Pod Insights Short Wave The First Woman To Get A New Kind Of Kidney Transplant About this episode Towana Looney became the first living person in the world to get a kidney from a new kind of genetically modified pig last month. Health correspondent Rob Stein https://www.npr.org/people/146944972/rob-stein got exclusive access to be in the operating room.
Towana is a 53-year-old grandmother from Gadsden, Ala. She's been on dialysis for four hours a day, three days a week since 2016. Her immune system would reject a human kidney. So the Food and Drug Administration made an exception to its usual clinical study requirements to allow Looney this new kind of pig kidney. But the procedure is controversial.
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0:15 Speaker 00 You're listening to Short Wave from NPR.
0:20 Regina Barber? Hey, Short Wavers. Regina Barber here. And I'm here with my colleague, NPR Health Correspondent and awesome guy, Rob Stein. Hey, Rob.
0:27 Speaker 02 Hey, Gina.
0:28 Regina Barber? I hear that you've been working on this really interesting story for the past year.
0:32 Speaker 02 Yeah, yeah. I've been following the developments of a biotech company called Revivicor that's been moving towards a very ambitious goal. And that is to use cloned genetically modified farm animals to provide organs for transplants for humans.
0:48 Regina Barber? OK, so you're saying farm animals. So there's like a farm just full of cloned animals?
0:52 Speaker 02 Yeah, yeah. In fact, I went to visit this farm. I drove down a road through the Blue Ridge Mountains in southwest Virginia to visit the Revivicor farm back in February. This farm, it has like 22 buildings and around 300 pigs.
1:09 Speaker 02 We had to change into hospital scrub before going inside to protect the pigs. They're really careful to make sure visitors don't bring in any pathogens that could infect the pigs. When we went into the buildings, we stepped into these tubs of disinfecting fluid to sterilize our boots. And then I got to see these cloned genetically modified adult female pigs.
1:31 Speaker 03 Do you want to hold one?
1:33 Speaker 02 Oh. It's OK. Yeah, it's OK. And some of them were pregnant with cloned pig embryos that were also genetically modified.
1:43 Regina Barber? Well, you're like breaking my brain here. OK, so there are these identical organs in all of these pigs so they can be used in humans, right?
1:50 Speaker 02 That's the idea. That's right. They cloned these pigs. They all have these 10 identical genetic modifications. And they're designed to make sure their organs, these piglets that are born, don't grow too big, won't cause complications like blood clots, and won't be rejected by the human immune system.
2:08 Regina Barber? That sounds very like sci-fi.
2:10 Speaker 02 It did to me, too, especially when I first heard about it. But it's real. And they're trying to address a very real problem, which is that more than 100,000 people are on the waiting list for transplants in the US. And about 17 die every day without getting one because there just aren't enough human organs available.
2:27 Regina Barber? It is devastating.
2:28 Speaker 02 Yeah. And last month, I was there for the very first transplant surgery of one of the Rivivacore kidneys with these 10 genetic modifications into a living patient.
2:39 Regina Barber? Wow, you saw the surgery?
2:42 Speaker 02 Yeah, I was inside the OR for the entire operation. And you know, Gina, this is, I should say, very controversial in a lot of ways. I talked to bioethicists and scientists who have a lot of concerns, you know, concerns about the pigs, about the patients themselves, who are desperate for anything, and even the possibility that this could cause a pandemic by spreading pig viruses to people.
3:07 Regina Barber? So today on the show, the first living person to receive a new kind of genetically modified pig kidney, and what that could mean for the future of transplant medicine. You're listening to Short Wave, the science podcast from NPR.
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6:13 Regina Barber? Okay, Rob, so you're the only journalist allowed in the operating room, right? So like, set the scene. How was it?
6:20 Speaker 02 So this operating room is in New York City, and in the room, there was this huge screen on the wall with the flight path of one set of surgeons. They're flying back from rural Virginia with two kidneys from one of the cloned genetic pigs being bred at the River River Core Research Farm.
6:35 Regina Barber? Wow. Okay, so who is this patient being operated on, receiving this transplant?
6:40 Speaker 02 Yeah, I met her a few minutes before they brought her into the OR. She's a 53-year-old grandmother. Her name is Towana Looney. She donated one of her kidneys to her mother in 1999.
