talent, etc.).
posted by paulcole at 12:58 PM on November 20, 2017 [1 favorite]
Except if you are super rich, the less money thing doesn't even enter into the equation.
And while the overall standard of care may be better in other countries, in the US if you have a giant bag of cash you can pay (or at least have the perception of paying) for a medical care experience that is the best in the world (with regards to surgical talent, etc.).
posted by paulcole at 12:58 PM on November 20, 2017 [1 favorite]
This is kind of a meta-observation but it's interesting how technological progress can create a race between otherwise unrelated developments that make a problem worse and developments with the potential to resolve the problem entirely. It is a toss-up whether this ethical dilemma is about to get much worse or suddenly disappear - there's not much in between.
In this case it's declining donor organ availability due to more success in saving lives, vs. the future potential of synthetic organs (grown, 3D printed, or otherwise). No one would really propose holding back on car safety advancements to keep the transplant wait times under control, but the problem is going to get much worse if autonomous vehicles can deliver on the promise of radically reducing traffic fatalities.
posted by allegedly at 1:02 PM on November 20, 2017 [2 favorites]
In this case it's declining donor organ availability due to more success in saving lives, vs. the future potential of synthetic organs (grown, 3D printed, or otherwise). No one would really propose holding back on car safety advancements to keep the transplant wait times under control, but the problem is going to get much worse if autonomous vehicles can deliver on the promise of radically reducing traffic fatalities.
posted by allegedly at 1:02 PM on November 20, 2017 [2 favorites]
This article is wrong-headed in almost every possible way. Being aghast that a few foreigners get rich enough to climb the walls the West has erected around itself to keep from sharing its wealth is pretty fucking ironic, and would be hilarious if it didn't make me so irritated.
C'mon, the phrase "sharing it's wealth" doesn't apply, because rich Americans are still getting theirs. These are wealthy foreigners buying their way past working class American citizens, many of them probably people of color, and they have every right to be angry over it, just another rung removed from the ladder.
posted by Beholder at 1:13 PM on November 20, 2017 [12 favorites]
C'mon, the phrase "sharing it's wealth" doesn't apply, because rich Americans are still getting theirs. These are wealthy foreigners buying their way past working class American citizens, many of them probably people of color, and they have every right to be angry over it, just another rung removed from the ladder.
posted by Beholder at 1:13 PM on November 20, 2017 [12 favorites]
If you're curious about the details of the current system, I did some research in the context of a fictional liver transplant scenario on House of Cards.
**spoilers for season 4**
On the show, President Frank Underwood needed a liver and Doug, a staffer, arranges for him to skip the line and get a liver ahead of someone with higher medical need.
**spoilers for season 4**
On the show, President Frank Underwood needed a liver and Doug, a staffer, arranges for him to skip the line and get a liver ahead of someone with higher medical need.
Organ donation in the US is handled by the Organ Procurement and Transplantation Network, which is run by the United Network for Organ Sharing. In theory other non-profit organizations could get involved, but nobody ever has. The rules governing who gets what organs in what order are debated on councils before becoming effective, and subject to a few goals and guidelines established in the National Organ Transplant Act.posted by vibratory manner of working at 1:20 PM on November 20, 2017 [2 favorites]
Rules for organ allocation vary by organ. For an adult needing a liver you're assigned either 1A status (roughly: dead within the week), or given a score based on your current liver function. Let's assume that Underwood qualified for 1A status. Within that category, candidates are ranked by total waiting time in 1A status. When a liver becomes available, you get bonus points if you're an exact blood type match as well.
When a liver becomes available, there's a specific order it'll be offered in. First to 1A candidates in the donor's region, then high scoring non-1A candidates in the region in descending order. At a certain threshold score, if it hasn't been taken, it'll be offered nationally to 1A candidates, then descending score, then regional low-scoring candidates, etc. Pediatric livers are offered to pediatric candidates in a given category before adult candidates, but otherwise the same.
There are no provisions whatsoever for considering the identity of the recipient.
So whether Frank is at the top of the list for a given liver depends on the age and region of the donor, blood type matches, and wait times of the other 1A candidates in his region or nationally, depending. It's not clear to me if the donor in this case was a minor or an adult.
