Which is probably how they got approval to do a pig heart transplant in the first place since he would never get on the transplant list.

I have an uncle in his sixties that has drank and smoked his whole life and he has been on heart and liver transplant list for about a year. Because he continued to live unhealthily his heart started failing this week with multiple heart attacks they moved him to level one priority and he will likely get his transplants this week. It feels weird that he is now ahead of others because they tried to be healthy and he did not.

Similarly a friend work for Alabamas football program and he couldn’t travel with the team to games in 2020 because he _hadn’t_ had Covid, while those who had gotten Covid could travel.

Basically… it’s hard to formulate rules for these sort of things and rarely are they “fair” to all involved.

Hey, regardless of the politics of the situation, I hope you and your family are doing okay. Sorry to hear about your uncle.

Thank you I appreciate the kind words.

I thought that hospitals specifically only put you on the list if you committed to a healthy lifestyle.

It likely varies hospital to hospital and region to region. I would hope it's more often the case than not though. I'm an organ donor and I wouldn't be happy to find out that my liver went to an alcoholic that wasn't making a strong effort at sobriety.

Do you know how arrogant that is? Alcoholics aren't people who deserve to die because of some kind of moral failing. Very often they're alcoholic because of other mental health problems or abuse. Would you want to deny a clininically depressed person your liver because they might commit suicide?

Im a recovering alcoholic myself, don't lecture me. I didn't say they deserve to die. But if they can't stay sober they don't deserve a liver over someone else who may need it more.

You don't represent alcoholics. Personal experience gives you a bias, not a justification for being condescending. Medical decisions are not and should not be based on moral judgements of the patient's behavior.

You're now changing your idea to add "over someone who may need it more", which is different, and I'm not disagreeing with that. It's the same as favoring young or healthy people because they're likely to gain more life extension from a transplant when the rest of their body is working OK.

I assumed that was implicit given the context of the conversation (a comment up the chain discussing their uncle who got higher priority because he continued to make poor lifestyle choices). Obviously I'd still rather my liver go to the aforementioned alcoholic than into the ground, but they wouldn't be my first choice.

There was and is no condescension present. I don't look down on them just like I wouldn't look down on a 90 year old man whose liver is failing from natural causes. Neither would be my first choice for recipients of my liver.

Sorry to imply he is still drinking. See my sibling reply to yours, but it is not sticking to the diet which is causing his issues.

Anecdotally, an ex-partner of mine here in Australia was denied a transplant for several years due to her heavy marijuana use, but was eventually allowed a transplant. Unfortunately her body rejected it and it had to be removed, and she passed away a year later.

He says he is committed to and I assume he has good intentions. He isn’t drinking or smoking, but water intake, salt intake, and red meat have been more challenging for his willpower/discipline.

Also, I have no idea if matters or not but he is wealthy (low eight digits) as well.

Honestly I can't find any fault here. Giving up the drinking and smoking has probably been monumentally difficult, and it's amazing that he's been able to do that. That alone tells me he is committed to getting healthier.

The diet stuff... honestly, nutrition "science" is full of contradictions. Sure, too much of anything is probably bad for you, but I don't think diet concerns should be a blocker for receiving a transplant.

At any rate, sorry you and your family has to go through this, and best wishes for your uncle's recovery.

The diet stuff is causing his body to fill with water. It isn’t just an eat healthier mandate. It is like becoming allergic to peanuts, but still eating them anyways when no one is looking.

Neither of those is a medical contradiction to receiving a transplant.

Smoking is the big no-no because it is fairly well proven to impair healing and increases chances of failure.

Evidence against red meat is very weak, and contradictory. Some studies show no harmful effects from non-processed red meat at all. In fact, there is just as much evidence against plant-based diets (they just aren't discussed widely due to the prevailing politics around CO2 etc), basically it's all just noise. Light alcohol use is absolutely fine in almost every case, and John Hopkins routinely does liver transplants for dependent alcoholics with an alcohol-related liver disease.

You should look up some centenarians cases, some lived on a diet of nothing but beer, waffles and blood sausages daily for several decades, and then had a nice healthy liver on autopsy at 100+ y.o., could've been from someone in their 20s.

