NEWYORK–TowanaLooneycanhardlycontainheranticipationasshewaitstogetwheeledtoanoperatingroomattheNYULangoneHealthhospitalinNewYorkCityforanhistoricprocedure.
"It'sgoingtochangemylife,"saysLooney,a53-year-oldgrandmother,fromGadsden,Ala.
Shevolunteeredtobecomethefirstlivingpersonintheworldtogetakidneyfromanewkindofgeneticallymodifiedpig.Scientistshopethiskindofpigwillsomedayprovideanunlimitedsupplyofkidneys,livers,heartsandotherorgansthatcouldalleviatethechronicshortageoforgansfortransplantationandsavethousandsofpatientseveryyear.
"We'regoingtomakehistorytoday,"saysLooney,beforenursestakeherinforthelong,riskyoperation.
NPRgotexclusiveaccesstobeintheoperatingroomforLooney'soperation,whichtookplaceNov.25,butwasn'tannouncedpubliclyuntilTuesday.
Looneywasdischargedearlierthanexpectedfromthehospital,buthadtoreturnforafewdaystohavehermedicationadjusted.Nevertheless,herdoctorsremainoptimistic.
"Itwouldchangeeverything,"Montgomerysays."Ithinkitwouldrevolutionizemedicineforsure."
WhilemanyothersshareMontgomery'soptimism,theprocedureremainscontroversial.Someworrytheorganscouldspreadpigvirusestopeople,settingoffanotherpandemic.Othersareuncomfortablewithexploitinganimalsfortheirorgans.Someworryaboutexperimentingonpatientsdesperateforanyhope.
ButLooneyhasnoqualmsthedayofheroperationtoday.
"ItfeelslikethesamedaythatIgavemymomakidney,"saysLooney."I'msoexcited."
Looneydonatedoneofherkidneystohermotherin1999.Afewyearslater,shedevelopedchronichighbloodpressureduringapregnancyandherremainingkidneyfailedin2016.Sincethen,she'sbeenondialysisforfourhoursaday,threedaysaweek.
Eventhoughusingpigorgansremainshighlyexperimental,it'sheronlychance,herdoctorssay.
DoctorsaremoreoptimisticthistimebecauseLooneyismuchhealthier.
"She'sinbetterconditionthanotherpatientswhohaveundergonethisprocedure.Sowe'rehopeful,"Montgomerysaysashescrubsintoleadthesurgery."Wehaveanamazingteamandeverything'sgoinglikeclockwork."
Looneyisalsothefirstlivingpatienttoreceiveapigkidneywith10geneticmodificationsdesignedtokeeptheorganfromgrowingtoobig,beingrejectedandcausingothercomplications.
"It'sareallybigday.She'satruepioneer,"saysDr.JaymeLocke.ShewasLooney'sdoctorbeforemovingfromtheUniversityofAlabamaatBirminghamtoNYU.She'sassistingMontgomerytoday.
AstheanesthesiologistputsLooneytosleep,Montgomeryandhisteamgetreadyforthelong,complicatedoperation.
"Everybodyready"Montgomerysaystothesurgicalteam."Allright."
MontgomerymakesanincisioninLooney'slowerabdomentobeginpainstakinglypreparingaspottoimplantthepigkidney.
"Scissors,"Montgomerysays.
ThesurgeonshavetofindanarteryandaveintoconnectLooney'sbloodsupplytothekidney.
"There'sthearterybranch,"Montgomerysays."Theveinlooksalittlesmall."
ThesurgeonspositionthekidneyinherpelvistomakeiteasiertoconnecttoLooney'sbladder.Aftermorethananhour,thesurgicalteamisfinallydonewiththatphase.
"Allright,Ithinkwe'reready,"Montgomerysays.
ThescreenonthewallshowsthehelicopterapproachingNYULangonewiththepigkidneys.ThechopperswoopsthroughtheclearblueskyalongtheEastRiverandsetsdownonthehelipad.Thearrivingcrewplacesawhiteboxaboutthesizeofamicrowaveoventhatcontainsthepig'stwokidneysonawheelchairandrushesittotheoperatingroom.
"Webroughtbothofthemback—therightandtheleftone—sowehavebackup,"Montgomerysays,asheremovesthekidneysfromtwoplasticbags.
"We'renotentirelysureexactlyhowwe'regoingtoputtheminyetuntilIhavealookatthem.Theplanistoonlyputonein,butwemayusethevesselsfromtheotheroneaswell,"Montgomerysays.