However!
a) since 2000, the secretary of the department of health and human services has ultimate authority over organ transplants. Prior to 2000, organ transplants were just regional. The show got this right - that's exactly who Doug went to. It's possible in real life that decision could have been made openly - depends on situation, exact injury, and who's in the relevant offices I imagine. I don't think you could do this silently - officials involved in allocating liver transplants would know that Frank had skipped the line.
b) The department of defense has it's own organ transplant guidelines which conflict with the civilian guidelines. I haven't found any of the details, but it's probably safe to assume that their system allows them to prioritize based on military need, that the president could be included here, and that the president would naturally go to the top of the list. However, if they can't divert a liver from the civilian system (I genuinely have no idea), then it's probably moot. Most of the military sourced livers are probably in the middle east or hospitals in Europe, so even if one did pop up it wouldn't be a great fit due to the large transportation needs.
c) None of that applies to directed donations. Doug might be the only one who actually knows him who's willing to step forward, but I bet if this situation played out in real life a number of individuals would step forward out of patriotism.
“At a time when there aren’t enough livers for ailing Americans, wealthy foreigners fly here for transplant”
My poorly-educated, shit-for-brains relatives would see “foreigner” and get angry;
i see “wealthy” and get angry.
Interesting, that.
posted by D.C. at 1:25 PM on November 20, 2017 [4 favorites]
My poorly-educated, shit-for-brains relatives would see “foreigner” and get angry;
i see “wealthy” and get angry.
Interesting, that.
posted by D.C. at 1:25 PM on November 20, 2017 [4 favorites]
if [the Department of Defense] can't divert a liver from the civilian system (I genuinely have no idea), then it's probably moot.
The DoD is actually the only organisation that can directly influence the number of available organs. Just saying.
posted by Joe in Australia at 1:25 PM on November 20, 2017
The DoD is actually the only organisation that can directly influence the number of available organs. Just saying.
posted by Joe in Australia at 1:25 PM on November 20, 2017
One concern was that patients went to China and received transplants using organs from prisoners. (China said it was stopping the practice in 2015, but experts question whether that has happened.)
Honestly, a lot of Americans have probably benefited from Chinese organs too. One particular story even got nominated for an Oscar, albeit it was about a Canadian going to China.
From my perspective, essentially when Westerners do it, it's called "medical tourism". But when foreigners do it in the US (and from what the article says still follow the rules and queue up), it's stealing.
posted by FJT at 1:27 PM on November 20, 2017 [3 favorites]
Honestly, a lot of Americans have probably benefited from Chinese organs too. One particular story even got nominated for an Oscar, albeit it was about a Canadian going to China.
From my perspective, essentially when Westerners do it, it's called "medical tourism". But when foreigners do it in the US (and from what the article says still follow the rules and queue up), it's stealing.
posted by FJT at 1:27 PM on November 20, 2017 [3 favorites]
Thanks for highlighting this stuff. It's sad what $ can purchase.
Another system abuse I see is elderly parents who get a green card/citizenship via sponsorship from very wealthy immigrant children.
The children then declare their parents to "have no assets" thus making them eligible for Medicaid or Medicare.
I'm pretty liberal but have trouble figuring out why our system gets such people into the system pretty quick but when 12-15million Americans still have no insurance and when others get under-insured.
But, back to the bigger point, between servicing such patients and even having "educational outposts" in $$$$ but civil rights poor countries (you know which institutions of higher learning do that garbage) -- even for the philosophically advanced and the heights of academia $$$$ talks more than justice or being enlightened.
posted by skepticallypleased at 1:33 PM on November 20, 2017 [1 favorite]
Another system abuse I see is elderly parents who get a green card/citizenship via sponsorship from very wealthy immigrant children.
The children then declare their parents to "have no assets" thus making them eligible for Medicaid or Medicare.
I'm pretty liberal but have trouble figuring out why our system gets such people into the system pretty quick but when 12-15million Americans still have no insurance and when others get under-insured.