Such is life.

Instead of contradiction, I believe you mean contraindication.

I'm also in agreement that cessation of alcohol and smoking are much more reasonable requirements for placement on the list than other dietary patterns that are highly individual regarding effects on overall health.

Chances are sugar intake is a bigger strain on his liver than the salt, but US doctors never tell people to eliminate sugar.

Sorry, I really don't mean to be a devil's advocate, but how do you know for sure that those others in the transplant line, also lived healthy lives w/ regular doctor visits.

Funny how having had COVID opens doors (eg. quarantine not required when traveling to some countries, and your example), but at the same time people are punished for not preventing it (vaccination, PPE). Talk about mixed incentives...

> (eg. quarantine not required when traveling to some countries, and your example)

For policies like quarantine following travel does it make any sense to distinguish anyone whether they have had covid, had a vaccine, had both a vaccine and covid, or had neither a vaccine or covid? Aren’t all of the above equally capable of carrying and transmitting the virus?

That's what I would think, but apparently Malaysia for example really wants people to have recovered from COVID specifically.

About everyone will get it sooner or later, vaccinated or not. (Pets are a reservoir, and nobody is vaccinating them.)

The best to hope for is not to die, be hospitalized, or suffer various long-term or permanent effects. Vaccination is all we have to prevent those.

Yes, but measures like the policies in question encourage people to get infected with symptomatic COVID so that they could go to doctor and get that very useful piece of paper.

That's the point. If you wanted to ensure people to not get COVID, do not give those who have had COVID pleasant exemptions. They failed, they should not be rewarded.

If everyone will get it, then no one who gets it and does not die or become seriously inconvenienced has failed. Dying, of course, is usually a fail, but literally everyone will do that, too.

I thought the last one on the list (neither vaccine nor covid) has a higher chance of carrying covid.

In general they are more susceptible to becoming infected and once infected they have higher risk of negative outcomes.

Yeah, that's my point. Because they are more susceptible to becoming infected, they're more likely to transmit the virus.

>Aren’t all of the above equally capable of carrying and transmitting the virus?

No. If I had Covid a month ago and recovered then baring a compromised immune system or new variant I am not going to get it again this month. So I am not "equally capable of carrying and transmitting the virus" compared to someone who "had neither a vaccine or covid".

> I am not going to get it again this month.

I understand that you would have antibodies and it be very unlikely if you carry the virus it would be unlikely to overwhelm your immune system in that time, but you can still carry/spread it right?

More directly related to the policy in question they can test you for antibodies, and maybe it is immaterial, but do they distinguish if you had covid 1 month ago vs 3 months vs 6 months? So does it work on the honor system or are they testing for antibodies, is it simply a matter of if you had covid at any point it doesn’t matter if you still carry antibodies you are not subject to quarantine?

Well it depends on your exposed viral load

Having anti-bodies reduces the viral load in your body, which also means that there are fewer viral fragments exiting your body

The policies are to reduce spread, not eliminate it

>but you can still carry/spread it right?

Once you have recovered? I don't think so, at least not if you have a healthy immune system.

From the article: “Doctors at the University of Maryland Medical Center were granted a special dispensation by the US medical regulator to carry out the procedure, on the basis that Mr Bennett—who was ineligible for a human transplant—would otherwise have died.”

He also basically murdered someone via stabbing so kudos for giving his body to science, but there's a case that he should have spent his life in prison.

He also lost a civil case, where the plaintiff was award 3.4 million in restitution, in which he paid $0 into.

https://www.washingtonpost.com/dc-md-va/2022/01/13/pig-heart...

> After Bennett got out of prison, she said, he “went on and lived a good life. Now he gets a second chance with a new heart — but I wish, in my opinion, it had gone to a deserving recipient.”

What makes him any less deserving? I don’t want to downplay the fact that he stabbed a guy, but the criminal justice system sentenced him and he, by all accounts, appears to have regretted his actions and reformed to be a good person. It seems like the system worked far better than it usually ever does. Once you’ve gone through the system and come out the other side rehabilitated, you’re done: continuing to deny random services, including in this case access to experimental surgery, is just cruel and seems really a desire for continued revenge against this person (which I definitely understand from a human perspective, but definitely does not belong in our social services scheduling).

