Surgeons' quest for life: the history and the future of xenotransplantation.

Abstract

SURGEONS' QUEST FOR LIFE: THE HISTORY AND THE FUTURE OF XENOTRANSPLANTATION REBECCA MALOUIN* None but those who have experienced them can conceive of the enticements of science. In other studies you go asfar as others have gone before you, and there is nothing more to know; but in a scientific pursuit there is continualfood for dhcovery and wonder.—Frankenstein in Mary Shelley's Frankenstein [1] Introduction The consumption of this "continual food for discovery and wonder" proved destructive for Victor Frankenstein, yet enabled him to reveal the "secret of life." Analogies may be drawn between young Dr. Frankenstein and his contemporary counterparts, surgeons specializing in transplantation. Such surgeons also search for a way to extend life and, in the process, occasionally lose a life—the life of the patient. The similarity ends there. Frankenstein lacked professional, psychological, and moral support, landmarks of the medical establishment today and, consequently , lost control of his experiment and, finally, his life. Scientists today, as hungry for discovery as young Frankenstein, must abide by many, strictly enforced guidelines allowing them to pursue the secret of life without incurring similar unfortunate results. Transplant surgeons experiment within a protective structure that reduces the magnitude of mistakes and, therefore, allows them to advance by learning from prior failures. Such advancements have fed the field of transplantation so that it has metamorphosed into xenotransplantation, or transplantation This paper is the product of an independent research project in an advanced biology course given by Mary C. McKitrick while the author was a third-year undergraduate student at the University of Michigan. *Address: 445 Rosewood Avenue, East Lansing, Michigan 48823.© 1994 by The University of Chicago. AU rights reserved. 003 1-5982/94/3703-0874$0 1 .00 416 Rebecca Malouin ¦ Future ofXenotransplantation between dissimilar species. Due to the novelty of xenotransplantation, medical precedents, procedural guidelines, and public opinion have not been firmly established so that claims of immortality and uncontrolled experimentation have "run rampant." Xenotransplantation has matured quite recently, though, much like other specialties in the medical profession , and through a supportive media and public understanding, may be the next frontier in the quest for the "secret of life." The Past The history of xenografting before the 1960s was a history of misunderstanding . The techniques and theories culminating in attempts at xenotransplantation reflect the popular social and scientific ideas of the period. Gasparro Tagliacozzi of Bologna (1547-1599), one of the first to record information regarding xenografting, related grafting, the "binding [of] two persons," to agriculture and the grafting of plants [2]. He concluded that difficulty would arise in xenografting due to the "problems . . . involved relating to the individual humoral constitution of the body of both man and animal" [2]. The strength of the myth of the unicorn found in a cavern in Lascaux, France, painted 20,000 years ago and incorporating characteristics of many species, may have continued to taint the scientific reasoning of this period for, as Dubernard and Flyer recognize in Principles of Organ Transplantation, "especially intriguing to the mind of the human has been the idea of endowing himself or herself with certain characteristics of various animals by transplantation of the appropriate part" [3]. Tagliacozzi concluded in his works concerning the feasibility of xenografting that "difficulties are so great that good judgment suggests success would be remote" [2]. During the seventeenth century, the transfusion of blood from animals to humans began after Harvey's demonstration of the circulation of blood and his treatise on the heart [2]. The blood of lambs was transfused into a boy in 1667, and shortly after into a healthy man for reasons "more by curiosity than by necessity" [2]. Miraculously, a patient of Jean Baptiste Denys who had been subject to similar medical treatments, "awakened . . . wonderfully composed and in his right mind" although "he pist a large glass full of such black Urine that you would have said it has been mixed with soot" [4]. The adverse prognoses of most of the experiments were not reported to the degree that is expected now with the current knowledge of incompatibility. This may be accounted for by the novelty of the experiments, the severity of the original dysfunction , and the absence of continual...