Xenotransplantation: A Success Story.

Show: FRESH AIR
Date: FEBRUARY 17, 1998
Time: 12:00
Tran: 021701np.217
Type: FEATURE
Head: Jeff Getty
Sect: News; Domestic
Time: 12:06

TERRY GROSS, HOST: This is FRESH AIR. I'm Terry Gross.

One of the most promising medical breakthroughs is also one of the most controversial: the transplanting of animal organs and cells into humans. Transplants from baboons, pigs, and other animals could save thousands of lives. About 10 Americans a day die while waiting for human organ donors.

But grafting animal organs into humans may also bring risks. In fact, a group of doctors has called for a moratorium on these transplants, known as xenotransplants, until more is known about the possible risk of spreading animal viruses to people. We'll hear from one of those doctors later in the show.

First, we're going to talk with Jeff Getty. Two years ago, he received a bone marrow transplant from a baboon, in the hopes that it would boost his immune system, which was knocked out by AIDS. He was the second person to receive this transplant. The first person died several days after the operation.

Getty is an activist in the campaign to proceed with research on xenotransplants. Getty now serves on the board of Cellular Therapeutics at Allegheny University of Health Sciences. He participated in a xenotransplant panel discussion over the weekend at the annual meeting of the American Association for the Advancement of Science.

I asked Jeff Getty to describe his transplant.

JEFF GETTY, ANIMAL-HUMAN TRANSPLANT RECIPIENT, AIDS PATIENT, MEMBER, BOARD OF CELLULAR THERAPEUTICS, ALLEGHENY UNIVERSITY OF HEALTH SCIENCES: Two years ago this winter, we put approximately 60 milliliters of baboon bone marrow cells into my arteries and hoped to engraft baboon cells into my bone marrow. The experiment was designed to try to find a way to stimulate my immune system to fight off HIV. At the time, I was fairly close to death with AIDS.

GROSS: What was -- why was a baboon's marrow cells chosen as opposed to another animal or another primate?

GETTY: The scientists that I was working with chose to use baboon bone marrow cells because those cells are naturally resistant to HIV infection. We were hoping that perhaps those cells could confer or teach my immune system about possibly being resistant as well.

GROSS: What were the results?

GETTY: The results were short-lived. We only have engraftment for a few weeks. However, my health improved rather dramatically and right now, they're in the process of writing a paper on it. They're almost finished with the paper, finally. I think I can attribute the improvement in my health more to the effects of the chemotherapy than the bone marrow itself.

However, one outcome of the experiment was, which was one of the reasons that -- that there's so much controversy going on now. There was concern about whether or not I was going to get a baboon disease of some type, and so far, they haven't found any and they've been looking real hard. And as a result of this, a lot of cross-species research is probably going to go forward.

GROSS: Jeff, how did you get to be the one to get this very experimental baboon transplant?

GETTY: Well as it turned out, I was one of the few people who actually qualified for the protocol. It was very difficult to qualify for it. You had to be extremely sick and almost dead, but also not having been infected with certain types of microbes that they didn't want on board. And I didn't have them. And I also knew about the protocol. I had worked on developing the protocol and I'm an activist and I know how to fight to get something approved. So, it was a perfect match.

GROSS: Why did you want to volunteer for this, 'cause I think some scientists were guessing that this treatment stood as good a chance of killing you as it did of helping you?

GETTY: At the time that I did the treatment, when we were just learning that protease inhibitors might even help, I had already failed those drugs. So I -- it was a life and death decision.

GROSS: Mm-hmm.

GETTY: I was almost dead the month before we did it. In fact, it was ironic because many of our doctors were told that -- that -- by scientists, by people opposing this that I was far too sick to undergo such a dramatic procedure. And then others told us that I was far too healthy to undergo this procedure. But as it turned out, it was just about right.

GROSS: What warnings were you given in advance?

GETTY: I was specifically warned in advance and signed consent forms around the dangers and the risks to my life. I was told that it could be as high as a 50/50 percent chance that I would be killed. I'm an activist. I believe that action equals life, so I'm going to go for it and I did. I was also given a lot of briefings about the fact that I could, in this very early stage of this type of science, I could pick up an animal disease.

So, I was carefully informed of that possible risk. And then I agreed to come in and be checked on a monthly basis for a long period of time so they could make sure that that didn't happen.

GROSS: I think the idea of animal-to-human transplants is still so new and experimental...

GETTY: Right, it is.

GROSS: ... that people -- people really wonder: well, you know, do you feel any different? Do you think about animals differently if there has been an attempt to save your life with an animal transplant? And I'm wondering, you know, if you felt affected that way at all?

GETTY: Well yes. We're definitely -- you know, I didn't -- there's one thing I did not realize at the beginning of this protocol, was I didn't understand how deeply entrenched and subconscious and deep-seated is this feeling among human beings that the human species should not be adulterated with animal components.

