Towana Looney knew that the first four people who ever received an organ from a pig died within two months. But the Gadsden, Alabama, woman was still game to try it herself.
After eight years on dialysis and five years of failing to find a human donor match, she was tired of that life and ready to try something new, even if it was risky.
Her doctor in Alabama, Jayme Locke, told her about the experimental transplant procedure and started to ask her if she was interested. “I didn’t let her get it all the way out of her mouth and I said, ‘yes ma’am,'” Looney, 53, said in a video interview recorded by NYU Langone Health. The doctor asked her why, despite the odds. “Number one, to help so many people,” Looney remembers responding.
“We stayed in contact for months. Same converstion. Same answer. Same conversation. Same answer.”
Looney finally had her surgery on November 25 at NYU Langone in New York City, and left the hospital 10 days later for an apartment a few blocks away.
She goes back to the hospital every day for health checks and is monitored in between with wearable sensors that track her blood pressure, heart rate, blood oxygen, temperature and other measures, to make sure anything brewing is caught before it causes any real trouble.
Her transplant surgeon’s eventual goal is to use organs from pigs to provide an alternative both for the 5,600 Americans who die every year waiting for a human organ to become available, and for the tens of thousands if not millions more who could benefit from a replacement organ but never make it to the list at all.
“This could completely change the math of end-organ failure and what that means in terms of the likelihood of getting a transplant,” said Dr. Robert Montgomery, who has a heart transplant himself, and said he had a 50-50 chance of not living long enough to receive his new organ. “Xenotransplantation is about eliminating that gamble.”
An opportunity and a challenge
The other four patients who received pig organs ‒ two hearts and two kidneys ‒ had a “honeymoon” period right after their transplants, Looney’s surgeon, Dr. Robert Montgomery, said in a videotaped interview conducted by the hospital. All four died less than two months later.
But Looney, a mother of two and grandmother of two, is the healthiest of them all, so Montgomery thinks she has the best chance of long-term survival. Montgomery is a professor and chair of the Department of Surgery at NYU Langone, as well as the director of its Transplant Institute.
“A lot of the problems have been related to how sick the patients were,” he said in the video. It’s not yet clear how long someone can live with a pig organ, and he’s hopeful that Looney will show that the animal organs can buy people much more time than a few months. “We have an opportunity here to get beyond that two-month mark and much further, so I’m very excited about that.”
Because none of the other patients has survived for long, doctors aren’t sure whether a pig kidney will be able to perform all the functions of a human kidney. The pig kidneys can clearly make urine and clear out waste, like their human counterpart, but a longer transplant will be needed to prove whether they can also regulate blood pressure, fluid levels, electrolytes, calcium metabolism and make and respond to hormones.
“We’ll have to see at the first four months, six months or a year if there’s anything a pig kidney can’t quite do that a human kidney is able to do,” Montgomery said.
What is xenotransplantation?
Xenotransplantation is the use of an animal organ for transplantation into a human. Although some have raised ethical concerns, bioethicists have noted that humans routinely kill animals to eat. Animal welfare advocates estimate that 124 million pigs are killed annually for food in the U.S. alone.
Pigs are used for transplant because their anatomy and size are relatively similar to humans. The pigs used for transplant are raised specifically for this purpose and 10 of its genes were altered to make its organ more likely to be accepted by the human body.
Three genes were eliminated to avoid an immediate immune rejection after the transplant, Montgomery said. A fourth gene was “knocked out” to prevent the pig kidney from continuing to grow after it was transplanted. The kidney of a full-grown pig is bigger than that of a person’s, so an adolescent pig is used, and the growth hormone receptor is eliminated to keep it from growing to its full size after the transplant, Montgomery said.
Six human genes were added to the pig to prevent blood clots once transplanted, help the human immune system manage the new organ and prevent an inflammatory response to the transplant.
Hoping for a different ending
Looney had donated one of her kidneys to her mother back in 1999 when her mother was suffering from kidney disease. Then, in 2006, she developed pre-eclampsia during pregnancy and it injured her remaining kidney. By 2016, her kidney was so damaged, she went on dialysis.
She qualified for the organ transplant list five years ago. But because of her natural immune system and the blood transfusions she had during pregnancy, her body would have rejected any human organ they tried to transplant.
“She basically won’t match with any other person on the planet,” Montgomery said in the video interview. “She was beginning to run out of options. She was going to find herself in trouble in not-too-distant future.”
Right now, xenotransplantation is being done only as one-off procedures to save the lives of people like Looney who have no other alternatives.
The hospital did not release the price of Looney’s care, though it is paying for most of it. Typically, insurance does not cover the cost of experimental treatment.
Montgomery said he expects several clinical trials of about eight to 10 patients each will start in 2025 at his institution and one or two others to provide safety and effectiveness data about the procedure and develop standard protocol. After that, larger, phase 3 trials will be conducted at more institutions.
“In about seven years, we should be in a position to do this as a routine,” he said.
In the hospital interview, Looney said she was eager to volunteer now, rather than spending more years on dialysis, just waiting to die.
“I want to know that I tried. I tried to make a difference. I tried to help me and to help people,” she said. “If you don’t try, how will you know? How will we learn? How will we be better? How will we make it better?”
Karen Weintraub can be reached at kweintraub@usatoday.com.
