0:00

In January of 2022, we brought you an

0:02

episode of Today Explained titled, The Man with

0:04

a Pig Heart. Yeah.

0:07

I understand it was an eight-hour

0:09

operation, and the surgeons were

0:11

quite straightforward with Mr. Bennett beforehand, that they really

0:14

couldn't guarantee even that he was going to wake

0:16

up from that surgery. But he

0:18

did wake up from that surgery with the pig heart

0:20

beating in his chest. A

0:23

few days later, he was off the

0:25

heart-lung machine breathing on his own. I

0:27

don't think I have any more. He's able

0:30

to talk. His recovery is expected to be

0:32

very slow because of his prior condition, but

0:34

he continues to be monitored in

0:36

the hospital. Today, we're

0:38

bringing you a sequel of sorts, The

0:41

Man with a Pig Kidney. Rick

0:43

Slaiman is waking up in his

0:45

own bed after receiving the world's

0:47

first successful transplant of a genetically

0:50

modified pig's kidney into a human.

0:52

Whether pig kidneys could save millions of lives

0:54

and whether we really need the pigs at

0:57

all. Coming up on Today Explained. Support

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2:24

to Today Explains. Is it

2:26

Today Explains or Today

2:28

Explains? Explain

2:31

now. Bill Matthews, Senior Correspondent

2:33

at Vox, also with Future Perfect. We just had

2:36

you on the show to talk about taxes, but

2:38

now you're back to talk about pigs? Pigs

2:41

and pig kidneys. And my interest

2:43

is more in the kidneys than the pigs. Okay,

2:45

what's going on with kidneys? So

2:47

for many years now, scientists have in

2:49

their scientist way been trying to figure

2:52

out how to take kidneys

2:54

from pigs and put them in humans, you know,

2:56

like you do. And

2:58

this has been a challenge because there

3:00

are a bunch of things on pig

3:02

organs. There are these molecules called antigens

3:05

that the human

3:07

immune system reacts very violently to. And

3:10

so you try to put a kidney from a

3:12

pig into a human, human does not like it,

3:15

bad things happen. And

3:17

the big breakthrough was that for the first

3:19

time they put a kidney from a pig

3:21

in a living human and

3:23

it worked. It didn't reject as

3:25

of our conversation right now. It

3:27

seems to be going well. There

3:29

was a complication after Rick Slaiman

3:31

received that genetically edited pig kidney,

3:33

but his doctors say he rebounded

3:36

well. And today he's back home

3:38

and no longer needing to schedule

3:40

dialysis treatment. We're going to keep

3:42

watching him closely three times a week

3:44

initially blood work and seeing him

3:46

in clinic. And I'm sure there are people

3:48

out there who are not familiar with like pig

3:51

organ transplant procedure. How does it work?

3:53

Is it like in face off where

3:55

they put, you know, Nick Cage right

3:57

next to John Travolta, except this time it's like a

3:59

dude. a pig and they just open them up

4:01

and swap? Nick Cage is usually

4:03

there, but that's unrelated. He's just interested. I'd

4:06

like to take his face.

4:11

There are special farms. There's a few

4:13

companies that do this. There's one called

4:15

eGenesis. There's one called ReviviCorps that

4:18

specialize in genetically engineering

4:20

pigs, specifically for transplant.

4:23

And so what they're doing is they're trying

4:25

to design pigs that do not have the

4:27

antigens that cause humans to reject. And

4:29

so they have these specialized farms where they raise these

4:32

pigs up. They will slaughter the pig.