And it was after the first year, having done this transplant, when I still continued to hear people joke about -- that my friends lived in a zoo, and of course that I liked to eat bananas, and that whenever they saw a monkey, they would look at me and giggle.

And at first, you know, these jokes were just kind of fun and I didn't mind. But after a while, I realized that we were tapping into something here that's really deep. Humans and animals should not mix. That's what people think.

So, when we start making products out of animals that then live and survive in humans to keep us alive, are we not creating some mythological character? Are we not creating the chimera? The centaur? The part human/part animal myth?

And it's a taboo that we're crossing. And I really think the bigger barrier here that we're facing on cross-species research is not just the science, but it is that myth, that taboo, and the feeling that people have -- and it's almost a subconscious feeling that they have.

GROSS: And -- and did you ever have that feeling at all?

GETTY: I -- after I received baboon bone marrow transplant, I went through the realization and the exploration of my own feelings, and realized that perhaps I was now part animal -- and part monkey at that. And frankly, it was an unusual experience. I mean, I had to get used to the fact.

So yes, the taboo was built into me as well. Now, I got used to it and it's no big deal. But you know, I -- we're -- I'm still hearing the jokes and it leads me to believe that we're breaking through a much larger barrier here than just some scientific concerns. And I think that's really what's going on.

GROSS: I think the greatest fear that some scientists have about animal-to-human transplants is the fear that an animal virus that humans cannot catch now might be bred in humans if animal cells or animal organs are transplanted into humans.

So the fear with a procedure like the one you had would be that a baboon virus that humans couldn't get now might be bred in the human body if baboon cells are transplanted into the human. Was this a concern of yours when you had the transplant?

GETTY: No, that's not my understanding of the science at all, and I've studied the science for a long time before I went forward with the procedure. The way I understand the science is, you're trying to refer to something called "recombination." And that is when a virus that's not been -- that's a benign virus or a virus that doesn't hurt people gets in and then can recombine with human DNA and form a new supervirus, sort of like in the movie "Outbreak" with Dustin Hoffman.

That is really considered to be an infinitesimal risk. That's a very, very low, low risk. The thing that I was more concerned about was getting an unknown baboon virus -- one that they had not yet detected. See, we knew what we had going in. And the risk was that we picked up something that we did not now or at that time -- did not yet know how to detect.

So that's why I had to agree to be followed for some time, as they were able to detect and find new baboon viruses. And they have never found any of the new viruses. The animals we used were very clean. They were raised in captivity and they were clean of most viruses. Of the known viruses the baboon had, Epstein Barr virus is almost identical to the human Epstein Barr virus which I already had.

So you know, in terms of risk with me, it was carefully quantified, and we had a good idea about what we were doing.

Now, if you want to talk about this pathological risk, let's just talk about it for a minute. I mean, first of all, the virus has to be infectious within the animal. Then, the virus has to be able to be transmitted into the human through an organ or cell delivery system. Then that virus has to be able to survive in a foreign environment, in a human immune system, and somehow become infectious within that human immune system.

Then if it becomes infection within a human's immune system, then it has to be infectious enough to be infected to another human's immune system. And each time you take one of those steps, each time you go over that next bridge of risk or the "what if" factor, it's -- the chances and the risk of this get smaller and smaller and smaller.

Several virologists have already come out and said that. There is a risk. It's a very small risk. But it's not like we're going to be transplanting cells into people who aren't going to be told what the risk is and people who aren't going to be told how to have safe sex and how not to transmit a blood-borne virus.

And again, we're not talking about aerosolized viruses -- viruses that you can sneeze on somebody.

GROSS: Were you given any cautionary advice about things not to do, so as to make sure you couldn't possibly spread a virus to somebody else.

GETTY: Of course. I'm a person who lives with HIV. I already have a virus I don't want to spread to somebody else. So as a result, I'm well aware of the type of procedures and the type of protections you have to take so that you don't transmit this virus. So, I'm a natural to get this type of research. I already have a virus.

GROSS: Mm-hmm.

GETTY: The problem is for me right now, when I look at the way the science is being done, is that the government and others who are the enemies of the science are trying to stop our science from going forward. And by the way, xenogenetic research -- cross-species research isn't just bone marrow transplants and it isn't just organs. It's something called biologics. Biologics are living medical products. These are living cell tools that can help us in many ways fight many diseases.

And they form one tool that's called a monoclonal antibody. The monoclonal antibody is a valuable tool that scientists use, and a lot of these antibodies are derived from the meurine (ph) model -- they come from mice. So, because these antibodies which can change a cell receptor on a cell so that it can do its job differently or perhaps not reject an organ or somehow alter our immune system -- because those antibodies are derived from animal models, they are -- there is this fear that they, too, could possibly be contaminated by an unknown virus or a vector virus.

