By Zubeida Mustafa
Two hundred children in Britain who faced certain death from liver failure are alive today and leading a normal, healthy life. They owe their recovery to the miracle of transplantation: the technology that allows surgeons to graft wholesome organs from one person to another.
Behind every milestone in medical science there is invariably a human story of sustained commitment and caring effort. In the case of these 200 British children the man who has made liver transplantation possible is Sir Roy Calne, a pioneer in the field of transplantology. A professor of surgery in the Cambridge University and president of the. International Transplantation Society, Dr Calne has contributed to the science of transplantation by his research on the immuno-suppressive drugs, without which no organ graft can be successful.
The defence mechanism of the human body normally ensures that it rejects foreign objects, which include organs taken from another person. Hence the use of drugs to suppress the immune reactions but in such measured doses that infections do not kill the patient.
Professor Calne was recently in Karachi at the invitation of the Society for the Welfare of Patients of Urology and Transplantation, Civil Hospital, for the Fasih Zuberi memorial lecture. The Karachi University conferred on him the honorary degree of Doctor of Medicine in recognition of his services in the training of transplant surgeons in Pakistan. Transplantology is a relatively new field in medical science which promises to revolutionise the management of patients suffering from kidney, liver and heart disorders. It is regarded as a life-saving technology. A surgeon can by grafting an organ transform the health of a person doomed to a short life on dialysis due to endstage renal failure, diabetics forever chained to insulin and patients dying of liver/ heart disease.
Dr Calne’s patients benefit from his expertise in another way. He is a skilful artist. Few people anywhere in the world would.be enjoying the privilege of having their surgeon paint their portrait. But Dr Calne feels differently about it. “I get to know my patients best when they are posing for a picture. It is then that they talk and open up as they would never when talking to me as a doctor,” he says.
His research is now directed towards improving the immunosuppressive regime which is indispensable for transplantation. Dr Calne’s work on the anti-cancer drugs—Azothiopine and Cyclosporin — has contributed to the high success rate of transplants. But his quest for a magic drug continues, the wonders of Cyclosporin notwithstanding. It is expensive and can have dangerous side-effects.
The dream of any transplantologist is to eventually help a patient with an organ graft survive without any immuno-suppressants. Dr Calne is optimistic about progress in this area, having observed seven patients who had a liver transplant seven to 22 years earlier and had stopped taking their medicines. Even 7-11 years later rejection had not occurred and their bodies had developed tolerance for the new organ.
What makes the prospect of success in this field so exciting is that it will open up new vistas in a related field, cross-species transplantation. It will be a medical breakthrough when surgeons successfully manage to graft animal organs in man. Organs from animals of the same zoological genus such as baboons and monkeys would stand a better chance of being grafted successfully. Dr Calne is, however, cautious. He doesn’t plan any xenotransplantation at the moment though he has been experimenting on animals in his laboratory
“We are still not ready for it,” he says. The patient in Pittsburg who received a baboon’s liver earlier this year died after 70 days. The heavy doses of immuno-suppressants he needed made him overly vulnerable to infections.
Transplantologists in Pakistan will follow Dr Calne’s research with profound interest. But until animals become safe donors of organs, the quest for human organs will continue. From where are the organs to be obtained for transplantation? The West has to some extent resolved the problem by going, in for cadaveric donation. “We have managed to persuade the public that transplantation is a gift of life from one person to another,” Dr Calne says. He is highly appreciative of the role of the media in Britain in dispelling fears and superstitions about organ donation. “The television programme which projected the plight of the little boy who was dying of liver failure and needed a transplant received a positive response from the millions of viewers who saw it. There were several donors after that,” he recalls.
“In many developing societies,” Dr Calne observes, “there is widespread ignorance about organ transplantation. There is first of all the superstition that the body should not be violated after death, though as far as I know no established religion has any objection to transplantation. Then there might be a general distrust of doctors taking care of a dying person: when they are interested in obtaining his organs, will they work hard enough to save our loved one, people may ask. They can be reassured if the team looking after a brain damaged dying person is different from the team that will carry out the transplantation.
” It is plain that transplantation is not simply a science and technology matter. It has its ethical dimension too. Dr Calne, as all good professionals with a conscience, is not oblivious of it. He warns against the marketplace entering the field of transplantology. Sale of human organs is most unethical and should in no circumstances be permitted.
Britain has learnt from experience how to check the unscrupulous practices that are possible. A few years ago four Turks were brought to England and each of them was paid a handsome amount to donate a kidney. The case received high profile media publicity and Prime Minister Thatcher was obliged to react strongly, describing the episode as “repugnant”. Within three months the parliament had passed a law making it illegal for any doctor to be involved in a transplantation operation in which the organ had been paid for. Even if the surgeon is not a party to the financial transaction, he is still held guilty. Now surgeons in Britain verify the source from which an organ is obtained and the patient who receives it. If the »organ comes from a living donor, he must be a blood relation. In other cases, even those of husband and wife, an independent comittee has to sanction the organ donation.
We have a long way to go before the ethics of transplantation will be addressed. Western professionals are now debating issues such as the paternity of a baby born to parents with gonads grafts. In Pakistan the need is to win acceptance for cadaveric donation of organs. Until that is done, »our surgeons will not be able to progress any further than renal transplants and that too within limited parameters. The practice of procuring organs from living donors also means that there is no hope for the 8,000 people in need of a liver transplant or the 5000 whose lives could be saved with a heart transplant.
“Human beings are the same all over the world. If they are informed correctly without exaggerating the benefits or risks of transplantation they can be motivated to donate organs,” says Dr Calne.
One can well ask, can’t Pakistan Television find a producer to show the plight of little children in need of a liver graft?
Source: Dawn 27-11-1992