6:50 Regina Barber? Oh.
6:50 Speaker 02 A few years later, she developed chronic high blood pressure during her pregnancy, and her remaining kidney failed in 2016. And since then, she's been on dialysis four hours a day, three days a week.
7:01 Regina Barber? So she's been dealing with this for almost a decade.
7:04 Speaker 02 Yeah.
7:04 Regina Barber? And this treatment, like transplanting an organ from another animal, it's a new experimental approach, right?
7:10 Speaker 02 Oh, absolutely. It's very experimental. There have been other patients who've received other kinds of genetic pig kidneys and even hearts, and those organs seem to work well.
7:21 Regina Barber? Yeah.
7:22 Speaker 02 But the patients in those cases were gravely ill with many other health problems and only survived weeks or maybe months.
7:29 Regina Barber? Oh.
7:29 Speaker 02 But like I said earlier, this is the first transplant of this specific kind of genetically modified pig kidney into a living person.
7:36 Regina Barber? Yeah, I don't think I've heard of clinical trials for this. Aren't those required before human patients can get these, like, experimental treatments?
7:44 Speaker 02 Yeah, that's right. In fact, the company's in conversation with the FDA to get approval for this right now, but it hasn't happened yet. So this was an exception to the FDA's usual requirements. It's called a compassionate use case, which, you know, gives patients who are desperately ill and basically have no other options access to experimental treatments. And Towana has an especially sensitive immune system, so doctors knew her body would reject a human kidney.
8:10 Regina Barber? Oh, no.
8:10 Speaker 02 But in the operating room, everyone was pretty optimistic.
8:13 Speaker 06 She's in better condition than the other patients who have undergone this procedure. So we're hopeful.
8:20 Speaker 02 That's the lead surgeon, Dr. Robert Montgomery. I watched as an anesthesiologist put Towana under.
8:27 Speaker 03 Everybody ready?
8:29 Speaker 02 And then the surgical team got to work. Robert, the surgeon, made an incision in Towana's lower abdomen to begin painstakingly preparing a spot to implant the pig kidney.
8:41 Speaker 03 Okay, scissors, the long ones. Okay, there's the artery.
8:47 Speaker 03 This is fascinating.
8:49 Speaker 02 Yeah, it was all very dramatic, you know, because as this was happening, the screen on the wall shows the helicopter approaching NYU Langone Health with the pig kidneys. The chopper swooped through the clear blue sky along the East River and sets down on the helipad. The arriving crew places a white box about the size of a microwave oven that contains the pig's two kidneys on a wheelchair and rushes it into the operating room.
9:12 Regina Barber? Wait, wait, so the organs arrive like during surgery?
9:16 Speaker 02 Exactly. While one team of surgeons was flying back with the pig kidneys, Robert Montgomery, the surgeon, and his team were preparing Towana to get the transplant. When the chopper arrived with the pig kidneys, they had both the left and right kidneys from the pig, just in case something went wrong with one. Robert removed them from their plastic bags and then meticulously started preparing one of them.
9:39 Speaker 03 Sew this thing in.
9:41 Regina Barber? And then they checked to make sure like everything's working, right?
9:44 Speaker 02 Yeah, yes, this is a big moment. They checked to see if blood from Towana's body is flowing into the pig kidney for the first time.
9:53 Speaker 03 All right, so we're about to reperfuse. How's our blood pressure?
9:57 Speaker 03 You'll see it'll be kind of a little bit dark colored initially. And now I'm taking the clamp off the artery.
10:05 Speaker 02 And then it happens.
10:07 Speaker 03 Yeah.
10:10 Regina Barber? Oh, thank goodness. I like my heart's racing and I'm just like hearing all this like, so the surgery was a success? Like, how's Towana doing now?
10:18 Speaker 02 Yeah, it was very dramatic. They then checked to make sure the kidney was doing its job, which was producing urine. And then she was discharged from the hospital less than two weeks after the surgery, which was earlier than they expected. And I, yeah, and then I went to visit her at an apartment where she's staying for, you know, probably about three months not far from the hospital, so the doctors can keep an eye on her. And I have to say, she is in amazing spirits. Most of the symptoms that had limited her before the surgery had disappeared.