But, back to the bigger point, between servicing such patients and even having "educational outposts" in $$$$ but civil rights poor countries (you know which institutions of higher learning do that garbage) -- even for the philosophically advanced and the heights of academia $$$$ talks more than justice or being enlightened.
posted by skepticallypleased at 1:33 PM on November 20, 2017 [1 favorite]
Since most of the rest of the world has some form or socialized medicine, what's the barrier to getting a transplant at home? Do Americans go abroad for transplants? As always, if you have wealth, you do what you can to work any system to your advantage. You do that if you don't have wealth, but it takes cash, so too bad for you. Being on the list for a transplant must be really miserable.
posted by theora55 at 1:47 PM on November 20, 2017 [1 favorite]
posted by theora55 at 1:47 PM on November 20, 2017 [1 favorite]
Declining violent and traffic deaths among young people mean fewer cadaver donors
Millennials are killing the dying industry.
posted by FirstMateKate at 1:52 PM on November 20, 2017 [13 favorites]
Millennials are killing the dying industry.
posted by FirstMateKate at 1:52 PM on November 20, 2017 [13 favorites]
Since most of the rest of the world has some form or socialized medicine, what's the barrier to getting a transplant at home?I think it's probably availability of organs. For maximum availability, you need to have an advanced medical system, which the US does when it comes to catastrophic acute stuff, a relatively high rate of sudden death of healthy people, and not a huge taboo on organ donation. The final one is definitely arguable (and varies a lot), but the US has the first two.
posted by ArbitraryAndCapricious at 2:00 PM on November 20, 2017 [2 favorites]
If you believe George Church, there could be pilot pig organs transplanted into humans within the next couple years. A company he spun off managed to create a pig strain that's missing some endogenous pig retroviruses that have skeeved people out for decades (though those viruses have never been shown to infect cotransplanted human tissue). That was likely the last major obstacle to pig organ transfer.
The next few years are going to get super complicated from a regulatory and IP perspective, but I think the smart money says that, within a decade or so, unless the government willfully shuts down this line of work for ideological reasons, we'll see pig organs transplanted into humans, a la Oryx and Crake.
It'll be expensive at first, and there will be failures and setbacks. It'll probably start with just kidneys. But I'm pretty hopeful that organ transplant will look totally different, and much more hopeful, in the next few decades.
posted by gurple at 2:02 PM on November 20, 2017 [1 favorite]
The next few years are going to get super complicated from a regulatory and IP perspective, but I think the smart money says that, within a decade or so, unless the government willfully shuts down this line of work for ideological reasons, we'll see pig organs transplanted into humans, a la Oryx and Crake.
It'll be expensive at first, and there will be failures and setbacks. It'll probably start with just kidneys. But I'm pretty hopeful that organ transplant will look totally different, and much more hopeful, in the next few decades.
posted by gurple at 2:02 PM on November 20, 2017 [1 favorite]
Pig heart valves are already transplanted into humans all the time, right? I'm sure that whole organs are a lot more complicated than that, but I'm not sure why they'd be squickier.
posted by ArbitraryAndCapricious at 2:03 PM on November 20, 2017
posted by ArbitraryAndCapricious at 2:03 PM on November 20, 2017
Millennials are killing the dying industry.
Don't be giving Paul W. S. Anderson any movie ideas.
: )
posted by Beholder at 2:04 PM on November 20, 2017 [1 favorite]
Don't be giving Paul W. S. Anderson any movie ideas.
: )
posted by Beholder at 2:04 PM on November 20, 2017 [1 favorite]
Pig heart valves are already transplanted into humans all the time, right? I'm sure that whole organs are a lot more complicated than that, but I'm not sure why they'd be squickier.
Pig heart valves and connective tissue aren't, I think, a risk for acute immune rejection. Pig organs are covered in galactose oligosaccharides; the first time a pig heart was transferred into a baboon, acute rejection happened and the baboon died within minutes.
Apparently, pig heart valves and connective tissue aren't a danger for transferring Porcine Endogenous Retroviruses (yes, PERVs), either. PERVs are the thing that the Church lab spinoff company just addressed. In a 2001 Frontline interview, David Cooper (a bigwig in xenotransplantation) referred to the danger from PERVs as a potential for "another AIDS epidemic", though lately he's been more sanguine (possibly because his collaborators don't have their own way to address the PERV problem).
posted by gurple at 2:20 PM on November 20, 2017 [1 favorite]
Pig heart valves and connective tissue aren't, I think, a risk for acute immune rejection. Pig organs are covered in galactose oligosaccharides; the first time a pig heart was transferred into a baboon, acute rejection happened and the baboon died within minutes.
