THE news of the first successful transplant of a genetically modified pig heart into a human recipient has polarised opinions in very much the same way the first successful human to human heart transplant, performed December 3, 1967, did.

Though the events of last week can equally be hailed as a world first, the operation may also be seen as the next chapter in a series of developments in the fight against one of the biggest killers of modern times, heart disease.

Despite becoming an international star overnight, Christiaan Barnard, after performing the first successful human to human transplant, still had the humility and insight to acknowledge that it was at best a palliative procedure and that the future would involve a solution that did not rely on the death of one human being for another to be able to live.

In the intervening years many significant breakthroughs have been made. Notable highlights include heterotopic transplantation, where a donor heart is inserted into the chest and the person’s own heart is left in situ with the hope that while the donor heart does the majority of the work, the native heart will recover, after which the donor heart may potentially be removed.

Assist devices inserted into the heart are another landmark and can either be used until the heart hopefully recovers, or a suitable organ is found, this being known as a bridge to transplantation.

However, orthotopic heart transplantation often remains the only option for the treatment of end stage heart failure, when all other treatments have been exhausted. In this procedure, the failing heart is removed and discarded, with a donor heart inserted in the position the original heart sat.

The subject of organ donation has become much less unsavoury over the years, thanks to its portrayal in popular television medical dramas as well as the highly publicised opt-out system in England, where all suitable adults are now assumed to have consented to organ donation at death, unless they have expressly advised otherwise.

Unfortunately, the wait for a heart transplant may be anywhere from days to years. By virtue, anyone needing this procedure will be extremely unwell and may deteriorate in the time for a suitable organ to become available, some to the point where they become too ill to undergo the strain of such a massive surgical procedure. According to the British Heart Foundation, one in six people waiting for a heart transplant will sadly never receive the organ they so desperately need.

Though the situation may be slightly better for other organs, for example liver and kidneys, one of the biggest issues facing any transplantation programme is still the scarcity of suitable organs. Even if everyone agreed to be a donor, not all would be suitable at the time of death.

The choice of a pig heart will no doubt alarm and amuse in equal measure, but it has been chosen as pig hearts are anatomically similar to those of humans. The heart selected was from a pig which had been genetically modified to reduce the chances of rejection. Despite this, the recipient of the first successful pig heart transplant will still require drugs to prevent his immune system rejecting the donated organ. As humans and pigs have different immune systems, these drugs will be stronger than those required after traditional human to human heart transplant.

The ethics of breeding animals for organs could occupy chapters or even volumes, and has already sparked massive debate. Yet this is not the first-time animal tissue, specifically that from pigs, has been used to help mankind. Along the way, humans have benefitted from porcine heart valves, insulin and even the blood thinner heparin, a compound used to reduce the risk of clots during surgery.

Significant religious leaders from both the Muslim and Jewish communities have advised that were pig heart transplants to become mainstream therapy, the acceptance of such an organ would not be against the teachings of either religion, as its aim would be the preservation of life.

Very recently, a genetically modified pig kidney was attached to a brain-dead recipient with poor renal function, outside the body, with full consent of the family and worked for several days, producing urine almost spontaneously. There is every possibility that at some point there may be the availability of organs on demand, similar to other prostheses such as joint replacements, without the painful wait that blights many suffering end stage organ failure currently.

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