The first person to receive a transplanted pig kidney is said to be recovering well. The four-hour surgery, which took place just over a week ago at Massachusetts General Hospital, appears to be successful, though its long-term success is yet to be seen. Doctors project that the new kidney could potentially function for years. Learn more about the first pig kidney transplant, and what it could mean for people living with end-stage kidney disease.*

The need for organs

The supply of human transplant organs comes nowhere near meeting the need for them. According to the Organ Procurement and Transplantation Network of the U.S. Department of Health and Human Services, 17 people die every day while waiting for an organ, and while around 27,000 kidney transplants occurred in 2023, the waitlist contained nearly 89,000 names.

One of those people was 62-year-old transportation manager Rick Slayman. After years of living with diabetes and hypertension that led to end-stage kidney disease (ESKD), Slayman received a human kidney in 2018, and was doing well until the organ began to fail in 2023. He went back on dialysis and once again added his name to the waitlist. 

Unfortunately, dialysis was particularly challenging for Slayman, whose combination of ailments (now including vascular disease and congestive heart failure) often caused the blood vessels connected to the dialysis machine to clot. The clots required increasing numbers of interventions, eventually totaling 30 or 40 procedures. 

Dr. Winfred Williams, associate chief of the Department of Nephrology at Mass General, recalls Slayman telling him, “I don’t think I can go on like this. I don’t want to go on like this.”

It was then, Williams said, that he suggested Slayman experiment with xenotransplantation (the transplantation of animal organs into human beings), in this case a pig kidney. Slayman agreed. “I saw it not only as a way to help me,” he shared in a statement, “but [also as] a way to provide hope for the thousands of people who need a transplant to survive.” 

What it could mean for other ESKD patients

The surgeon who performed the transplant, Dr. Tatsuo Kawai, director of the Legorreta Center for Clinical Transplant Tolerance, said that when he and his 15-member transplant team connected the pig kidney’s blood vessels to Slayman’s, the kidney immediately began to generate urine. 

Other doctors call the surgery a ‘significant medical milestone.’ Slayman’s encouraging early results represent a ray of hope for people living with chronic kidney disease (CKD), which is progressive and currently has no cure, and especially ESKD.

In addition, Williams said, “It also could be a potential breakthrough in solving one of the more intractable problems in our field, that being an unequal access for ethnic minority patients to the opportunity for kidney transplantation.”

Black Americans and Hispanics or Latinos are significantly more likely than White Americans to experience kidney failure, with Black Americans being at greatest risk but historically having longer waiting times for new kidneys. Slayman, who is Black, is playing a significant role in paving the path toward greater equity.

Considerations

As promising as this medical breakthrough is, there is much still unknown concerning the long-term benefits and drawbacks of pig kidney transplants. Although pig kidneys share many similarities with human kidneys, said Director of the Mass General Transplant Center Dr. Joren Madsen, “The human immune system reacts incredibly violently to a pig organ, much moreso than to a human organ.” 

The process, even the concept, of xenotransplantation is also controversial. The kidney used for Slayman’s surgery came from a genetically modified pig. The company that provided the organ, eGenesis Bio, made 69 edits to the animal’s DNA, including removing three genes and inserting seven, to make the animal more compatible with humans. The company also blocked retroviruses that pigs naturally carry that could be transmitted to humans. 

Some experts are concerned about the entire process, on two fronts. First, says L. Syd Johnson, of SUNY Upstate Medical University, “The risks could really be catastrophic from the introduction of a novel mutated virus that might infect a human.”

His second concern is that the pigs are “treated like machines for the sole purpose of being disassembled to provide spare parts for humans. I think the hubris of this kind of human intervention–and the radical exploitation of a human-created, built-for-purpose animal–should really give us pause.”

To those who have spent years, in some cases decades, making such surgeries possible, xenotransplantation is critical to solving the human organ shortage and saving human lives on a large scale. 

*Goodman, B. (2024, March 12). Pig kidney transplanted into living person for first time. CNN. https://www.cnn.com/2024/03/21/health/pig-kidney-transplant-living-person/index.html 

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