Theteamthenstartsanotherlong,delicatetask:preparingthepigkidneysforimplantation.Thatinvolvesmeticulouslyseparatingthekidneys,removingfatandlocatingthenecessaryveinsandarteries.
"ThatIthinkisanartery,"Montgomerysaysatonepoint."Thatthinginthebackthere."
Finally,oneofthekidneysisready.
"OK,let'ssewthisthingin,"Montgomerysays.
Theygingerlycarrythegrayish-purplekidneytoLooneyontheoperatingtableandstartattachingit.
"Allright–we'resewingtheveinnow,"Montgomerysays."Ijustdidmysideofthevein,andwe'redonewiththeveinandwe'removingontotheartery."
Afterthey'redonestitchingthekidneytothebloodsupply,thesurgeonstakeacrucialstep:TheyunclampthearteryandveintoletLooney'sbloodflowintothepigorgan.
"We'reabouttore-perfuse.How'sherbloodpressure"Montgomerysaysjustbeforetakingtheclampoffthevein."You'llseeit'llbekindofalittlebitdarkcoloredinitially.AndnowI'mtakingtheclampofftheartery.Itshouldbeniceandpink."
Andthat'sexactlywhathappens,triggeringapplauseandcheersintheoperatingroom.
"Beautiful,"Montgomerysays."Gorgeous.Itlooksbeautiful.Nevergettiredofseeingthat."
Thencomesthefinalstep:makingsurethepigkidneyisdoingitsjob—producingurine.Montgomeryunclampsatubeleadingoutofthekidneythathe'lllaterattachtothebladder.
"Herewego,"Montgomerysays,promptinganotherroundofcheersandapplauseasurinestartsgushingout."Lookatthat.Thatisgreat.Lookatthat.Beautiful.Gorgeous.It'sjustpouringout.I'mgoingtohavewetsockstonight,"Montgomerysays,laughing,asurinesplasheshim.
Finally,MontgomeryturnstoattachingthepigkidneytoLooney'sbladder.
"Let'sfinishthejob,"Montgomerysays."Let'sgettheplumbingdone."
Montgomerypullsoffhisgloves.
"Couldn'thavegonebetter.Couldnothavegonebetter,"hesays."We'rereallypleasedatthispoint.Butyouknowit'searlydays.It'sabigdeal.Butwe'reofftoagoodstartandthat'sreallyimportant."
Montgomery,whohimselfreceivedahumanhearttransplantin2018,knowsthere'salotmoreworktobedonetoseeifthiswillworkforLooneyandotherpatients.Buthe'sthrilled.
"Whenyoureallythinkaboutwhatwejustdidit'sprettyamazing,"hesays."PuttingapigorganinahumanbeingandhavingitworkrightawayYouknow,it'slikeStarWarsstuff,right"
Looneytriedotherexperimentalproceduresbeforethis,butnothingworked."Thishasbeenalongjourneyforher,"saysLocke,herlong-timephysician."Andheresheistoday.I'mexcitedforhertogetherlifeback."
"It'sasuperexcitingday,"agreesDavidAyares,presidentandchiefscientificofficeratRevivicor,who'sbeenwaitingoutsidetheoperatingroomtohearhowthesurgerywent."Unbelievable."
Ayaresarguesthegoodthatwouldcomefromprovidingenoughorgansfortransplantsoutweighsthedownsidesofslaughteringanimals.
"Thegoalisanunlimitedsupplyoforgans,"Ayares."We'retryingtosolvetheorganshortagecrisis.Sohavinganunlimitedsupplyofkidneys,heartsandotherorgansiswhatit'sallabout."
Ayaresforeseeshugefarmsbreedinggeneticallymodified,clonedpigsaroundthecountrytosupplytheorgans.
Criticssayacarefulstudyisneededtorigorouslyevaluatethepigkidneysinsteadofperformingthesesurgeriesone-by-oneunderdifferentconditions.
"Idohavesomeconcernsaboutthepossibilityofmisinterpretingtheresultsoftheseexperiments.Theyarenotresearchtrialsandarenotintendedtogenerategeneralizableevidence,"hesays."Thepeoplewhohavereceivedorgansundercompassionateusewereallverysick,anditispossiblethatpeoplemaydrawinappropriateconclusions,positiveornegative,abouttheseexperiences."
Theonlywaytogetreallyusefulinformationwouldbetoperformtheseprocedureswithmoreuniformconditions,somesay.
Inthemeantime,thereareethicalconcernsaboutexperimentingondesperatelyillpatients.
