From foreign graft to self-repair: The biological transition beyond organ transplantation

“ And, of course, peg legs and hooks for persons who had lost their hands might be called replacive surgery, though they were very crude. Later on came more refined dentures, artificial limbs, corrective lenses, skull plates, hearing aids, plastic or cosmetic surgery, blood transfusions, all types of skin grafts, et cetera.
"The 1950s saw the beginning of bone and corneal transplants, use of plastics in arteries, those huge heart-lung and kidney machines, implantation of electrodes in the heart to steady its beat—many things which were mostly emergency or stop-gap measures. ”

“ In recent years we have seen the miracle of terminally ill patients receiving a second chance at life with a new heart, liver, lung, or kidney. We have seen children with leukemia regain their health through bone marrow transplants; we have witnessed the restoration of sight to the blind through new corneas; and we have seen thousands of Americans resuming normal lives after receiving a transplanted organ or tissue. But many others still wait, and many die waiting for a suitable organ to become available. ”

“ This year marks the 50th anniversary of the first successful organ transplant in the United States. Since that time, organ and tissue transplantation have significantly increased, and last year, more than 25,000 Americans received an organ transplant. ”

“ There was little or no talk as the three doctors worked at the operating table. The overhead light in the ship's tiny surgery glowed brightly; the only sound in the room was the wheeze of the anaesthesia apparatus, the snap of clamps and the doctors' own quiet breathing as they worked desperately against time.
Dal felt as if he were in a dream, working like an automaton, going through mechanical motions that seemed completely unrelated to the living patient that lay on the operating table. In his training he had assisted at hundreds of organ transplant operations ”

“ Fuzzy huddled on Dal's shoulder as if he could sense his master's excitement. Very few races under contract with Hospital Earth ever attempted their own major surgery. If a Moruan surgeon had walked into a tight spot in the operating room, it could be a real test of skill to get him—and his patient—out of it, even on a relatively simple procedure. But organ-transplantation, with the delicate vascular surgery and micro-surgery that it entailed, was never simple. ”

“ Strong support for this view of a specific cell structure is supplied by the numerous experiments on transplantation. The surgeon nowadays tries, as much as possible, to retain the full strength of the functions of every organ, and, if some of the tissues are missing, he seeks aid in substitutes. It is found that only those tissues graft which are taken from the same species, while still better results are obtained by the use of parts of the same individual. Heteroplasty, i.e., the attempt to graft foreign tissues, has never succeeded. A body requires cells in harmony with itself. ”

“ Thousands of families have made the same selfless decision and have given the gift of life to someone in need of an organ or tissue transplantation. Today, approximately 55,000 Americans are on the national organ transplant waiting list, hoping for a second chance. Yet, every day, 10 people will die because organs are not available. These tragic deaths are unnecessary. Our country has a large number of people who qualify as organ donors-but many still have not chosen to become donors. ”

“ Ironically, recent surveys indicate that about 93 percent of all Americans have heard about organ transplants, but the need for organs far surpasses the number donated each year. Our organ procurement system is being managed effectively by the private sector but can be improved to meet a larger portion of the need. For these reasons, I supported the establishment of the American Council on Transplantation. The primary goal of this national umbrella organization is to increase the availability of organs for transplantation. ”

“ For many people across our country, receiving an organ or tissue transplant means relief from suffering and a marked improvement in the quality of their lives. For others, it literally means the difference between life and death. And the demand for such donations continues to grow. In the last six years, the number of people on the national organ transplant list has doubled, from more than 30,000 in 1993 to more than 62,000 patients today. ”

“ The bill contains a highly objectionable provision that would delay the implementation of HHS' final Organ Procurement and Transplantation rule for 90 days. This rule, which was strongly validated by an Institute of Medicine report, provides a more equitable system of treatment for over 63,000 Americans waiting for an organ transplant; its implementation would likely prevent the deaths of hundreds of Americans. Since almost 5,000 people die each year waiting for an organ transplant, we must be allowed to move forward on this issue and implement the rule without further delay. ”

“ Statistics show that approximately 60 Americans receive a transplant every day. However, at the same time, another 15 people die because not enough organs are available. There are more than 79,500 patients waiting for an organ transplant, and another person joins the waiting list every 13 minutes. ”

“ Thousands of lives have been saved by the miracle of organ and tissue transplantation, a medical procedure made possible only by the extraordinary generosity of those who agree to donate and the profound compassion of their loved ones. Recipients are often able to resume normal lives after their transplants, working and caring for their families, and many children are in school today due to a donated liver or bone marrow. Still, the need for organs far exceeds the number donated, and many Americans wait-and some will die waiting-for suitable organs or tissues to become available. ”

“ Meanwhile, hundreds of kidney patients from Israel, which has its own well -developed, but under-used transplantation centers (due to ultra-orthodox Jewish reservations about brain death) travel in 'transplant tourist' junkets to Turkey, Moldova, Romania where desperate kidney sellers can be found, and to Russia where an excess of lucrative cadaveric organs are produced due to lax standards for designating brain death, and to South Africa where the amenities in transplantation clinics in private hospitals can resemble four star hotels. ”