4:34

They don't just take the kidney and then send

4:36

them off to a nice farm. They

4:39

take the kidney, transport it in

4:41

cold storage, and then

4:43

it's transplant it the way a human kidney

4:45

would be transplanted. What's new is just who

4:48

the kidney is coming from. And

4:50

why a pig? So pigs are

4:52

a lot like humans, just biologically, in

4:54

terms of species

4:56

that outside apes and

4:58

monkeys, and especially among species

5:01

that we have a lot of experience

5:03

growing at large scale in

5:05

farms and such, much closer to

5:07

pigs than to cows or to other kinds of

5:09

livestock. And that

5:12

makes them very appealing as a potential

5:14

source for organs like this. Just

5:17

to give a little bit of the prehistory, since 2021, versions of this

5:19

experiment have been

5:22

happening. There's

5:25

a team at NYU that's been doing

5:27

a lot of studies. The pig kidney

5:29

appears to replace all

5:31

of the important tasks that the

5:33

human kidney manages. Their

5:36

studies involved brain dead patients. So they

5:38

would have someone whose heart

5:40

was still working, they were still breathing, they

5:43

had a sort of biologically functioning body, but

5:45

they had no consciousness, they were legally dead,

5:48

and the families of these people consented to

5:50

have pig organs transplanted

5:52

into them. It's only sitting

5:54

that his final act, he

5:57

will be helping so many in the need.

6:00

through this innovative medical advancement.

6:02

And they found a lot of success

6:04

doing that, but it was also an

6:06

unusual case. The ideal is that

6:08

you want to be able to do this with people who aren't brain

6:11

dead and see how

6:13

long it works and what kind of life it enables them

6:15

to live. And so Rick Slayman,

6:17

who is the recipient in this case,

6:19

who is a 62-year-old Massachusetts man, he's

6:21

from Weymouth. He saw this as not

6:23

only as a way to improve his

6:26

own personal life, but a way to

6:28

provide hope for the thousands of people

6:30

who need a transplant to survive. He

6:33

was the first person to be alive and not brain

6:35

dead and actually get one of

6:37

these, and he got it at Mass General. My

6:39

deepest gratitude goes

6:42

to our MGH team. It

6:51

seems to be working out well. The thing you

6:53

worry about with any transplant is rejection, is

6:56

the immune system rebelling and attacking the organ. And

6:58

he seems to be in good health. The

7:01

kidneys producing urine, which is what kidneys are

7:03

supposed to do, and it seems

7:05

to be successful so far. And

7:10

how big a deal is this scientific breakthrough-wise, like scale

7:12

of 1 to 10? I would say

7:14

this is like an 8 or a 9. We

7:17

had good reason to believe this would work, but

7:19

I think these social ramifications of it working

7:21

are pretty enormous. So

7:25

about 120,000 people every year

7:27

get diagnosed with what's called

7:29

end-stage renal disease or kidney

7:31

failure. Their kidneys don't work anymore.

7:34

And once you get to that point, you

7:36

need to replace the function of your kidneys somehow.

7:39

One way of doing it is dialysis. This is how most people

7:41

do it. It will keep you alive

7:43

for a few years, but the majority of

7:45

people on it die within five years. What

7:48

you really want is a transplant, and

7:50

there aren't enough human kidneys. They're

7:54

about in the range of 20,000 to 25,000 transplants a year in the U.S. Compare

7:58

that to the people being newly- diagnosed every

8:00

year, almost all of whom would benefit

8:02

from getting a kidney transplant. So

8:05

in an ideal world, dialysis wouldn't

8:07

exist. It's a really crappy substitute

8:09

for having a kidney, but

8:12

there have not been enough human kidney donors so

8:14

far, so we've had to rely on it. What

8:17

this is sort of opening the

8:19

possibility to is that we

8:21

could grow enough kidneys in pigs and

8:24

transplant those and have that be our sort

8:26

of first line of treatment for kidney failure

8:28

as opposed to relying on dialysis. Do we

8:31

know how long this guy who got the

8:33

kidney from the pig will live? We

8:35

don't have any information about how long

8:37

pig kidneys can last just because it's

8:40

never happened before. We do

8:42

have a lot of information on human kidneys

8:44

and how long they can last. So

8:47

a kidney from a living donor lasts

8:49

about 12 to 20 years, so it

8:51

can last a very, very long time.

