Are Pig Kidney Transplants the Future of Organ Donation? Exploring the Possibilities:

2023 was a big year for advances in kidney transplantation. I’ll tell you why pigs may be the future. I’m Dr. Blake Schusterman. I’m a board certified kidney doctor and nephrologist. I’m also the cooking doc and everything we talk about here is just information. This is not medical advice. Make sure you like, subscribe and share as we talk about kidney transplant and pigs. So let’s talk about pig kidneys. How would a pig kidney even work in the human body? let’s talk about the amazing thing that happened 23 to move this step forward and the possibility of pig kidney transplant in the future. And think about this as we’re talking.

If you had kidney disease or if you have kidney disease and are on dialysis and somebody offered you a pig kidney, would you take it?What would your concerns be? Would it be worth it to get you off of dialysis? Well, how would this even work? Taking a step back, the us needs more kidneys. There are currently about 90,000 people on the kidney transplant list in the United States and only 15,927 kidney transplants were done in 2023. Now you might think at that rate, we’d catch up pretty fast, but you forget that every year we add thousands and thousands, tens of thousands of people to that kidney transplant list, people that need a kidney. So unless a person has a living donor, someone to actually give them a kidney, they can end up waiting two to five years and sometimes even longer before their name comes up and they get a match for a deceased donor kidney that comes their way.Much of that time while they’re waiting, they may be on dialysis, which is a life-sustaining, life-saving treatment, but it comes with problems. The dialysis does enough to keep somebody alive and keep them out of the hospital, but it doesn’t necessarily keep them feeling great and give them lots of time to enjoy their life. So with all the options limited, the scientific world is looking to artificial kidneys. and pig kidneys, anything to help people get off dialysis and help them lead a more normal life with kidney failure. And that’s my goal as a nephrologist. Okay, now let’s dig into pig kidneys. First question, why pig? Well, I’m no pig expert, but according to the national kidney Foundation, the internal workings of a pig kidney are very similar to the internal workings of a human kidney.So according to the NKF, a pig kidney has similar blood flow to a human kidney, can balance electrolytes and fluids just like your kidneys. It can handle the same foods that humans eat and it has a similar egfr or estimated glomerular filtration rate as human kidneys. Now, of course, you can’t just surgically place a pig kidney in a human kidney without problems. You can’t even take a human kidney and pop it into another human body without problems because our immune systems unless it’s a perfect match, our bodies will reject it. They’ll attack it. Kidney, you are not part of us and you do not belong here and all cells attack. And in no time, that kidney that they just put into that body will become inflamed and stop working.
It can happen immediately or it can happen over time. That’s why people who get kidney transplants need to take immunosuppressive medicine, something that says, okay, immune system, calm down. Don’t work so hard to attack this kidney. just see if we can get along in peace. Okay, now imagine if surgeons took a pig kidney. Knowing what you know about how the body rejects another human kidney, imagine it took a pig kidney and put it in a human body without preparing it first. You’d get all out war you’d get something called hyper acute rejection and that is what happens when the body just rejects that kidney immediately. It doesn’t work. It shuts down, and it never provides kidney function for the person that gets the kidney.
but luckily for us scientists have figured out that there may be a way to solve this problem. Brilliant people out there, thank goodness. These scientists are modifying the genes of the pig kidneys so that those pig kidneys don’t produce the kind of cells that are recognized by the human body and makes the human body attack them. Essentially what the scientists are doing are they’re teaching those pig kidneys to like put on their invisible shields, kind of like think harry potter invisible cape or something like that when they get in the body they don’t want the body to see them they don’t want the body to see that they’re an enemy they don’t want the body to see that they don’t belong there they want them to be invisible and if the body doesn’t see them the body won’t produce cells to reject them that is the goal and by editing the genes in that pig kidney the scientists have done some amazing things and 2023 was a banner year for that so two places NYU Langone and University of Alabama Birmingham did essentially this
they took a pig kidney that had been genetically altered they put it into a human body that was brain dead. So these people’s organs were working fine, heart, lungs, digestive system, but they were considered brain dead. And these people that were brain dead had donated their bodies to science. Heroes. So they kept their bodies alive on machines. And then the scientists and surgeons went to work with these pig kidneys to see if they could work in these people who were brain dead, but had donated their bodies. Now, each center did things a little bit differently. At UAB, they implanted kidneys that had 10 genetic modifications. At NYU Langone, they took kidneys that just had one genetic modification. We don’t know which works better for the long one.