“ Encouragement of organ and tissue donation must always be accompanied, of course, by thorough reflection and complete information. Recent medical and technological developments are posing new moral and ethical questions about transplantation in certain circumstances. Individuals, and society as a whole, must carefully consider these questions so that we never undercut our reverence for the sanctity God vests equally in the life of every person, from the moment of conception until natural death. ”

“ It was the brainchild of a Dutch doctor whose research project had just been sawed off at the knees by Stanford University. Then Bartlett moved the entire operation to a clinic at the BMD campus out in New Jersey called the Dorian Institute. It's all very hush‐hush, but I can tell you Gerex has a new procedure in clinical trials that can literally work miracles. The head researcher, this Dutch doctor, has pioneered a new treatment using a stem cell procedure to trick an organ into regenerating itself, even a heart. It's like you grow your own transplant. ”

“ Regenerative Medicine.—The Director of NIH shall, as appropriate, continue to consult with the directors of relevant institutes and centers of the National Institutes of Health, other relevant experts from such institutes and centers, and relevant experts within the Food and Drug Administration, to further the field of regenerative medicine using adult stem cells, including autologous stem cells, therapeutic tissue engineering products, human cell and tissue products, human gene therapies, and genetically modified cells.”. ”

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"The potential [of stem cells] for saving lives . . . may be unlimited. Given the proper signal or environment, stem cells, transplanted into human tissue, can be induced to develop into brain, heart, skin, bone marrow cells—indeed any specialized cells. The scientific research community believes that the transplanted stem cells may be able to regenerate dead or dying human tissue, reversing the progress of disease." ”

“ At this moment, the full promise of stem cell research remains unknown, and it should not be overstated. But scientists believe these tiny cells may have the potential to help us understand, and possibly cure, some of our most devastating diseases and conditions. To regenerate a severed spinal cord and lift someone from a wheelchair. To spur insulin production and spare a child from a lifetime of needles. To treat Parkinson’s, cancer, heart disease and others that affect millions of Americans and the people who love them. ”

“ They were indeed running stage‐three clinical trials of their stem cell procedure on a variety of maladies. There was no double‐blind placebo. You either were cured or you were not.
Jesus, it was incredible. They were shooting for nothing less than the unified field theory of medicine, aiming not just to patch some failing element of the human body but to regenerate entire organs. Among their stated objectives were building pancreatic islets, reconstructing the ventricles of the heart, reconstituting the damaged livers of individuals with advanced cirrhosis. ”

“ On several recent occasions, I have asked the American people to be aware of the opportunities to donate their organs, and I have made special pleas for young children in need of liver transplants. The response proved to be overwhelming. Tragically, however, many desperately ill persons, including young children, have died while awaiting a suitable organ. ”

“ The fact must be emphasized that practically 95 per cent. of the animals die under the treatment, which sufficiently indicates the toxic effects of the agent used. We must remember that transplanted tumors are under all circumstances at a certain disadvantage as compared with the normal tissues of the body. After all, they are implanted on a foreign soil. Their blood supply is impoverished and imperfect. They have a natural tendency to undergo necrosis, and in many cases spontaneous retrogression. ”

“ However, there were "immortal cells" buried within us all, so‐called stem cells that could replicate forever, unchanged. They were present at the very beginning of life and all our differing body tissue was created from them. Some still lingered on in our body, as though to be available for spare parts. If one could figure out how to transfer the characteristics of those cells to other cells, then the possibility existed that we could regenerate damaged or aging tissue in our vital organs. The trick was to figure out the mechanism whereby stem cells managed to cheat time. ”

“ This week I made a decision on a complex and difficult issue, the federal role in embryonic stem cell research. Based on preliminary work, scientists believe these cells, which may have the ability to replace diseased or defective human tissue, offer great promise. They could help improve the lives of those who suffer from many terrible diseases -- from juvenile diabetes to Alzheimer's, from Parkinson's to spinal cord injuries. ”

“ Today, a third of all new medicines in development are based on biotechnology. Designed to attack the underlying cause of an illness, not just its symptoms, these medicines have tremendous potential to provide not only more effective treatments, but also cures. With improved understanding of cellular and genetic processes, scientists have opened exciting new avenues of research into treatments for devastating diseases—like Parkinson's and Alzheimer's, diabetes, heart disease, AIDS, and cancer—that affect millions of Americans. ”

“ On matters of life and science, we must trust in the innovative spirit of medical researchers and empower them to discover new treatments while respecting moral boundaries. In November, we witnessed a landmark achievement when scientists discovered a way to reprogram adult skin cells to act like embryonic stem cells. ”