8:53

A kidney from a deceased donor lasts maybe

8:56

8 to 12 years, so much less time.

8:58

It's much worse to get a kidney from

9:00

a deceased donor than from a

9:02

living donor. We don't know how pigs are

9:04

going to stack up, if they're going to be worse than

9:06

either of them, if they're going to be somewhere in the middle. Maybe

9:09

they're better than either of them. Maybe the pigs are

9:11

up to something that we don't understand, but that's just

9:13

something we don't have data for right now. Okay,

9:16

so this isn't a guaranteed path to another 10, 20 years

9:18

of life yet. However,

9:22

what's the deal? Are people dying

9:25

to get one of these pig kidneys, you think?

9:27

And if so, how long until

9:29

this can scale up? I think if you

9:31

talk to anyone with kidney failure who's currently

9:33

on dialysis, they will do

9:36

almost anything to get a

9:38

kidney from whatever source. It is the difference

9:40

between life and death. It

9:42

is the difference in the near term between a

9:44

life where you often have to go to a

9:46

dialysis center three or four times a week and

9:49

wait for hours for a machine to process

9:51

your blood and are

9:53

left exhausted and unable to do your job

9:55

or engage in daily life and

9:58

being more or less... back to normal life with

10:01

a transplant. People are very, very

10:03

desperate for these things. And in terms of

10:05

how long it's going to take, tissues

10:08

like organs are treated by the

10:10

FDA sort of like a drug,

10:12

and drugs before they're available have

10:15

to be tested for safety and

10:17

effectiveness. And so this

10:19

was a very early pilot study

10:21

with one person. They're gonna

10:23

need to do phase three, real

10:26

sort of at scale studies on

10:28

a number of people to make sure that

10:30

these kidneys work. And after

10:32

that, I think it's gonna take some time

10:35

to ramp up to the point where there's

10:37

enough supply to meet the demand, because the

10:39

demand, not just in the US but internationally

10:41

is enormous. Okay, so the

10:43

machinery is ramping up, the science is

10:46

ramping up, the world is taking note,

10:48

but I hear Dylan that

10:50

you think we shouldn't even need pigs

10:52

kidneys. So I

10:55

wanna be clear on this. I think this is a great

10:57

step forward. I admire everyone who worked on it. I think

10:59

they're doing something that will

11:03

save lives given the reality of the world we

11:05

live in, they're here. It

11:10

irritates me a little bit, in

11:13

part because I donated my kidney many

11:15

years ago, and it's

11:17

not that hard. And

11:20

it's something that a lot of people could do,

11:23

and almost no one does it. And

11:25

we could live right now in a world

11:28

where enough people are donating their kidneys that

11:30

this isn't even necessary. There are more than

11:32

enough people walking around with two healthy kidneys

11:34

who could donate one and

11:37

save someone's life to

11:39

clear this backlog. It's

11:42

just not happening. And so there's a part

11:44

of me that looks at the situation and

11:46

asks like, why are we forcing pigs to

11:48

do this thing just because we don't have

11:50

the stones to do it ourselves? AndATH

11:57

Branham. You.

12:02

And makes his case that we shouldn't need

12:04

the pigs when we return until they explained.

12:17

Some of us are to come from:

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13:19

Ext. Hi

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I'm Kayla Lorenz, host of Power

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User, and like many millennials, I

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can't afford to do anything I have. Also, like

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many millennials, my TikTok and Instagram feeds

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week, pro-content creators renovated the

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news, that's all on our latest episode of