Apparently, pig heart valves and connective tissue aren't a danger for transferring Porcine Endogenous Retroviruses (yes, PERVs), either. PERVs are the thing that the Church lab spinoff company just addressed. In a 2001 Frontline interview, David Cooper (a bigwig in xenotransplantation) referred to the danger from PERVs as a potential for "another AIDS epidemic", though lately he's been more sanguine (possibly because his collaborators don't have their own way to address the PERV problem).
posted by gurple at 2:20 PM on November 20, 2017 [1 favorite]
"If you believe George Church, there could be pilot pig organs transplanted into humans within the next couple years. A company he spun off managed to create a pig strain that's missing some endogenous pig retroviruses that have skeeved people out for decades (though those viruses have never been shown to infect cotransplanted human tissue). That was likely the last major obstacle to pig organ transfer."Pig cells are hilariously immunologically incompatible with primates like us for both a lot of absurdly big and a lot of still fatal small reasons, and when you're transplanting more than just connective tissue that can be chemically treated in pretty harsh ways this becomes a serious problem. George Church removing PERVs from his strain of pigs is a really neat stunt, but it is not actually the meaningful step towards xenotransplantation that it is carefully designed to seem like. The techniques that he used are super neat, and remarkably high-throughput, but not nearly the kind of high throughput that could plausibly make pig organs safe on a non-geological time scale.
"Pig heart valves are already transplanted into humans all the time, right? I'm sure that whole organs are a lot more complicated than that, but I'm not sure why they'd be squickier."
There is a lot of honest neat stuff the George Church does, and a whole lot more neat stuff that he is involved in. However, if you as a layman are hearing about something connected to his name, you can pretty safely bet that it is probably completely nonsense for reasons he is papering over knowing that no one ever holds him accountable for his bullshit when he talks to the general public. Its a shame really, particularly because it causes confusion exactly like what we're seeing in this thread.
posted by Blasdelb at 2:30 PM on November 20, 2017 [6 favorites]
...it is probably completely bullshit for reasons [Church] is papering over.
Oh, and potentially much worse than that. There have been triple-species xenotransplantation experiments that have shown no infection of human tissue with PERVs. Muhammad Mohiuddin kept a pig heart beating in a babboon for three years, no sign of infection. There have been plenty of other xenotransplantation experiments, nada nada nada.
So, in walks George Church and eGenesis (the spinoff company) with this new technology for ridding pigs of PERVs with CRISPr. As Mohiuddin puts it, "If FDA mandates us, ‘To move forward you need to get rid of this PERV since George Church has shown you how to do it,’” he says, “then of course, yes [they will have to].”
If PERVs are a new AIDS epidemic waiting to happen, the Church has gotten us one step closer to transplanting pig organs without unleashing that horror. But if they're not -- if PERVs just wouldn't transfer to humans, for whatever reasons -- then he's potentially set us back years, by introducing something that could become a new regulatory hurdle to xenotransplantation.
posted by gurple at 2:37 PM on November 20, 2017 [1 favorite]
Oh, and potentially much worse than that. There have been triple-species xenotransplantation experiments that have shown no infection of human tissue with PERVs. Muhammad Mohiuddin kept a pig heart beating in a babboon for three years, no sign of infection. There have been plenty of other xenotransplantation experiments, nada nada nada.
So, in walks George Church and eGenesis (the spinoff company) with this new technology for ridding pigs of PERVs with CRISPr. As Mohiuddin puts it, "If FDA mandates us, ‘To move forward you need to get rid of this PERV since George Church has shown you how to do it,’” he says, “then of course, yes [they will have to].”
If PERVs are a new AIDS epidemic waiting to happen, the Church has gotten us one step closer to transplanting pig organs without unleashing that horror. But if they're not -- if PERVs just wouldn't transfer to humans, for whatever reasons -- then he's potentially set us back years, by introducing something that could become a new regulatory hurdle to xenotransplantation.
posted by gurple at 2:37 PM on November 20, 2017 [1 favorite]
Of the million+ Americans who go abroad for medical treatment every year, how many are seeking livers, I wonder?
Inserting “foreigners” into this issue is total xenophobic, American-exceptionalist garbage. The US has more wealthy people than any other country, and they’re a lot more of a burden on us out here than ours are on you in there.
posted by Sys Rq at 3:47 PM on November 20, 2017 [4 favorites]
Inserting “foreigners” into this issue is total xenophobic, American-exceptionalist garbage. The US has more wealthy people than any other country, and they’re a lot more of a burden on us out here than ours are on you in there.
posted by Sys Rq at 3:47 PM on November 20, 2017 [4 favorites]
Another system abuse I see is elderly parents who get a green card/citizenship via sponsorship from very wealthy immigrant children.