“ My own view is that the regenerative capacity is not something primary, but rather an adaptation to the organism's susceptibility to injury, that is, a power which occurs in organisms in varying degrees, proportionate to the degree and frequency of their liability to injury. Regeneration prevents the injured animal from perishing, [Pg 8] or from living on in a mutilated state, and in this lies an advantage for the maintenance of the species, which is the greater the more frequently injuries occur in the species, and the more they menace its life directly or indirectly. ”

“ When, however, we make a comprehensive survey of the interesting field of regeneration processes, we discover a continuous series [104] of development from the simplest repair of plasm in the unicellular protists to the sexual generation of the higher histona. The sperm-cells and ova of the latter are redundant growth-products, which have the power of regenerating the whole multicellular organism. But many of the higher histona have also the capacity to produce new individuals by regeneration from detached pieces of tissue, or even single cells. ”

“ A certain degree of regenerative capacity is thus indispensable to all multicellular animals, even to the highest among them. We ourselves, for instance, could not escape the numerous dangers of infection by bacilli and other micro-organisms if our protective outer skin did not possess the faculty of regeneration, at least so far that it can close up a wound and fill up with cicatrice-tissue a place where a piece of skin has been excised. ”

“ Cells are being born and cells are dying every moment of our existence. Cells reproduce themselves by enlarging and subdividing, the original cell swelling until it finally forms two parts with a small connecting "waist"; then the connection parts and there are two independent cells instead of one. The new cell in turn divides itself up, and so on.
Cells enable the body to carry on its work of continual regeneration. Every part of the human body is undergoing a constant change and tissues are being continually renewed. ”

“ In like manner all the functions of the body form an endless chain in which not a single link must be faulty or missing, if healthy organic life is to continue.
This accumulation of cells, however, is by no means inactive. On the contrary, organic life is nothing but the constant dying of the old and the reconstruction of new cells; it means that we are in a perpetual condition of composition and consequently of decomposition throughout our entire being, its different parts and organs. ”

“ All our processes of repair, all the reactions of the body against the attack of accident or of disease, are hereditary endowments, worked out with infinite pains and labor through tens of thousands of generations. The utmost that we can do with our drugs and remedies is to appeal to and rouse into action the great healing power of nature, the classic "Vis medicatrix Naturæ," an incarnation of our past experiences handed down by heredity. ”

“ But beyond this there is normally no regeneration. The soldier who has lost an arm in battle cannot return home and in quiet seclusion reproduce a new limb. That which seems to be among lower animals a well-established law of organic growth does not here obtain. This is probably due to the fact that the higher histological differentiation of the tissues in the more highly developed forms of life is a bar to regeneration. In their devotion to special and minute details of physiological work, the cells have, so to speak, forgotten their more generalized reproductive faculties. ”

“ We have no means of deciding whether the ordinary wear and tear of the tissues is made good by means of gemmules, or merely by the proliferation of pre-existing cells. If the gemmules are thus consumed, as seems probable from the intimate connection between the repair of waste, re-growth, and development, and more especially from the periodical changes which many male animals undergo in colour and structure, then some light would be thrown on the phenomena of old age, with its lessened power of reproduction and of the repair of injuries, and on the obscure subject of longevity. ”

“ But the somatic cells have lost this power to a gradually increasing extent, so that at length they became restricted to a fixed, though perhaps very large number of cell-generations. This restriction, which implies the continual influx of new individuals, has been explained above as a result of the impossibility of entirely protecting the individual from accidents, and from the deterioration which follows them. ”

“ Yet we are not without gruesome echoes of this lost power of regeneration in that our whole brood of tumors, including the deadly cancer and sarcoma, are due to a strange resumption, on the part of some little knot of our body-cells, of the power of reproducing themselves or the organ in which they are situated, without any regard to the welfare of the rest of the body. Cancer is, in one sense, a throwing off of the allegiance to the body-state and a resumption of amphibian powers of independent growth on the part of certain groups of our body-cells—literally, a "rebellion of the cells." ”

“ To sum up, the tissues from which cancer grows, in their normal process of repair tend to reproduce themselves more or less exactly, or if the injury is too gross, they are replaced by scar tissue; but when we reach the age at which their biological work is done, there is a tendency to atypical reproduction, in which an atypical cell continues to reproduce itself atypically and grows at the expense of the organism, eating into or eroding it as it enlarges, till it finally kills the host on which it preys. ”

“ How extraordinary and limitless this power is may be seen from the fact that a little group of cancer-cells grafted into a mouse to produce a Jensen tumor, from which a graft is again taken and transplanted into another mouse, and so on, is capable, in a comparatively few generations, of producing cancerous masses a thousand times the weight of the original mouse in which the tumor started! ”

“ The great problem is what starts the cells to grow and why the growth differs from that of normal tissue, why it is not regulated and coördinated as are other forms of growth. When a small piece of the skin, for instance, is cut out growth as rapid as that in tumors takes place in the adjoining cells, but it ceases when the loss is restored. ”