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Power User. Today,

15:03

I explained

15:11

his back still with Dylan Matthews from

15:13

Vox, who recently revealed that

15:15

he has donated one of his kidneys. So

15:18

Dylan, you're talking to me right now with

15:20

just one kidney. I am, and I've had

15:22

just one kidney since August 22, 2016. So

15:26

it's been over seven years, and

15:28

coming up on my eighth anniversary. Humans

15:31

don't really need more than one kidney. If

15:34

you donate one, the other one grows to

15:36

pick up the slack. I get

15:38

checked up with my doctor, and my kidney function

15:40

is totally normal. I promise

15:42

I can still produce urine. Yeah,

15:48

it's totally fine. It was

15:50

an intense experience at the time, and I

15:52

think I got through sort of the initial

15:54

sort of pain and discomfort of the surgery

15:56

with the help of my now wife and

15:58

my dad. and I don't want to

16:01

underplay that, but it's also over in

16:03

a couple weeks. After those couple weeks, it doesn't

16:05

affect your life more or less at all. You

16:08

are at slightly elevated risk of kidney

16:10

failure decades in the future,

16:12

but that's about it. I think

16:14

I met you after you had donated your kidney,

16:16

Dylan, but I know that in the six years

16:19

I've known you, you've always

16:21

had healthcare and a good job

16:23

and lots of support from your

16:25

colleagues. Does saying that more people

16:27

should just be donating their kidneys

16:30

sort of negate the fact that there are a

16:32

lot of Americans and a lot of people on

16:34

this planet who don't have the level of comfort

16:36

and security that we have? If you're

16:38

interpreting what I'm saying as literally every human on

16:40

the earth, regardless of circumstance,

16:42

should go out and have

16:44

kidney surgery. That's not what I'm saying. What

16:46

I'm saying is that I know a lot

16:48

of other healthy people who have jobs and

16:51

healthcare and paid leave and

16:53

do not have small children who they

16:55

would need to get special care arrangements

16:57

for while they donate, who

16:59

absolutely could donate and for whom it would be every

17:01

bit as easy or easier than it was for me

17:03

and still aren't doing that.

17:05

And I think that's both a

17:08

personal annoyance to me, but it's

17:10

also, I think, like a major policy issue. And

17:12

I think the past few decades have

17:14

made it clear we're never

17:16

gonna get enough people stepping up

17:18

to donate just from pure altruism.

17:20

People just won't behave that way.

17:23

You need to figure out some way to

17:25

get them to donate at scale if we're

17:27

gonna solve this problem. When did

17:29

humans start donating and transplanting

17:32

kidneys long before this pig stuff?

17:34

The first successful kidney transplant was December 23rd,

17:37

1954, and it was on identical twins. Oh

17:43

no, we didn't think we made history. We didn't

17:45

even think of history. We thought

17:48

we were gonna save a patient. So

17:50

Ronald Herrick gave his kidney to his identical

17:52

twin, Richard Herrick. Just one of those things

17:54

that was kind of out of this world,

17:56

I thought, and it's something that

17:58

hadn't been done before, you know. nothing about it.

18:00

So I thought about it

18:02

a long time. And Richard

18:05

died eight years later, but the kidney worked.