> there's a case that he should have spent his life in prison.

Why? Normally you do this because you want people that cannot reform to stay away without resorting to murder. This person was gravely ill, which is it's own prison.

Why? If he had murdered Edward Shumaker (which seemed to have been what he intended to do), instead of merely stabbing him seven times, causing paralysis, and making him live the rest of his life in a wheelchair while in constant pain before ending his own life via a drug overdose of pain medication, a sentence of murder would be something the judge would have to consider. David Bennett Sr. got off pretty easy for ruining someone's life.

Well that really raises the question of what did he die from? If not from the heart, how do they proceed with the research? Gotta do the next one on a person whose not already nearly gone. That seems like a highly sensitive line, no doubt it's a big discussion to move it.

"What people die of" seems like the sort of question the medical community should be quite good at answering.

People are waiting for human heart transplants and dying from the wait. I don't think there will be a shortage of patients who we can ethically treat whilst researching this new technique. It certainly isn't binary with a hard "sensitive line".

> "What people die of" seems like the sort of question the medical community should be quite good at answering.

Does it? I'm definitely not a doctor, but it seems like a very difficult question to answer.

Even with perfect information, it seems unlikely there is always a simple/single answer. I would naively expect things like (and I'm making a bit up here, because I'm really not a doctor) "not enough oxygen reached his cells, because his lungs were bad at refreshing the air in them, his heart was bad at pumping blood in circles, his veins and arteries were in bad shape due to diet, and he wasn't moving around much because he had a cold further reducing circulation".

But also, we don't have perfect information. We have this set of measurements we could make without harming the patient, or consuming too much time on really expensive equipment like MRIs. Many of those measurements are no doubt themselves subject to some degree of interpretation error and confounding factors.

Maybe I underestimate our doctors, or overestimate the problem, but it doesn't sound easy to me.

One of Atul Gawande's books (Complications) mentions that amongst deaths where an autopsy is done, the cause of death was misdiagnosed by the doctor about 40% of the time. Quote from book [Page 197, Chapter name : "Final Cut"] ---

"How often do autopsies turn up a major misdiagnosis in the cause of death? I would have guessed this happened rarely, in 1 or 2 percent of cases at most. According to three studies done in 1998 and 1999, however, the figure is about 40 percent."

I think 100 years from now people will look back on our current medicine the same way we view medicine from 100 years ago. There is some impressive progress, but we know less than we think we do and conduct a lot of wasteful and harmful procedures.

It's disturbing to learn how thin the evidence is for a lot of modern medical operations. For example, the recommendations for certain cancer screenings have actually been reduced in recent years after it was found they were causing net harm.

It's a bit startling to realize just how young medical science is. I think it's not unreasonable to compare medicine (and a lot of biology) in the nineteenth century to the state of physics in the sixteenth century.

And certain major areas of medicine that people don't think about that much (outside of the field) such as medical informatics are younger still. This stuff has a huge impact on how medical care is actually delivered, but can be kind of left out of the broader public discussions around medicine due to the focus on the actual literal medicines.

Perhaps autopsies are much more likely if the doctor is unsure of the cause?

You're not overestimating the problem - and it's not an easy one to solve. Cause specific mortality is hard, which is why measures like all-cause and excess mortality are often used. For example, the whole "With vs. From COVID?" question is, in the actual field, not actually a controversy because this is how we've measured all infectious disease deaths basically forever.

This is especially true for severe cases like this, people in the ICU, etc.

If someone is in the ICU for multi-system organ failure, gets an infection, and then dies of multi-system organ failure, did the infection kill them? Was it a contributory cause? The same sort of question arises as in this case.

That's why I'm noticing studies that use "all cause mortality". In other words, some people receive X treatment and a similar control group does not. Then you look at how many died in each group regardless of cause because it's just too difficult (and death is pretty much a binary measure). For example, cholesterol lowering drugs (I don't have a source) seem to have no impact on all-cause-mortality, suggesting a failure in our understanding.