This is the situation now where we're not just talking about cross-species research in organs and bone marrow transplants. We're talking about a huge field of science here, and possible cures for cancer and cross -- HLA bone-marrow transplants, heart transplants from non-matching donors. There's all kinds of implications that are now being held up because of this one "what if."

And frankly, you know, to get to the root of the matter, how is it that these viruses could be transmitted if we got one in a patient? And the answer is: they're blood-borne viruses. They could be transmitted if they did get through through sexual contact. How do we stop viruses from transmitting sexually? Condoms -- we know how to do that. We know how to do that in AIDS. We've already shown that we can have a major impact.

So, I'm tired of hearing people say: "oh, well you could unleash another virus like AIDS." The equivalent of that would be the first 10 people who were ever infected by HIV would have to be in our protocol, sign the consent form, taught how to use condoms, carefully monitored every month, and told that they already had the virus.

If that had been the situation at the start of AIDS, AIDS never would have happened. So, we're talking about a controlled group of individuals in an experiment. We're not talking about mass application to the general population.

GROSS: But still, I mean, do you object to the idea of proceeding slowly with caution in something that is so new?

GETTY: I think we should proceed slowly with caution. I do not think we should stop the science in moratoriums, which is what's -- people are trying to do. And again, the answer here lies with the patient, and you vilify the patients. I mean, you say -- the patients could start this plague. The patients could have these viruses. You're asking me about my personal training that I was giving -- you know, concerned that perhaps I wasn't even told that I could transmit a virus.

The answer here is really with the patients. The patients need to be informed and taught about how to have safe sex. And we're not going to transmit these viruses. And those circumstances where a virus could get through are very, very infinitesimally small. So, it's only going to be a rare case that this is going to happen in the first place. If everybody's using condoms, there shouldn't be any problems.

GROSS: What have you been told about at what point you cease to be at risk of any baboon virus?

GETTY: The enemies of this research and the virologists who are against it are -- refuse to admit that I might ever not have a baboon virus. In other words, politically they cannot say that yes, we believe Mr. Getty does not have any viruses. Because the day that they say that is the day that they lost the debate. It's the day that we proved that we could do xeno research and follow someone long-term and find out that yes, they did not have a virus.

So, they're never going to ever let that go. So as a result, politically, nobody can ever declare me to be clean of viruses, even though they can't find any in me.

GROSS: Jeff, you say that, you know, people are concerned about transferring viruses from animals to humans, but it hasn't happened so why are they so worried? But the research is still so new, that just 'cause it hasn't happened yet doesn't mean that it can't happen or that it won't happen.

GETTY: I think that if you really spent the time to read on this stuff and enlighten yourself, you might not come up with the same angle. I spent a long time studying it before I came to the conclusions that I did. People have been in contact with animals in animal husbandry for thousands of years. We are continuously being exposed to animal blood and being bitten by animals and having the same routes of transmission. For God's sake, we're having sex with animals.

And -- and if there was a huge amount of -- of pathogens that were going to infect the human race, we would already be seeing these. We're seeing a limited amount of this stuff coming through. Occasionally a flu gets through or something like HIV gets through. But it's not a common practice. It's not commonly occurring when you look at how many times we are being exposed to animal blood and pathogen.

I mean, we eat it. We eat it half-cooked.

GROSS: You know that flu that recently jumped from chickens to humans and there are thousands...

GETTY: Right.

GROSS: ... of chickens that were slaughtered. Did that give you pause?

GETTY: No. You know, you know what -- I really think that -- that you didn't just listen to a word I've just said. And you know, I think that's enough. I mean, really, how many chickens have we eaten in the last hundred years? How many chickens' heads have we cut off and had their blood pour on us? 50 billion? We get one chicken to cause a flu to transmit through to some people in Hong Kong, and now all animal research must stop?

I mean, these are things that are very, very rare and remote occurrences.

GROSS: My guest is Jeff Getty. We'll talk more after a break.

This is FRESH AIR.

Back with Jeff Getty. Two years ago, he received a bone marrow transplant from a baboon to strengthen his immune system, which was knocked out by AIDS.

Were you confronted by any animal rights activists? And, are they involved in this issue now?

GETTY: Oh, God -- you want to go there? Yes, while I was in the hospital, I received some 350 letters of love and support from all over the world and four death wishes from animal rights activists. It's irrational. I mean, we're eating animals every day. I mean, I just had one for lunch and frankly if you'd think that we couldn't use animal cells or organs to keep people alive, but still eat them is ridiculous. And I don't get the point at all here.

GROSS: You have made yourself a voluntary guinea pig, in a way, for several procedures. You've taken experimental AIDS drugs for years.

GETTY: Mm-hmm.

GROSS: And you helped smuggle in certain AIDS drugs when they were...