18:08

Oh, gee, we knew immediately. It

18:10

was marvelous. It poured out urine

18:12

all over the floor. Actually,

18:15

the nurses of the waddlers had to

18:17

keep it mopped up. But it was

18:20

so reassuring. I'll never forget it because

18:22

it just pinged up the way we

18:24

wanted little punk date blood vessels over

18:26

the kidney surface. It was

18:28

snug as a bug in the rug. And

18:30

the reason they kind of had to do

18:33

it with identical twins is every

18:35

previous attempt to do something like this had run

18:37

into the problem of organ rejection. So we talked

18:39

about this with pigs, but humans also

18:41

don't like it when organs from other humans get put

18:43

in them. And the theory of the

18:45

surgeons in that case was, if we

18:48

use identical twins who have generally

18:50

identical DNA anyway, we're

18:52

not going to run into that issue. And

18:54

they were right. It worked pretty well for

18:57

identical twins. So in the subsequent

18:59

few decades, it kind of ramped

19:01

up but was understood as something that had

19:03

a really high failure rate. And

19:05

also was best done between

19:07

very close relatives, because

19:09

you had this fear of organ

19:11

rejection. This seems

19:13

almost impossible that you have

19:16

twins, one dying of

19:18

kidney disease and another healthy. Where

19:23

we get sort of the modern organ transplant

19:25

world and organ transplant economy is in the

19:28

1980s, when a really effective immunosuppressant

19:32

becomes available at mass for the

19:34

first time. An immunosuppressant is a

19:36

drug that weakens your immune system,

19:38

which might not sound like something you want. But if

19:43

your immune system is trying to kill

19:45

this new organ that's been implanted into

19:47

you, it's something you very much want.

19:50

And so the availability of an effective

19:52

immunosuppressant meant that about 40

19:54

years ago, doctors started to be able to translate the

19:58

vaccine. transplant

20:00

kidneys from cadavers, from non-family

20:02

members, and have very high confidence

20:04

that it would work. And how

20:06

does this progress over the decades? I

20:08

mean, how many kidneys are being donated

20:11

now and who's donating them? Do we

20:13

know? So the most recent

20:15

year we have data for is 2021. That

20:18

year, about 25,500 kidney transplants were performed in the US. That's

20:24

a pretty good number. It's 25,000

20:26

people who got a

20:28

new lease on life from donations. The

20:30

vast majority of those, about 19,500, were from deceased donors. So

20:35

they were recovered from recently

20:37

dead people, were found healthy enough

20:40

to be used in implantation, and

20:42

transplanted to patients. Only about 6,000

20:45

were from living donors. And so were

20:47

from people like me and other folks

20:50

who've undergo surgery while

20:52

alive and donate one of their

20:54

organs. Would more people be donating

20:56

if you could just sell them? Because you

20:58

can't sell them, right? At least in this country?

21:01

No. There's a law called the

21:03

National Organ Transplant Act. That

21:06

was pushed by a young congressman

21:08

named Al Gore. The

21:10

guy who invented the internet? I took

21:12

the initiative in creating the internet.

21:16

He invented the internet and single-handedly

21:18

identified global warming. Last

21:20

month, right here in this place, I announced

21:22

that the first six months of the year,

21:25

January through June, each

21:27

set new records for high global

21:30

temperatures. But he also helped

21:32

craft this law to shut down

21:34

markets and kidneys. Wow. It

21:37

imposes penalties up to $50,000 and

21:39

five years in prison for the buying

21:41

or selling of organs. Congressman Gore says

21:43

those penalties are needed to prevent what

21:45

has already become a problem in some

21:47

countries. I think people's

21:50

intuitions about that are reasonable. I

21:52

think people have this image of if

21:55

you were allowed to sell your kidney, that this would be

21:57

a way that people preyed upon the poor. It's

22:01

quite common for the Sunday newspapers

22:03

to carry classified ads from poor

22:06

people wanting to sell their kidneys and

22:09

their eyes while they're still alive. We

22:11

have already had classified advertisements

22:14

in the United States. There's a

22:16

lot of illegal key sales anyway

22:18

and those markets are in fact

22:20

very exploitative. There's one

22:22

country on earth where you can sell your

22:24

kidney, which is Iran. And

22:28

there's been a lot of interesting research

22:30

suggesting that people who sell their kidneys

22:32

there are sort of shamed and marginalized.