10:46 Speaker 07 No weakness, no tiredness, no fatigue, no swelling from fluid intake. I can eat more, I can drink more, I can walk longer distance. It's just amazing.
10:59 Regina Barber? Wow, wow, that's, that's amazing.
11:01 Speaker 02 Yeah, Towana says she'll never forget the first time she peed after the surgery. It was the first time she'd been able to do that in almost eight years.
11:09 Speaker 07 I was like, wow, I told the nurse I'm peeing. She said, no kidding. She's a European alive, which is a good thing. That was exciting to me.
11:22 Regina Barber? That is incredible.
11:22 Speaker 02 And she's really looking forward to spending more time with her daughters and grandchildren once she can go home and returning to her job as a cashier at Dollar General, an activity she just couldn't do before.
11:34 Speaker 07 I just want to go shopping and not have to sit down and I want to eat what I want to eat while I'm shopping and I want to travel and stay more than three days. I ain't got to come back to dialysis. I ain't got to leave a day early to be at dialysis at 4:30 in the morning, 5 o'clock.
11:52 Regina Barber? I am so happy for her. It seems like she's optimistic and like her doctors are optimistic too, but this procedure is still like very controversial, right?
12:02 Speaker 02 Oh, absolutely. You know, I talked to other scientists and bioethicists who said there's not a ton of scientific evidence to support these kinds of surgeries. Elsie Johnson is a bioethicist at SUNY Upstate Medical University in Syracuse, and she told me she's worried about the health of the pigs and about people getting these treatments. And she says the way it's happening now with individual experiments, all different teams and protocols and orders and different genetic modifications is not the best way to do science. Plus, she worries that these operations might be exploiting patients who are desperate for anything that could help them.
12:38 Speaker 05 It's worrisome when patients do something because they believe it's going to save their life when we don't have good evidence that that will actually happen. And I worry about patients like that being exceptionally vulnerable and potentially exploited, even unintentionally, and just being exceptionally vulnerable to false hope in a situation where hope is, at this point, perhaps not warranted.
13:06 Speaker 02 She's also concerned about the possibility of transmitting viruses from animals to patients, even something that could potentially be transmitted from person to person. The fear is another pandemic. In fact, everyone in the operating room that day, including me, is being tested to make sure we didn't catch a pig virus.
13:24 Regina Barber? Oh, that would be awful.
13:26 Speaker 02 Tell me about it. But on the other hand, patients like Towana are out of other options.
13:32 Regina Barber? Right. And, and given that, like, what do her doctors say about her chances for, like, long-term health? Will this kidney last her a long time?
13:40 Speaker 02 That's the big question. And, you know, Gina, we're in uncharted territory here. We just, no one really knows what's going to happen. In fact, after being discharged early to an apartment near the hospital, Towana was back in the hospital for a few days because she had to get an additional anti-rejection drug.
13:56 Regina Barber? Oh, no.
13:57 Speaker 02 Yeah, that was a little worrisome. But her pig kidney is still working well, it seems. And doctors remain optimistic. And that's because, you know, she's a lot healthier than the other patients who had received other kinds of genetically modified organs before this. And also, even if this pig organ does fail, she still has the option to go back on dialysis, despite how unpleasant that would be. And, you know, Towana, who's very religious, says she's happy with the decision, despite what she's heard from some of her friends.
14:24 Speaker 07 I have one thing to me. It's not in the Bible for us to receive human, for a human to receive animal bodies. I said, you ate bacon this morning for breakfast, didn't you?
14:40 Speaker 07 It's, it's life-saving.
14:44 Regina Barber? Rob, thank you so much for bringing us this, like, incredible story. I hope you come back and, like, keep us updated.
14:50 Speaker 02 Oh, absolutely. I'll definitely be following this one.
14:57 Regina Barber? This episode was produced by Jessica Young and Rachel Carlson. It was edited by our showrunner, Rebecca Ramirez, and Rob checked the facts. Patrick Murray was our audio engineer. Beth Donovan is our senior director and Colin Campbell is our senior vice president of podcasting strategy. I'm Regina Barber. Thank you for listening to Short Wave from NPR.
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