VIEW: Caveat emptor! —Syed Mansoor Hussain
Daily Times
Monday, June 25, 2007
United States President George W Bush vetoed a stem cell bill for the second time this week. The reason why stem cells are such a big issue is that most of them are derived from an aborted foetus. However, what makes these cells important to medical research is that they can be grown into almost any organ or tissue of the body.
Why do we need such cells? The many diseases we suffer from are because certain types of tissues or cells in the body are either abnormal at birth or develop disease during a lifetime. This includes a vast gamut of ailments. Many that cause failure of vital organs are now treatable by replacing (transplanting) these organs or damaged cells from a human donor.
If possible, these stem cells can be used to develop new organs or tissues instead of relying, as is currently the procedure, on donated organs. Many of us who read science fiction know of something called a clone. Essentially a clone is a genetically identical individual, sort of an identical twin grown in a lab.
A recent sci-fi movie called ‘The Island” is about clones kept in readiness as an insurance for the rich in case they need an organ for transplantation. Successful transplantation of organs from one human to another is of course one of the great achievements in medicine. But it does lend itself to the possibility of criminal activity.
The first successful transplantation of an organ was that of a human kidney from one identical twin to another almost fifty years ago. The reason why identical twins are perfect organ donors is because they are genetically identical. Therefore the body of the recipient of an organ from an identical twin does not ‘reject’ it. Rejection is the main problem in transplantation.
The human body has an elaborate system of defences called the immune system that combats any invasion by ‘foreign’ biological organisms. This is what helps us fight off infections from bacteria and viruses. But, this same system also fights off or ‘rejects’ any transplanted organ considering it foreign. The exception of course is a ‘cloned’ organ or one from an identical twin. And, in the future, from transgenic animals. (The Island of Dr Moreau).
Transplantation became a successful medical treatment only after the development of special medicines that suppress the rejection process without killing the patient. The modern era of transplantation really started when the drug Cyclosporine that successfully suppresses the rejection process came into common use about twenty years ago. The use of this drug with some others has made transplantation of organs safer and much more successful.
Millions of people develop problems that can only be treated by transplantation. This includes people with liver disease, lung disease, heart disease and most importantly kidney disease. The list is expanding by the day. The treatment of disease that destroys the human kidney is one of the great success stories of medicine.
Today, kidney dialysis or using a machine to clean out the blood if the kidneys have failed, is an accepted treatment. However, there is drama and history behind this. Willem Kolff, the inventor of this system, did it during World War II while his country was under Nazi occupation. His invention allowed patients with non-functioning kidneys to survive for many years.
That such patients could now be kept alive for many years provided an impetus for finding a permanent cure for them, leading to kidney transplantation. Today, kidney transplantation is the commonest transplant operation in the world. The reason for this being that every normal person has two kidneys, and donating one does not affect their health in any significant way. However, there are not enough willing donors for all the people that need a transplant.
The 1978 film, ‘Coma’, based on a novel by writer and physician Robin Cook, was about patients who came to hospital for routine operations but kept dying. These patients had dead brains but living bodies, and were then stored so their organs could be harvested for transplantation. The movie is also noteworthy for highlighting another important problem. The longevity of Michael Douglas as a lead male actor.
The reason why I thought about this movie was because of the recent incident where some hospital owners and surgeons involved in kidney transplantation in Lahore were arrested. Evidently they were keeping people, yes human beings imprisoned so that their kidneys could be removed against their wishes and then transplanted. This is about as evil as it gets.
Sadly these criminals have been released on bail. Personally I would have preferred to see them at least tarred and feathered when they came out of jail. But then they have already made so much money selling Pakistani kidneys to rich Arabs that they could bribe their way out of anything. And, that is one of the most bizarre success stories about tourism in Pakistan.
Pakistan might not be a favourite when it comes to regular tourism, our former paragliding minister of tourism notwithstanding. But it is a favourite when it comes to ‘transplant tourism’. As a country we are willing to sell the kidneys of our poor to the highest bidder. I realise that our government has recently taken some timid and most likely temporary steps to stop such activity.
Considering the financial clout of the transplant criminals, nothing permanent is likely to happen. Economic imperatives drive this business. As long as there are enough poor people willing to give up a part of themselves for money and rich people willing to buy, the business will go on. And government functionaries can always be bribed.
The saddest part of this modern form of ‘medical’ prostitution for me is that without the participation of doctors such criminal activity could not happen. When Mammon replaces Hippocrates as the driving force behind medical practice, ‘caveat emptor’!
Syed Mansoor Hussain has practised and taught medicine in the US. He can be reached at smhmbbs70@yahoo.com
http://www.dailytimes.com.pk/default.asp?page=2007%5C06%5C25%5Cstory_25-6-2007_pg3_4
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