GETTY: Yeah, in a pinata.

LAUGHTER

GROSS: Uh-huh. Why -- I mean, a lot of people would say you've really exposed yourself to a lot of risk. I mean, I realize the greater risk was dying, but tell me why you've taken so many risks for so many years with experimental therapies, including animal-to-human transplants, which was perhaps the most dramatic of all the rest that you've taken.

GETTY: Yeah, there was many other things that I've done. I've transplanted cells from two of my sisters directly into my body, and they were not blood matching and people thought that was going to kill me as well.

I've had HIV most of my adult life. I'm out 18 years here folks, and the one thing that I have learned through the 1980s when there was no therapies and the early 1990s, too, is that the only way I was going to stay alive was going to be by taking action. You talk to any cancer patient who's been told that they only have six months to live and now they're here 10 years later. They're alive because they took action.

I read Bernie Siegel's (ph) books, you know -- "Love, Medicine and Miracles" and I got off my butt and started fighting. And every time I took action to get something new or to obtain another drug, sometimes the drugs helped me, sometimes they didn't. But I can tell you right now, I wouldn't be alive now if I hadn't fought as hard as I did.

GROSS: As an activist and as someone who has been the recipient of an animal transplant, what would you like -- how would you like to see government guidelines change for animal to human transplants?

GETTY: Well, I told the New York Times recently that I think I have the answer to the whole problem, and the answer is that we're not bringing in behavioral science. We're not bringing in social science.

I mean, the real risk of danger here -- the real risk of infection to the general population -- is going to only happen when we have uninformed patients or people who do not know how to protect themselves so they don't transmit a virus.

So, it's really boiling down to sex. And it seems like we don't want to talk about sex. And even in the protocols that I signed consent forms to, sex was only briefly mentioned, but it's the most important part of this.

I really think that if we design protocols that screen out sex addicts; screen out drug addicts and alcoholics -- people that might slip up -- and then have everybody in those protocols sat down in a room for a half a day and taught how to use condoms and taught safe sex techniques, and then told that they just must assume that they have a virus like HIV for a long period of time, then we can go forward with these experiments and find out.

Now, if it turns out that xeno research really is a key to saving thousands of lives, and it's going to be a widespread application, then we can develop, through cloning, animal models that are completely clean of disease and you'll know that we don't have these risky pathogens floating around out there. And that'll be in decades to come.

GROSS: How is your health now?

GETTY: My health has been fairly good for the last two years. I mean, it hasn't been a bed of roses, but I'm able to keep my weight on. However, my immune system remains pretty much shattered and I am looking for new drugs and possibly new ways to stay alive, including bone marrow transplants.

GROSS: So, what new experimental therapies are you still hoping to try?

GETTY: We're looking at a couple of ideas. You know, we've found that some human beings are naturally resistant to HIV also. So, why not try to do a bone marrow transplant from one of them to someone like me to see if we can, you know, teach that immunity to the other immune system?

GROSS: Jeff Getty -- he received a bone marrow transplant from a baboon two years ago.

I'm Terry Gross and this is FRESH AIR.

Dateline: Terry Gross, Philadelphia
Guest: Jeff Getty
High: Jeff Getty is an animal-human transplant recipient who advocates continued research in this field. Getty, who has AIDS, received bone marrow from a baboon in an effort to jump-start his immune system. Getty vehemently opposes a proposed moratorium on animal-human transplant research.
Spec: Health and Medicine; AIDS; Animals; Transplants; Politics; Government
Please note, this is not the final feed of record
Copy: Content and programming copyright 1998 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1998 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Jeff Getty
Show: FRESH AIR
Date: FEBRUARY 17, 1998
Time: 12:00
Tran: 021702np.217
Type: FEATURE
Head: Dr. Fritz Bach
Sect: News; Domestic
Time: 12:30

TERRY GROSS, HOST: This is FRESH AIR. I'm Terry Gross.

One of the research pioneers who helped make it possible to transplant animal organs into human bodies is now calling for a moratorium on this procedure. Dr. Fritz Bach is the Louis Thomas Professor of Surgery at Harvard University. Dr. Bach conducted early research into testing tissue compatibility between organ donors and recipients. In 1968, he performed one of the first two successful matched bone marrow transplants.

For the past eight years, he's been researching cross-species transplants. But now he thinks we need to learn more before we proceed with animal to human transplants, known as xenotransplants. Dr. Bach is part of a group of doctors calling for a moratorium until we further explore potential risks.

I asked him why he's calling for a moratorium.

DR. FRITZ H. BACH, PROFESSOR OF SURGERY, HARVARD UNIVERSITY: The reason why my co-authors and I called for moratorium is because there's the possibility that a virus or other infectious particle...

AUDIO GAP, WILL SEND TRANS

... go from a pig organ transplanted to a human would first infect that patient and then spread to the general population.