The children then declare their parents to "have no assets" thus making them eligible for Medicaid or Medicare.
I'm pretty liberal but have trouble figuring out why our system gets such people into the system pretty quick but when 12-15million Americans still have no insurance and when others get under-insured.
This is just offensive, xenophobic garbage. Yes, you can buy effectively buy a visa. If you have that kind of cash, you don't put up with the hassle that is everything involved in Medicaid unless you exist only in the imagination of nativists. You also don't have your elderly parents rely on Medicare, which is admittedly less hassle, but nonetheless, the point stands.
posted by hoyland at 4:20 PM on November 20, 2017 [6 favorites]
The children then declare their parents to "have no assets" thus making them eligible for Medicaid or Medicare.
I'm pretty liberal but have trouble figuring out why our system gets such people into the system pretty quick but when 12-15million Americans still have no insurance and when others get under-insured.
This is just offensive, xenophobic garbage. Yes, you can buy effectively buy a visa. If you have that kind of cash, you don't put up with the hassle that is everything involved in Medicaid unless you exist only in the imagination of nativists. You also don't have your elderly parents rely on Medicare, which is admittedly less hassle, but nonetheless, the point stands.
posted by hoyland at 4:20 PM on November 20, 2017 [6 favorites]
But of course, people are eligible to receive donated organs even if they had previously indicated an unwillingness to be donors
I guess I knew this, or I would have if I had ever thought about it, but it's shocking enough that I wonder if most people do know it. I am not a great fan of an opt-out system but there's no way you should be able to get on a transplant waiting list if you're an adult and haven't checked Yes on your own organ donor card. not until they start growing organs in vats and there's no shortage anymore.
posted by queenofbithynia at 5:45 PM on November 20, 2017
I guess I knew this, or I would have if I had ever thought about it, but it's shocking enough that I wonder if most people do know it. I am not a great fan of an opt-out system but there's no way you should be able to get on a transplant waiting list if you're an adult and haven't checked Yes on your own organ donor card. not until they start growing organs in vats and there's no shortage anymore.
posted by queenofbithynia at 5:45 PM on November 20, 2017
Well, that would mean foreigners couldn't get organs at all unless there was some foreign reciprocity. Also, lots of people who need organs would be unsuitable donors (at least for major organs) so it wouldn't necessarily increase the supply all that much. The ones you need to sign up are young, healthy people, but they're also less likely to contemplate the possibility of needing organs themselves. I do think rewarding potential donors might help, but it would have to be a benefit that doesn't make the organ donation system look bad.
posted by Joe in Australia at 7:24 PM on November 20, 2017 [1 favorite]
posted by Joe in Australia at 7:24 PM on November 20, 2017 [1 favorite]
Another system abuse I see is elderly parents who get a green card/citizenship via sponsorship from very wealthy immigrant children.
The children then declare their parents to "have no assets" thus making them eligible for Medicaid or Medicare.
Besides hoyland's excellent point about nobody dealing with Medicaid who doesn't have to, the entire concept of "declaring their parents to have no assets" is nonsense. When you sponsor a family member you sign a contract that you will support them financially and that they will not use any means-tested federal benefits until they have worked for 10 years in the USA or become a citizen (5 years, usually, plus an English language test).
posted by the agents of KAOS at 7:54 PM on November 20, 2017 [6 favorites]
The children then declare their parents to "have no assets" thus making them eligible for Medicaid or Medicare.
Besides hoyland's excellent point about nobody dealing with Medicaid who doesn't have to, the entire concept of "declaring their parents to have no assets" is nonsense. When you sponsor a family member you sign a contract that you will support them financially and that they will not use any means-tested federal benefits until they have worked for 10 years in the USA or become a citizen (5 years, usually, plus an English language test).
posted by the agents of KAOS at 7:54 PM on November 20, 2017 [6 favorites]
Are you telling me that if you have lots of money you can get better treatment? In the AMERICAN health care system?????
posted by EndsOfInvention at 4:17 AM on November 21, 2017 [3 favorites]
posted by EndsOfInvention at 4:17 AM on November 21, 2017 [3 favorites]
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posted by blob at 11:33 AM on November 20, 2017 [3 favorites]