"Iworrythatit'sanofferpatientscan'trefusebecausethealternativeiscertaindeath,"saysJohnson,theSUNYUpstateMedicalUniversitybioethicist."Iworryaboutpatientslikethatbeingexceptionallyvulnerableandexploited,beingexceptionallyvulnerabletofalsehope."
Johnsonisalsoskepticalthatthecompanyisdoingenoughtopreventthespreadofpigvirusestopeople.Therewasevidenceoneofthepigheartrecipientsgotinfectedwithapigviruscalledporcinecytomegalovirus.
"It'simpossibletopredictwhatthepublichealthimplicationsmightbeifhuman-to-humantransmissionofapigvirushappens,"Johnsonsays."There'salotofconcernrightnowaboutpigsbeinginfectedwithH5N1[birdflu].Withxenotransplantation,therisksincreasebecausewe'repotentiallyputtinganorganthatharborsavirusintoapatientwhoisimmunosuppressed."
Johnsonalsoworriesaboutthepigs.
"Thegeneeditsarenotmadetobenefitthepigs.Thegene-editingisanattempttofitasquarepegintoaroundhole—tosandofftheincompatibleedgesofapigorgantoforceittoworkinahuman.ButwhatdoesthatdotothepigHowdoesitaffecttheirhealth"shesays."Theenvironmentsinwhichthesepigsareraisedforxenotransplantationnecessarilydeprivesthemofmanyoftheirbasicsocial,psychologicalandphysicalneeds."
Inthemeantime,Looney'snewpigkidneyappearstobefunctioningwell,andherrecoveryisproceedingfasterthanexpected.Infact,shewasdischargedfromthehospitaltoanapartmentnearthehospitallessthantwoweeksaftertheoperation.NPRmetheragainthere.
"Ifeelwonderful,"Looneysaysafteransweringthedoorwithawidesmile."Ifeellikeawholenewperson—likeIgotasecondchanceinlife."
Looney,who'sstayingwithherhusband,WillieBennett,willbemonitoreddailyatthehospitalforthreemonthsbeforehopefullyheadinghome.
She'senjoyingcooking,beingabletoeatanddrinkawidervarietyoffoodsandbeverages,andexploringNewYork,althoughshe'sbeingcarefultoavoidcrowdsandwearsamask.She'stakingmedicationtoreduceherriskofrejectingthekidney,makinghervulnerabletoinfections.
Thesymptomsthatlimitedherbeforetheoperationhavedisappeared."Noweakness.Notiredness.Nofatigue.Noswellingfromfluidintake.Icaneatmore.Icandrinkmore.Icanwalklongerdistances.It'samazing,"shesays."It'slife-changing."
She'llneverforgetthefirsttimeshewasabletourinateafterthesurgery–itwasthefirsttimeshe'dbeenabletodothatinalmosteightyears.
"Iwaslike,'Wow!'"shesays."Itoldthenurse,'I'mpeeing!'Shesaid:'Nokidding.You'repeeingalot,whichisagoodthing.'Itwasexcitingtome."
Looney,who'sdevoutlyreligious,saysshesangchurchhymnsthenightbeforethesurgery.Butshehadnodoubts.Herdoctorsfullyexplainedtherisks,shesays,andshewasunconcernedaboutpigvirusesorothercomplications.Shehopestheprocedurewillhelpherandotherpeopleinthefuture.
"Halfofmyfamilyhaskidneydisease,"shesays."Howmanycouldthishelp"
Herfamilyandfriendshavebeenverysupportive,althoughonefriendobjectedtotheprocedure,saying"it'snotintheBibleforhumanstoreceiveanimalparts,"Looneysays."Isaid,'Youatebaconthismorningforbreakfastdidn'tyou'"laughing."It'slifesaving.'"
Looney'sdoctorsdetectedabloodclotinthekidneyaftershewasdischarged,butwereabletoflushthatoutwithfluids.She'sstayinginthehospitalforafewdayssodoctorscanadministeranadditionalanti-rejectionmedication.Butherkidneyseemstocontinuefunctionwell,thehospitalsays.
Looney'slookingforwardtoreturningtoherjobasapart-timecashierataDollarGeneral,travelingandspendingmoretimewithherfamily,especiallyhertwoadultdaughtersandtwograndchildren.
Beingondialysisforfourhoursaday,threedaysaweekmeantshecouldrarelytravelfarforlong.
"Iamsohappy.Ijustfeellikethisisasecondchanceatlife,"shesays.
HerdaughtersandgrandchildrenplantovisitherforChristmasintheone-bedroomapartmentthehospitalisprovidingforher.
"It'samazing,"Looneysays."It'sthebestChristmaspresentintheworld."