And since we're thus putting the population at risk, we felt very strongly that we needed to first inform the population about the risk and secondly get some input from the population and through a representative body of course, as to under what circumstances they want to undertake that risk.

GROSS: How here's the thing -- if you're asking the public about their thoughts on taking this risk, I think there might -- it's possible that there'd be so many just almost irrational fears and taboos associated with the combining of animal and human parts, you know, that -- the whole mythology of, you know, the half man/half beast. Are you concerned that you might get an irrational fear instead of a rational assessment of the risks that the public is taking?

BACH: I'm not sure I would ever classify a true fear that anybody in the public has as irrational. We live with these fears. We live with these concepts and we were brought up that way. And that's exactly part of the ethical issue that we're concerned with here.

But we're not going to be able and it's not desirable to go out to the public -- and what we suggest as one possible mechanism is that there be a national advisory committee that would be composed of a wide variety of individuals, ranging all the way from ethicists to scientists who understand this, but who would represent the most common thoughts and different ways of thinking in out society; and that these people would devote the time to being informed and represent the people in the advice they give.

GROSS: How great do you think the risk is that new epidemics would be created as a result of animal-to-human transplants? Is this a minuscule risk that you're taking very seriously because even though it's minuscule, it's still a risk? Or is this a pretty large risk?

BACH: Nobody can give you an answer to that. And I'm not going to even try.

GROSS: Mm-hmm.

BACH: I can tell you the risk is greater than zero. There is a risk. And you just said it beautifully -- even if the risk is minuscule, if it occurs, it is an awful event to have happened.

GROSS: Now are you most concerned about un -- about undetectable viruses that we don't even know about, or undetectable other particles that we don't even know about infecting humans? Or are you more concerned with viruses that we know exist, but that might transfer from animals to humans after a transplant?

BACH: Both. There is evidence now, at least in the test tube, that pig viruses can infect human cells. That of course gives us a substantive basis for underpinning the worries that we have. But as I said before, there are many other possibilities.

And I'm afraid at the end, even though we should do everything we can to minimize the risk, we're not going to know if there's some other previously unrecognized infectious particle that may cause a problem that we can't even screen for; where we would not even recognize the illness for a while in the patient or in somebody that it spreads to. We have to be concerned about both.

GROSS: Now you mention -- you mention that pig viruses have been shown to spread to human cells in a test tube. How are pig organs or pig cells being used now medically?

BACH: The only uses at the moment, and it's still quite limited, is that there are nervous system cells being transplanted from pig to humans, and that there is the use of pig livers for patients whose own livers have failed.

And in those cases, one runs the patient's blood through the pig liver and outside the body, the pig liver. And then returns it to the patient and uses the pig liver to clean the blood of the patient in such a way that hopefully the patient's liver has time to recover or if not -- if it does not recover, so that the patient can get a liver transplant.

GROSS: So, this is like the temporary use of a pig liver.

BACH: Right, right, exactly.

GROSS: So, are you recommending that that use of pig livers be stopped now as part of the moratorium?

BACH: That's correct. But again, please let me stress that the moratorium means -- I'm sure you understand -- that we stop now, discuss it, and then hopefully find a way that is acceptable to proceed. But it's a temporary moratorium that we're suggesting so that these discussions can take place. And to be honest, so that the public can be better informed of what this is all about.

GROSS: What's your guess about how long this moratorium would last if you had your way?

BACH: Oh, if I had my way, it would last a very short period of time, and have the committee work very hard to come up with the appropriate advice on these ethical issues. Again, let me separate those from the technical issues that the FDA and CDC and other institutions of the government are involved in, so that they could deal with these ethical issues and give their advice, and so we could proceed.

But one has to recognize that we cannot make preconditions to such a committee. That committee has to act in its best senses after being fully informed on behalf of the public in whatever way it sees fit.

GROSS: Who ultimately decides on your proposal for a moratorium?

BACH: Oh, I suppose it depends who gets involved. The FDA and its associated agencies have to consider this, but hopefully the president or vice president or someone in the Congress would appoint such a national committee to be advisory to them.

GROSS: Advisory to the...

BACH: Would be advisory to the president or advisory to the Senate or whoever would appoint that committee. It's not clear who will take up the question of the moratorium, and it seems to me there are only really two places where somebody could say "yes, it's important to have a discussion of these ethical issues" and one place is in the White House. And the other place is in the Congress.

And if somebody takes that up and appoints such a national advisory committee or uses some other mechanism to deal with the ethical issues, that committee would report back, advise the president, let's say, and the president could then act as to what should be done next.

GROSS: Now let me ask you, if we kind of carefully screen behaviorally for the people who were animal transplant recipients, and they pledged to not have any kind of blood-type contact with anybody else, and they pledged to have safe sex.

BACH: Right.

