BY ANJEANETTE ROBERTS – SEPTEMBER 26, 2019
Greater love has no one than this: to lay down one’s life for one’s friends. — John 15:13
More than 6,000 people die every year in the US because they didn’t receive a transplant in time.1 Help may arrive soon, according to a recent press release from the National Institutes of Health, which highlights research that might help save some of these lives. Researchers have turned data from successful studies of organ preservation in rats to applications in human health and treatments.
Keeping organs viable is key. To meet that challenge “scientists have greatly extended the amount of time human livers can be stored for transplantation by modifying a protocol that extends the viability of rat livers. Previously, human livers were only viable for an average of nine hours, but the new method of preservation maintains liver tissue for up to 27 hours, giving transplant doctors and patients a much longer timeframe to work with.”2
Due to tissue damage caused by the formation of ice crystals in liver tissue, human livers for transplant are routinely stored and transported at temperatures above freezing (4°C). This process has allowed about nine hours for viable liver transplants from donor to recipient. Previous research conducted in rats allowed development of a method for supercooling livers by perfusing them with a cooled protective solution that included additives of a modified glucose compound and polyethylene glycol (a component of antifreeze). By this method, rat livers could be stored at temperatures just below freezing (-6°C) yet avoiding the formation of ice crystals, thus extending the time for successful transplants. However, human livers are much (200 times) larger than rat livers, and when this method is directly applied to human livers it does not sufficiently protect them from the formation of damaging ice crystals.
Prolonging Organ Storage
Working in collaboration, researchers at Massachusetts General Hospital and Harvard Medical School have modified the protocol with three additional steps that now allow perfusion of human livers and prolonged storage at subzero temperatures.
- They removed air from the supercooling storage bag, eliminating the air-solution interface where ice crystal formation progresses more rapidly.
- They included two more additives to the protective solution: trehalose and glycerol. Both of these components are used in cryogenic preservation of cells at temperatures far below zero, but had never been used in organs destined for transplant.
- They developed a perfusion delivery system—using machine perfusion rather than manual perfusion—that solves the problem of delivering a more viscous modified supercooling solution. Machine perfusion allows profusion at 4°C with the traditional protective solution followed by gradual decreases in temperature while increasing the concentration of the additives.
Researchers have yet to implement this new protocol in human transplants, but traditional standards of assessing liver viability indicate that this process will not negatively affect these organs.3 This is certainly good news. The increase in time of viability gives transplant teams more time to get an organ from the deceased donor to the neediest recipient, not just the closest. So this factor may save some lives each year as patients in critical condition may be able to receive organs from more distant sites.
Every Life Saved Matters
Over 120,000 people remained on the wait list at the end of 2015—a year in which nearly 31,000 transplants took place. Despite the amazing ability to save over 30,000 lives in a single year, the gap between the number of patients on the wait list and the limited number of available organs continues to widen.4
Although the news from NIH is promising and may save thousands of lives, another challenge remains. The time from harvest to transplant is not the primary reason why so many people are left on the donor recipient lists or find that their time runs out before receiving a donor organ. No, the biggest problem is the insufficient number of donors/organs available.
One possible solution to the organ shortage problem might be to change policies surrounding organ transplants from appropriate deceased donors. Many people believe that there would be no shortage of organ donations if we would adopt a national opt-out policy (also known as intended consent or intended approval) as compared to the current opt-in policy (also known as explicit consent).5
There are hard and soft versions of intended consent policies.6 A soft version of intended consent is likely to do well in the US where there is widespread religious support for organ donations already.7 Under a soft policy of intended consent, the intent for organ donation is assumed, but the option to opt out remains open to the family.8 If increasing human organ donations doesn’t meet the organ shortfall, perhaps additional animal research will close the gap.
How Shared Physiology and Genetic Similarity Help
The extended time for liver transplants came from insights garnered in rat studies and highlights one of many ways that research in animals has helped provide practical applications affecting human health and treatment. Perhaps research in and with animals will provide a solution to the organ shortage problem as well. Researchers are investigating this possibility. Another recent report highlights how human organs for transplant may one day be grown as animal chimeras (or animal hybrids growing human-like organs) thanks to gene-editing techniques provided by CRISPR technology that allow for gene manipulation of blastocysts.9
Both of these studies show how scientific advances and research in animals might help save human lives and improve quality of life for those suffering from organ disease and deficiencies. Many people think that the only explanation for all of life sharing the same DNA code and similar physiologies is that naturalistic evolution has occurred. But it’s obvious our shared biologies provide a way for us to discover means to better care for creation and for others who suffer from various ailments and disease. As we consider these insights into how God has provided for us through shared biology with animals and capacities to discover ways to steward creation and care for one another better, we can see ways to help others.
Loving Our Neighbor
A hallmark of following Christ is that we love God with all our heart, soul, mind, and strength and that we love our neighbors as ourselves. All the law and prophets are fulfilled in these two great commandments. Our neighbor may be the one we find in need no matter who they are or what circumstances surround their needs (Matthew 5:42–47, 22:37–40; Luke 6:27–28, 10:25–37).
Organ donation really is a way to give the gift of life. And who knows whether such a gift might extend someone else’s life and provide greater opportunity for them to discover grace, generosity, and new life in Christ before their time runs out. These studies and our actions show how God allows us to discover ways to care for one another and creation, and by acts of mercy, to contribute to human flourishing.
- Raffaele Girlanda, “Deceased Organ Donation for Transplantation: Challenges and Opportunities,” World Journal of Transplantation 6, no. 3 (September 24, 2016): 451–59, doi.org/10.5500/wjt.v6.i3.451.
- “Scientists Triple Storage Time of Human Donor Livers,” National Institutes of Health, September 9, 2019, https://www.nih.gov/news-events/news-releases/scientists-triple-storage-time-human-donor-livers; Reinier J. de Vries et al., “Supercooling Extends Preservation Time of Human Livers,” Nature Biotechnology (September 9, 2019), doi.org/10.1038/s41587-019-0223-y.
- “Scientists Triple Storage Time of Human Donor Livers.”
- Girlanda, “Deceased Organ Donation for Transplantation.”
- “‘Opt Out’ Policies Increase Organ Donation,” Stanford SPARQ, accessed September 20, 2019, https://sparq.stanford.edu/solutions/opt-out-policies-increase-organ-donation.
- Runólfur Pálsson, “Organ Donation Law in Iceland: Is It Timely to Adopt the Intended Consent?,” trans. Google Translate, Læknablaðið: The Icelandic Medical Journal 103, no. 2 (February 2017): 65, doi:10.17992/lbl.2017.02.119.
- “Religion and Organ Donation,” National Kidney Foundation, accessed September 20, 2019, https://www.kidney.org/atoz/content/religion-organ-donation.
- Chris J. Rudge, “Organ Donation: Opting in or Opting Out?” British Journal of General Practice 68, no. 667 (February 2018): 62–63, doi.org/10.3399/bjgp18X694445.
- Alejandro De Los Angeles, Nam Pho, and D. Eugene Redmond Jr., “Generating Human Organs via Interspecies Chimera Formation: Advances and Barriers,” Yale Journal of Biology and Medicine 91, no. 3 (September 21, 2018): 333–42, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6153627/pdf/yjbm_91_3_333.pdf.
NOW THAT YOU’VE DISCOVERED REASONS TO BELIEVE
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