Organ Transplants

Dr. Thomas Starzl is often referred to as “the father of modern transplantation.” This incredibly prolific physician and researcher, who often worked three days nonstop on a particular procedure, managed to author four books, 292 book chapters, and 2,130 scientific articles. His accomplishments in surgery, immunology, and many other medical fields are legendary. He is considered the most cited physician in the world. The renowned Thomas E. Starzl Transplantation Institute was named in his honor.

I was quite impressed, therefore, when Dr. Starzl came to the University of California, Davis, where I was a medical student. His lecture was held in the largest hall, and it was standing room only. After the lecture, I found myself in the crowded lobby near the dean of the medical school. Next to him, almost hidden by the dean, was the diminutive Dr. Starzl — who caught my eye and gestured hello. The dean noticed and introduced me as a somewhat outspoken medical student. “So,” Dr. Starzl asked me. “What do think of transplant medicine?”

“Really impressive,” I replied, “but I think it’s a gimmick.”

The dean’s face hardened and turned ashen. Starzl was slightly taken aback. “Why do you say that?”

“Well, no matter how good it gets,” I said, “the number of available organs will never meet the need, and in the end, a few thousand transplants won’t make any difference in the overall public health.” At that point, the dean quickly introduced a couple of other people to the famous surgeon, and the attention turned away from me. (Weeks later, I apologized for embarrassing him, but he laughed and said he privately agreed with me.) Many years have passed since then. Transplant surgery is much improved and commonplace throughout the world. But it is still horrifically expensive, and medical insurance is understandably reluctant to pay for it. A liver transplant is about $350,000 and up. The fact is: Organ transplants are still available only to the wealthy and the fortunate. Some poorer countries have entered this rather exotic type of medical tourism. Because of ethical issues, they have shied away from publicity. Patients who desperately need a transplant, and are losing hope, might learn informally about kidneys available in India for about $40,000. Regardless of what the official line is, most people suspect the truth; these kidneys are purchased from povertystricken beggars, of which India has tens of millions. Most people are disgusted by the thought of people resorting to selling their organs for cash. In fact, this is illegal in the United States Those who need the organs, however, often find a way to rationalize this activity.

The transplant business in China is much more insidious and therefore officially denied. However, a December 2005 article in a British financial magazine revealed the truth in its headline: “China’s deathrow kidneys get U.K. buyers.” It appears that executed prisoners in China had “voluntarily donated” their organs for transplant to foreigners. The price charged to the U.K. patients — about $30,000 for a kidney — included a monthlong hospital stay. In Chinese prisons, inmates have a blood sample taken for type and matching. Every year, about 5,000 prisoners are executed, typically with a bullet to the back of the head. Official government policy allows the “harvesting” of organs if the prisoner or prisoner’s family has given written consent, or if the body is not claimed after execution. The actual practice is slightly different. According to confidential reports, the transplant service simply puts out an order for a prisoner with the medical tourist’s blood type. Professor Nadey Hakim, head of transplantation surgery at Hammersmith Hospital, United Kingdom, believes that the prisoner’s organs are then harvested before execution, in order to ensure quality. (In October 2007, the Chinese government officially denied further harvesting of prisoner’s organs for foreign transplants; but I suspect this denial may join a long list of other official denials — such as not having political prisoners, not forbidding religion, not destroying Tibetan monasteries, etc. — which are all rather unconvincing when you look at the evidence.)

For the near future, organ transplant will continue to be the only recourse for some patients. But another therapy is on the horizon, which will ultimately make transplants a relic of history. It is a way of regenerating organs that will be available to everyone, at a much cheaper cost, and truly has the potential to transform the public health. This is stemcell technology.