GROSS: Could we be confident that even if there was some kind of germ that took hold in the recipient's body, that that germ wouldn't be spread to other people and therefore wouldn't cause an epidemic?

BACH: Please let me tell you I'm not a virologist or infectious disease expert. And the reason why we have Jay Fishman (ph) as the second author on that paper is because he provided that kind of expertise in our discussions.

So I can't tell you for sure, but certainly that is the major concern we have -- that there be that kind of spread. But let's think for a second what we're saying here. A virus could cause disease 20 years after it infects a patient.

And we transplant somebody whose happily married, and we're asking that patient, plus the spouse, to sign consent. I'm not sure such a consent would be legal. It's being done in a situation where the patient is about to die, and at least some attorneys and legal minds that we've asked have said it would not be legal.

Second of all, what happens five years later if that marriage breaks up and there's a new partner who says "I'm not going to allow myself to be monitor -- relate to this. I mean, it's a very difficult thing. We've gone all the way to people suggesting that patients be put in quarantine for years after transplantation. So, this is not a simple issue and I'm afraid not as simple as perhaps your question might suggest.

GROSS: My guest is Dr. Fritz Bach. He's a professor of surgery at Harvard. We'll talk more after a break.

This is FRESH AIR.

If you're just joining us, my guest is Dr. Fritz Bach, and he's a pioneer in transplantation research and immunology. He's a professor of surgery at Harvard. And we're talking about xenotransplants, which is the transplantation of animal organs or cells into humans. And Dr. Bach is calling for a temporary moratorium on these transplants until we know more about them and their results.

Dr. Bach, what are some of the new possibilities that animal-to-human transplantation offers?

BACH: Well first of all, it's an issue that at the moment, using human organs, there are many, many patients who never get an organ because there's a shortage of human organs. So the people who at the moment are dying, and there's about eight to 10 per day in the United States alone, because we don't have an organ, would easily get an organ because we would presumably have an unlimited supply of organs.

Second of all, the criteria we currently use for who can be a recipient are relatively restricted in part based on how many organs we have. And here we could probably extend those criteria -- relax them -- so that more people could benefit.

And then there are all of the kinds of transplantation that clearly we couldn't do from humans to humans, where for instance we're implanting cells into patient's brains and into their spinal cords to treat various brain diseases. We couldn't do that without going to another species.

There's been long effort to transplant eyelets (ph), those are the cells in the pancreas that produce insulin and regulate our sugar levels. If they don't function well, you get diabetes.

Clearly, if we could use for instance pig eyelets to transplant to humans, we would have all the eyelets we need and treat what is really a dread disease -- childhood diabetes. So the possibilities are almost unlimited. I mean, of course, that's not right, but they're enormous.

GROSS: Tell me about what diseases you think might in the long-run be treatable through animal-to-human transplants.

BACH: Well certainly all of the ones that we are now trying to treat with human-to-human transplants. And that is a long list. I mean, in the last decades, we've come a long way to where transplantation of the kidney, transplantation of the heart, of the pancreas, of the lung, of the liver -- is the therapy of choice for certain patients. And as I say, we could expand that.

But in addition to that, as I say, there's preliminary data that we may be able to treat certain diseases of the brain such as Parkinson's disease, by transplanting pig neural cells into the brains of patients with Parkinson's disease. And it's early yet and there should be no hope generated here for patients who have these terrible diseases -- at least for immediate treatment. But these are all possibilities for the future.

GROSS: Now, most of the research I've heard about has to do with baboon transplants and pig transplants. Why baboons and pigs?

BACH: Baboons because it is easier to transplant from a donor who is closer to humans in terms of genetics and everything else. And so a non-human primate such as the baboon is a better donor in terms of making it less likely that the baboon tissue's cells will be rejected.

At the same time, to comment further about the baboon, some of the very good virologists in this world such as Jonathan Allen (ph) have pointed out that the infectious risk that we spoke about earlier in fact is much greater from the baboon.

Why the pig? Because the pig is a good animal in general to breed. We can genetically manipulate it, which is a big part of our hope of solving the problems of xenotransplantation. We can have all the pigs we want, and economically, size-wise and many other things, the pig is suitable, and presumably offers a lesser infectious risk.

GROSS: You know, I think we're medically using pig heart valves to transplant into humans and insulin derived from cows. Do these not pose the same infectious problems as liver transplants or....

BACH: A heart.

GROSS: ... yeah.

BACH: No, they don't. The heart valves that are transplanted are almost totally dead tissue. They're not composed of live cells the same way that we're now proposing for all of these xenotransplantation trials. And as such, we don't have the same infectious risk that we worry about. There may be a few live cells some people speak about in a heart valve, but it's primarily tissue that is not live tissue.

The insulin is of course very highly purified before it is given, and now we produce insulin actually by molecular genetic techniques. So, no, there's nowhere near the risk using these approaches.