Certain invasive cancer treatments can look a lot more effective than they really are, if all cause mortality isn't measured. It's possible to reduce the risk of a patient dying from the particular cancer they have while also lowering their overall life expectancy, since the procedure itself can be extremely harmful.

I have a slide in a lecture somewhere noting that no one would ever die of a healthcare-associated infection if, when admitted to the hospital, they were put in a room full of ozone or hydrogen peroxide fog and intense UV light, while never being seen by a nurse or doctor.

Dying from lung damage is discounted in that scenario.

Indeed. That's the point of the example. "You will almost certainly die in this room, but you won't die of an infection. So if we just look at infection-related mortality, everything is fine."

> "What people die of" seems like the sort of question the medical community should be quite good at answering.

Yes and no, I think.

Technically my dad died of asphyxia. His cancer had spread to his lungs, he'd gotten pneumonia and was in hospital on oxygen. The doctors were clear he wouldn't be going home in the months he potentially had left. So he asked to be disconnected from the oxygen and he died an hour later.

So did he really die of asphyxia? Was it pneumonia, or the cancer? Clearly they were contributing factors, but in the end it was his decision to stop the oxygen, so as such was it suicide?

To me it doesn't really matter. He's gone and I'm just glad he didn't have to hang on to the bitter end.

They're not. Attribution is difficult.

> "What people die of" seems like the sort of question the medical community should be quite good at answering.

Does it? As far as I know, not only are they happy to admit that they can't do it, efforts to try have mostly ceased. We used to do autopsies.

https://www.todaysgeriatricmedicine.com/archive/SO17p26.shtm...

> In the United States it is estimated that the rate of major errors (eg, incorrect cause of death [CoD], incorrect manner of death) found on death certificates completed at academic institutions is approximately 33% to 40%. Internationally, this rate at some hospitals rises as high as 80%

> A wealth of literature is available highlighting the prevalence of death certificate inaccuracy seen at the national and international levels, as well as multiple studies that indicate lack of training as the root cause in the United States. Despite these noted errors, death certificate data continue to inform research pathways and drive medical practice.

https://americanmind.org/salvo/a-covid-death-the-bureaucracy...

> natural cause of death reports are known to have a 20 percent to 60 percent inaccuracy rate according to the peer-reviewed literature.

> The system isn’t built to allow for investigation. In fact, in the state where I worked, doctors are supposed to provide causes of death within 15 hours of the death

> 30 percent of doctors have reported being instructed by the coroner to put an inaccurate cause of death on purpose so the [coroner's] office won’t need to take the case.

> When I worked as a death certificate clerk, I occasionally would send death certificate worksheets to multiple doctors involved in a patient’s care if we had a rush to bury or cremate. In these situations we needed to cast a wider net to find a rapidly responding doctor to finish the record before final disposition. Many times each physician would report an entirely different cause of death.

Death certificates and cause-of-death attribution mainly exist to satisfy procedural requirements, not because they're supposed to be informative or helpful. Courts need to do cause-of-death attribution. It can't be done. So they solve their problem by the very simple method of pretending they can do it anyway. (Courts take this approach everywhere, not just in death certificates. Drug dogs, accounting errors, expert testimony...)

That was my biggest question too. patients die all the time after receiving a human organ transplant just due to the body being in a poor state and/or rejecting the organ. So it was either that case in which even if he received a human heart the same outcome of him dying would have happened. Or it was the pig heart that was the problem. Hopefully it can be determined which case happened, and I am glad he got to spend a few more months with his family.

I think that "Exactly what has happened since and the precise cause of Mr Bennett's death is not clear." indicates that the reporter is not clear, not the physicians. Other sources like https://www.wbaltv.com/article/man-received-historic-pig-hea... talk about infections and indicate his illnesses and treatment were well understood. Even though the patient was a public figure he has HIPAA rights and the hospital has obligations towards him. I don't doubt much more will come out in subsequent published research.

The chance they don't understand in great, great detail the cause of Mr. Bennett's death is nearly zero. The chance that IRBs aren't equipped to handle the ethics of this decision in the future are also very low.

My uneducated guess:

If he had survived for a long time, we would have known that it worked. He didn't survive, so we didn't learn much.