That’s why different people are doing different things. But let’s focus on nyu’s kidney first. The first thing they did is they removed the kidneys from this person who was brain dead and been kept alive by machines. that allowed them to see that the pig kidney they put in was doing all the work. So they took a pig kidney from something called a gal safe pig and placed them in the patient. Now that gal safe pig is a pig kidney that doesn’t have a gene called alpha gal and alpha gal is that signal that that kidney gives off that the body, the human body recognizes it says you’re foreign attack and leads to that hyper acute rejection. So if that pig kidney does not have that gene and does not produce that alpha-gal, the human body doesn’t recognize it as foreign.
At least that’s the theory. So removing that gene is like the invisibility cloak on that pig kidney. The other thing they did is they took that pig’s thymus gland and the thymus gland is responsible for a lot of the immune activity in the body. And they put that pig thymus gland in the pig kidney and then that pig kidney and thymus into the body. and the thought is that that helps the kidney adjust a little bit to the immune system of the human that they’re just going into. So trying to get at things two ways. First, you’re teaching the kidney not to send off cells and immune responses that trigger the human body to attack it. And that’s through genetic engineering. And by taking the stymus gland, which is part of the immune learning of the pig, and implanting that at the same time as the kidney.
at the same time, you are giving the person immunosuppressive medicine. So just in case there’s something that triggers the immune system, it doesn’t have a full-on attack against that kidney. Guess what happened? That kidney worked immediately. How could they tell? It started producing urine almost the second that they put the pig kidney in the human body. And that kidney worked for two full months. So they kept this person who was brain dead alive for two full months on machines. and they watch these pig kidneys work and maintain pretty normal kidney function over the course of those two months. Totally spectacular. So maybe this is the future. Maybe pig kidneys are gonna be the way for people to get off of dialysis. Amazing. Maybe pig kidneys are gonna be the way we get that waiting list way down.
But of course there are questions. These kind of advances don’t come without scientific questions and ethical questions. So let me run a few of these questions by you because as we’re analyzing all this, it’s important to think about the problems that may arise should this come full scale to the general public. First, would you take a pig kidney? I mean, sure, it sounds good in theory, but at the same time, you’re having a pig kidney in your body. A little different when it’s your actual body and you’re thinking about it that way. There’s questions about animal safety and ethics. I mean, have you seen those lovely little pigs on Instagram? Would you want to just raise pigs and take their kidneys so humans can improve?
Maybe, maybe not. Would people from strict Jewish or Islam faiths who don’t eat pork or pig accept a pig kidney? What is the impact on the rest of the body when you put pig kidneys in there a year, two years, five years down the road? Who would get the first pig kidneys? How would you decide which person on the list got a pig kidney and which person gets a human kidney? Would you leave it up to the individual to choose? there be some kind of ranking system? Lots of questions still remain before this comes to the general public, but it is so exciting that the world is working to help get people that i see every day with kidney failure off of dialysis.
There are other things that may be in the future like a wearable artificial kidney or maybe an implantable artificial kidney that kind of does the job of the kidney filtration and getting rid of the fluid and maintaining balance. All this is amazing and we didn’t have this years ago. Now, we’re probably at least five to 10 years away from any of this becoming a reality, but it’s fun to dream and think about the future. I’m glad we have more options in general for helping people with kidney disease, and I hope we have more in the future. Thanks so much for watching today. Make sure you like this video. Subscribe so you never miss a new recipe or new health tip. I’ll be talking about other things related to the future of kidney failure, like these artificial kidneys and the wearable kidneys in the future.
check out my website, cookingdoc.com. Check out my book, The Cooking docs Kidney Healthy Cooking, A Modern 10-step Guide to preventing and managing kidney Disease. This is national kidney Month. I hope you’re learning a lot about kidneys and taking care of your kidneys. I will see you next time.