GROSS: Do you think it's possible at some point we'll be able to clone organs that don't pose the risk of the spread of new germs?

BACH: I think we're a little ways away from cloning organs. That's a very difficult topic from a scientific point of view, but in terms of cloning cells and such, that we're much closer to and certainly that would ease many of the concerns that one has.

GROSS: Now you've devoted a good deal of -- of your career to research pertaining to animal-to-human transplants. What do you think has been the most important contribution you've made so far?

BACH: Well I should correct you, if I may. I've devoted most of my career to transplantation, certainly. I find it a fascinating area and one where we learn a great deal about many topics that hopefully will help us treat other diseases in addition to transplantation per se. It's really the last decade that I've totally devoted myself to xenotransplantation.

I think the contribution was probably along with many other people who realized this, to recognize that we could genetically manipulate a donor pig. By that I mean is we could introduce a very few carefully selected genes -- mainly human genes -- into that pig so that when you transplanted the pig organ, which is still a pig organ, it would have a few human genes expressed in it to suppress the rejection response if that organ is put into a human.

And in fact, the first of those ideas came from my own laboratory, together with a colleague of mine Dr. Gus Dalmasso (ph) at the University of Minnesota in Minneapolis, where we showed that if you take a human inhibitor -- a gene for human inhibitor -- one of the things that causes rejection, you could actually protect the cells that are most important in the transplanted organ. It gets a little technical beyond that, but that's now been done by a number of biotechnical companies -- biotech companies and shown that expression of this human gene in the pig organ prevents some of the rejection that we've been trying to get over.

GROSS: Are you currently doing xenotransplant research?

BACH: Oh, yes, 100 percent of my effort is xenotransplant research. As I say, I retain fully my enthusiasm for it, and what we're doing in fact is we're trying to see what other genes we might eventually place into a pig that will be a donor pig to try to get around the several different problems that exist in terms of rejection of a pig organ, by a primate and eventually by a human.

GROSS: You know, I find it very interesting that you are so involved in xenotransplant research and so enthusiastic about the ultimate possibilities, and the lifesaving possibilities -- and yet you're also the person who's leading the charge for a moratorium. And I'm wondering if there's a sense of personal responsibility that you have here that if something did go wrong, because you've been so active in xenotransplant research that you'd -- you'd bear some responsibility for it.

BACH: I think it would have been presumptuous of me to say that, but if I may, I would just agree with what you've said. I -- I think it is very important that those of us who have the privilege of doing biomedical research, and it really is a privileged life we lead, balance our concern for the patients with being very responsible in terms of what we do.

And I'm in a position where I had the great opportunity to work for a year and a half with the people who are the co-authors on that paper and others, to discuss this, and benefited from -- enormously from their input. Harvey Feinberg (ph), who's the last author on that, was for years the dean of the Harvard School of Public Health and is now provost of Harvard University; Norman Daniels (ph), who's one of the main authors on that paper, is the professor and chairman of philosophy at Tufts University.

There was a tremendous amount of very sage input. But yes, I have a personal responsibility I think. But I see no conflict in this at all.

GROSS: What was the turning point for you that made you decide it was time to call for a moratorium on animal-to-human transplants?

BACH: Well, that arose out of the discussions which we had for well over a year in this group in Boston who met. But the turning point that led me to have those discussions, to help organize such a committee, and together with Dr. Feinberg, lead those discussions, was that man in England, David White, from a biotech company known as Immutran (ph), said he was ready to do pig heart transplants to humans.

And I thought that was so premature and to some extent irresponsible that I came back and said: "my heavens, we have to really consider what we're doing here. What are the issues?" -- outside of the scientific ones with which I was totally involved and entranced by.

GROSS: How is the rest of the world dealing with this question? You're asking for a moratorium here in the United States.

BACH: Right.

GROSS: Are there similar moratoriums in other countries?

BACH: Well actually, Britain has done exactly that. Britain has put into place a moratorium until there be -- is more information. It started with something known as the Kennedy Committee, and there's now an interim regulatory authority. But they have a moratorium.

France, I can only tell you very informally, is discussing the ethics first. I just heard that in a discussion I had two weeks ago in Paris. And Canada certainly has put the ethics on the front burner and plans to discuss those before making any decisions.

So I think that what we're proposing for the U.S. is not at all out of step with what others are doing.

GROSS: Dr. Bach, what do you say to patients who are dying now and would have the possibility of being saved by animal-to-human transplants? You're saying, you know, basically you're saying "sorry, we're -- this really isn't ready to go forward."

BACH: That's the most difficult question you pose, and there's no member of the committee that met here that did not grapple with that. It's a horrible situation, but you know the first three words I ever heard in medical school were "primum non notore" (ph) which means "first do no harm." And the professor of surgery who wrote those on the board said you've got to have that be the guiding principle in medicine; goes back a long way.

