Doctors at the University of Alabama at Birmingham and the NYU Langone Transplant Institute in New York City reported successfully implanting genetically modified pig kidneys into two "brain dead" men this month.  The New York patient, a 57-year-old man, has demonstrated continuous kidney function for over a month, the longest time that a gene-edited pig kidney has functioned successfully in a human.  The team plans to observe the patient's kidney functioning until mid-September, during which time he is being provided with cardiopulmonary support in a critical care setting.

In Alabama, a 52-year-old man with both "brain death" and renal failure underwent removal of his native kidneys and was implanted with a pig kidney that had received ten genetic modifications.  In contrast to last year's results (in which the xenograft kidney placed into the "brain dead" person failed to function properly), Dr. Jayme E. Locke and her team reported that this time, the xenograft kidney functioned well for the full seven-day study period, which included daily kidney biopsies.

These xenografts not only made urine, but they cleared ... toxins and maintained normal renal function, and really stability, in this model for a full seven days," said Locke. "And, in fact, at study completion, the kidneys were still working[.]"

Medical ethicists are less impressed.  Joel Zivot, M.D., M.A., J.M. wrote in an opinion piece for MedPage Today:

Broadly, the rightness or wrongness of this type of procedure [is] the consequence[] of a series of moral choices, thus far unreported and unexamined, and include the problems of brain death, human experimentation, consent, rationing, and animal rights.

He points out that the concept of "brain death" has turned people into resources, commodities to be used for the valuable vital organs they possess.  Most people do not receive any type of informed consent when they selflessly sign a donor card at the Department of Motor Vehicles and have no idea that they can be considered "dead" while they are still respiring and have a beating heart.  Or that doctors currently are not following the legal definition of death by neurologic criteria under the Uniform Determination of Death Act (or UDDA, some form of which has been passed into law by all 50 states).  While the UDDA requires "cessation of all functions of the entire brain, including the brainstem" for a diagnosis of "brain death," doctors now generally follow the 2010 American Academy of Neurology Guidelines, which require only documentation of coma, a bedside test of brainstem reflexes, and an apnea test.  No other special studies of "the entire brain" are required.

According to Dr. Zivot,

[d]eath is the permanent absence of the signs of life.  Permanence remains a problem in the case of "brain death" as we can't know the durability of the state of death until it proves itself durable.  Mistakes have been made in determining death. ... Brain death determination continues to have uncertainty.  It is conceivable that a tiny remnant of brain function may elude detection.  As functional brain imaging advances, we will likely detect brain activity we thought absent.  How comfortable are we with the possibility that some deep brain function might still be present in those we call brain-dead?

In 2008, The President's Council on Bioethics published a white paper, "Controversies in the Determination of Death."  At that time, they justified continuing the neurological standard for "brain death" because of strong moral convictions about the respect owed to the newly "dead."  While they granted the necessity of maintaining these "bodies" for a short time to facilitate organ-harvesting, they deplored the unnecessary anguish of families whose loved ones were continuing to be ventilated and maintained after such a diagnosis.

But the two "brain dead" men discussed above are receiving no such respect.  They are being maintained on ventilators as xenograft hosts until such time as the experiment is terminated and they are sacrificed for pathological examination.  And it is very unlikely that these men were given the chance to consent to this treatment.  Zivot writes:

Current advance directives contain no language for such postmortem wishes.  Individuals may sign up to be organ donors in advance of death, but donating one's entire brain-dead body to host a xenograft transplant is without clear precedent. ... Brain death, as a criterion for death, must constantly reflect what is known and justify why the possibility of a wrong brain death diagnosis can be set aside if a xenograft experiment, or any other experiment, is at stake.

The best possible outcome would be that perhaps some of these "brain dead" people now being used as xenograft hosts would demonstrate neurological improvement during the time that they are being given top-flight ICU care as medical test subjects.  The diagnosis of "brain death" is usually a self-fulfilling prophecy, with these unfortunate people either quickly becoming organ donors or having their medical support withdrawn.  But more and more people, such as Zack Dunlap, Jahi McMath, Taylor Hale, Trenton McKinley, and others, are proving doctors wrong about their "brain death" diagnosis.  These "brain death" survivors prove that this diagnosis can be made in error, and that using these people for medical experimentation is ethically unjustified.

Dr. Heidi Klessig is a retired anesthesiologist and pain management specialist.  Her work may be found at respectforhumanlife.com.

Image via Pxfuel.