If we try with enough people who are as critical as him, eventually one could survive and we would know that the procedure works for at least some people.

I believe he surpassed several important “milestones” for a transplant patient so his death doesn’t mean the surgery was unsuccessful by any means. And even if it was a total “failure” of a surgery and the patient died on the table that doesn’t mean the team “didn’t learn much”. Not by a long shot.

It's an amazing story of which your friend must be tremedously proud. Now that it's been done, no doubt the results will improve. What an amazing time to be alive seeing these leaps in medicine. I think the pandemic has, in part, really made biology and medicine super cool again.

Well also, condolences to Edward Shumaker, who he murdered, and Edward's family. [0]

[0] https://www.wionews.com/world/patient-in-ground-breaking-hea...

I prefer not to call him pig-hearted because pigs are smart, kind, and beautiful animals. https://www.onegreenplanet.org/animalsandnature/phenomenal-r...

I suppose he made a good guinea pig, though.

Better him than actual guinea pigs.

His assault definitely contributed to Shumaker’s early death but he didn’t “murder” him.

Why, because Bennett couldn't be convicted of it? Bennett took decades off Shumaker's life. AFAICT it's for practical reasons that he got a lesser charge, not for philosophical reasons.

https://www.swordandscale.com/murder-charges-under-the-delay...

I think that particular exception to double jeopardy is unique to New York. It’s not my area of expertise so I could be wrong but I think most of the country still uses some version of the “year and a day” rule.

> contributed to Shumaker’s early death

That sounds like murder to me. Call it what it is. A slow death committed with the intention of a fast death doesn't make it not a murder.

And the pig.

And the pig's family.

isn't this supposed to be kept private by your friend under medical privacy laws?

What are you referring to?

I could've written this. Further, HIPAA has exclusions for dead research patients.

Choosing a guy next to his deathbed is not the greatest PR move. People will associate the death to the transplant.

Choosing someone not next to their deathbed is very likely something that would never get approved by an ethics board.

I do wonder, however, if there were potential patients available, who were near death solely due to the need for a heart transplant (and were near-certain not to get a conventional human transplant in time), and not also because of a host of other issues.

Given the complexities of the human body and how central strong circulation is to them, "Near death from heart failure, ineligible or outside the window for another transplant, but lacking any life-threatening non-cardiac comorbidities" is going to be a tough find.

I’m glad this team was more concerned about science and minimizing risk than PR. Hopefully negative press doesn’t cause much of a hinderance.

How is this negative press? This transplant was a huge success.

It is bad press for people who only read (or understand) headlines.

The man with the pig heart died. Sounds bad. Pig heart not good.

Swipe.

Next newsflash.

Not sure about that aspect either. They invested a boatload of money into a guy that can't even make a 1-year follow-up. How are they supposed to observe the transplant long term?

Why are you so concerned about being able to observe it long-term when prior to this it had never even been able to be observed short term?

Do you think they should be doing this on a bunch of healthy people to "learn more"? Like you think there will be volunteers?

Or do you think it's simply impossible and shouldn't have been done at all?

Or are you just being contrary to be contrary?

Healthy people? Well, it's not like it's "raining organs" for people on a waiting list. Many of them will die waiting. There must be someone on a slight better shape and willing to take a chance.

It may not be ethical to do this under the guise of administering medical practice even if there is informed consent. Part of a doctors duty is to be the rational actor to say “you could have 6 months to live and this procedure has no evidence that you’ll live any longer, in fact, it could shorten your life to the time of your surgery”.

This is advocating for civil engineers to willingly approve on a bridge they have no evidence won’t collapse, just because the current bridge needs serious replacement.

Define "slightly better shape". Because that's now your inclusion criteria. You have to be sick enough that "Or this might not work and kill you" seems like an acceptable risk, but not as sick as the guy they chose by arbitrary and hidden metrics primarily based on looking at the outcome retrospectively.

People needing an organ less urgently are going to be unlikely to take a huge risk on something unproven. People needing an organ urgently but with fewer red flags otherwise would similarly likely prefer the human organ they could get over the experimental one.