It's a horrible situation. I don't know what one says to the patient except that we desperately want to try and help you, but we have an issue here we've got to resolve before we can do that.

GROSS: Dr. Fritz Bach is a professor of surgery at Harvard. He's one of the doctors calling for a moratorium on animal to human organ transplants.

Coming up, TV coverage of the Olympics.

This is FRESH AIR.

Dateline: Terry Gross, Philadelphia
Guest: Fritz H. Bach
High: Dr. Fritz H. Bach is a professor of surgery at Harvard University. He is a specialist in animal-human transplant operations. Last month, he and six other public health experts and bioethicists called upon the U.S. government to issue a moratorium on animal-human transplants. Bach says there is a risk that an animal virus could genetically mutate in a human recipient and spread among the general population.
Spec: Health and Medicine; Animals; Transplants; Politics; Government
Please note, this is not the final feed of record
Copy: Content and programming copyright 1998 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1998 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Dr. Fritz Bach
Show: FRESH AIR
Date: FEBRUARY 17, 1998
Time: 12:00
Tran: 021701np.217
Type: FEATURE
Head: Olympics Coverage
Sect: News; International
Time: 12:55

TERRY GROSS, HOST: The Olympics have been going on for 11 days now, and TV critic David Bianculli has been watching all of the CBS coverage and more. Here's his report.

DAVID BIANCULLI, FRESH AIR COMMENTATOR: From the very start, CBS has blown it with these 1998 Winter Games from Japan. The network doesn't seem to know how to handle the 14-hour time delays, much less the constant weather delays in the outdoor skiing events.

So what CBS does instead is pad with features and profiles, and construct taped events as seemingly-live dramatic stories, even though a lot of drama has been drained by the time delay.

Hermann Maier (ph), for example, was the Austrian skier who wiped out so memorably in the downhill last week, yet was determined to compete in the men's super-G held a few days later. Anyone who read the morning papers yesterday knew the result: Maier, amazingly, had come back to win the gold in the super-G.

Yet instead of showing the event in its early morning coverage yesterday, CBS waited until prime time to broadcast a tape of the super-G race. Even more cynically, CBS started the race coverage at the end of its first hour of prime time, holding Maier's run until the beginning of the second hour so that viewers would have to stay tuned.

But with a whole day passing in between the event and its telecast, there wasn't much drama. And with CBS packaging most events after the results are known, the network manipulation is painfully clear. Here's the way it works: if CBS presents a profile of an athlete, you can pretty much count on that athlete winning a medal.

Things got so bad for a while that last week one hour of prime time coverage on CBS contained only three minutes of actual competition. There was, however, 16 minutes of coverage from skating practice. Since Friday, there's been a lot more coverage of actual sports. Last night's three hours of prime time contained exactly one hour of competition, and that's good by CBS standards.

Even so, there were dumb toss-away features, like the second CBS reporter in as many days to sample the dreaded Japanese blowfish.

What could CBS be doing otherwise? Thanks to my giant satellite dish, I have an answer to that question, because I've also been watching coverage from Canada's CBC. Canada is a lot more serious about coverage and a lot more interested in a lot more sports. It broadcasts overnight so that most events can be seen live. I watched the U.S. women's hockey team beat Canada for the gold on the CBC this morning around four -- hours before the event was broadcast on CBS's early show.

Canada also covers most of medal ceremonies so that we can hear national anthems from winning countries -- something CBS almost never does unless America gets the gold. Canada even offered lots of live coverage of curling, that weird sport that's like shuffleboard on ice where the athletes are miked during competition and even the women scream like pirates. It's my new favorite sport, and the CBC coverage is why.

Listen.

(BEGIN AUDIO CLIP, CANADIAN BROADCASTING CORPORATION TELECAST OF OLYMPIC CURLING COMPETITION)

CURLING TEAM MEMBERS: No, no, do it -- yeah, whoa, hard, whoa, go ahead, whoa.

ANNOUNCER: And here's a good draw by Erica Brown (ph).

CURLING TEAM MEMBERS: Whoa, whoa, whoa, whoa.

ANNOUNCER: Well behind those guards.

BIANCULLI: On the CBC, I've watched live coverage of everything from curling to cross-country skiing and had a great time. I haven't gotten much sleep, but that's part of the fun. And when it comes to fun, CBS just doesn't compare, eh?

GROSS: David Bianculli is TV critic for the New York Daily News.

Dateline: David Bianculli, New York; Terry Gross, Philadelphia
Guest:
High: TV critic David Bianculli reviews Olympic coverage.
Spec: Media; Television; Sports; Olympics; CBS; Asia; Japan; Nagano
Please note, this is not the final feed of record
Copy: Content and programming copyright 1998 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1998 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Olympics Coverage
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.