22:35

But also it's the only country on earth that doesn't have a

22:37

kidney shortage. The market clears. They

22:39

charge enough for the kidney that

22:42

their people are not dying of kidney failure in Iran

22:44

the way they are here. Is

22:47

anyone looking at Iran and saying, why don't we

22:49

take a page off their book? It's

22:51

not the best spokesperson. Like if I had

22:54

to pick a country, they

22:57

also have a universal basic income and

23:00

UBI people don't bring it up for some

23:02

reason. Look at Iran. It's a

23:04

weird place. The

23:08

proposals that I've heard from people in

23:10

the US are less, their

23:12

market is sort of person to person. A

23:15

person who needs a kidney can buy it from

23:17

someone who has a kidney. I

23:19

think the opportunities for exploitation there are

23:21

really high and people have a reasonable

23:24

aversion to it. What

23:26

people are proposing in the US is

23:28

a system where living

23:30

donors' organs would be distributed the way they

23:32

are now based on need. People

23:34

could not pay more to get an organ faster, but

23:37

people who donate would be compensated at

23:40

the very least for cost think or

23:42

like not being able to work or

23:44

sort of paying and suffering. It's

23:47

not that preferably just as

23:50

compensation for the labor that they're

23:52

performing. people

24:00

are just going to start donating their

24:02

kidneys more often. Is

24:05

it possible that this development with the

24:07

pigs fills the void? Yeah, I think

24:09

if I'm looking at my crystal ball

24:11

and trying to say what will happen

24:13

in the next 10 years, my guess

24:15

would be that the

24:17

status quo when it comes to

24:19

kidney compensation continues. And it's the

24:21

status quo that genuinely deeply

24:24

angers me. You've

24:26

had me on the show before and I like

24:28

to think I keep my cool generally, but I'll

24:31

lose my cool here for a second. Okay.

24:34

When I donated my kidney, everyone

24:37

got paid. My transplant surgeon

24:39

got paid, the transplant surgeon who implanted the kidney

24:41

got paid. My anesthesiologist got

24:43

paid, his anesthesiologist got paid. The person

24:46

who flew the plane transporting my kidney

24:48

from my hospital, his hospital, got paid.

24:50

All of our nurses got paid. All

24:53

of the social workers who arranged the chain because

24:55

we sort of set off a chain where I

24:57

donated to him, his daughter donated to somebody and

24:59

on and on. A lot of people worked hard

25:01

to get that set up and they all got

25:03

paid. I was the only person

25:06

in that whole system who was not compensated

25:08

at all for the work I was doing.

25:11

And I think that mostly enrages me

25:13

because it's part of a system that is killing

25:15

tens of thousands of people every year for no

25:17

reason. But it also enrages

25:19

me because kidney donors are

25:22

doing something important. And

25:24

I think if you were doing important work,

25:26

you deserve to be compensated for it in

25:28

some way. And it truly

25:31

pisses me off when opponents of compensation

25:33

are like, but it's like a beautiful

25:35

selfless house. Like, shut up, pay

25:38

people for their work. Like

25:40

your, your gratitude is not going to save these

25:42

people's lives. And

25:45

is that how you think we really fix this? I

25:47

think in a good world, we would fix it that

25:49

way. I think in the world we live

25:51

in, we're going to wait for the pig kidneys to be

25:54

ready in maybe 10 or 15 years. And

25:58

I think hundreds of thousands or millions. people are going

26:00

to die who don't have to die. And

26:03

I think we're going to shift to the

26:05

pig system. People will get pig kidneys. We

26:08

will all be very happy at this

26:10

scientific advance. And

26:13

people will mostly not look back and

26:15

ask themselves how many people we let

26:17

die because we didn't want to compensate

26:20

donors fairly. Dylan

26:27

Matthews, vox.com, that's where you can

26:29

read his piece all about his experience

26:31

donating a kidney. It's called,

26:33

Why I Gave My Kidney to a Stranger

26:35

and Why You Should Consider Doing It Too.

26:38

His latest is titled, Pig Kidney

26:40

Transplans Are Cool. They Shouldn't Be

26:43

Necessary. Our program today was

26:45

produced by Victoria Chamberlain and Hadi Mawagdi.

26:47

We were edited by Amman Al-Asadi, in

26:49

fact checked by Anouk Dusseau, and

26:52

mixed by David Herman. I'm Sean

26:54

Ralmas for this is Today's Point.