On January 7, 2022, David Bennett received a heart transplant from a pig that had been genetically engineered to be a more compatible organ donor than most other pigs. Two weeks after the operation, Mr. Bennett was still alive; his immune system hadn’t rejected the heart.
This is good for Bennett and for many other heart patients. In 2017, about 3200 Americans received life-extending heart transplants, but about 7500 others died of heart disease because there weren’t enough donated hearts for human transplantation.
Cadaver organs are in short supply partly because not everyone signs up to be an organ donor, and after a person’s death, the relatives of registered donors often disallow the donation anyway. In addition, to be a heart donor, death must arrive without significant damage to the heart. Head injuries causing death fit into this category, but these have decreased as driving has become safer. Cars now have seat belts, air bags, and other safety features that reduce deaths in car crashes. So, thousands of people die in the United States because the supply of cadaver hearts is inadequate to meet the demand of severely ill heart patients.
If genetically engineered pigs can supply the needed hearts, the lives of these people can be saved (by which I really mean “extended,” as we all die eventually). More than 74 million hogs and pigs were produced in the US in 2021, so there could be lots of porcine hearts to transplant.
But there are problems. Every year about 650,000 people die of heart disease. Each heart transplant costs almost $1,400,000. The cost of transplants to save the lives of all those who would otherwise die of heart disease would soon reach a trillion dollars a year.
It gets worse. Over 30 million Americans are currently diagnosed with some form of heart disease. Most of these people survive without surgery, and those who have surgery are safer with repair of their own heart than they would be with a heart transplant. But that probably still leaves some millions who doctors think would benefit from a heart transplant if hearts for transplant were available. We don’t know the real number because the insufficiency of hearts to transplant means that the issue doesn’t come up for most people who could potentially benefit.
The history of renal dialysis in the United States suggest that an increasing number would be considered eligible if there were no shortage of hearts for transplant. It was assumed originally that dialysis would be available only to people in a narrow category, because it was so expensive. But once it was clear that dialysis could extend people’s lives, there was so much pressure to extend its use that Congress passed a law in 1972 that provided dialysis at public expense to anyone who could benefit from it.
Statins that lower the level of bad cholesterol (LDL) in the blood has an ever-expanding use. Although I happen to have quite low LDL, a cardiologist recommended that I take statins to make it lower still, because at my advanced chronological age, my level of LDL creates a 22% chance of an adverse cardiovascular event (probably not leading to death) within the next 10 years. Even though the physician acknowledges that my physiological age may be considerably younger, he would have me take statins just as a precaution.
I therefore expect that recommendations of heart transplants would mushroom if enough hearts were available. Part of the reason is that we’re reluctant to accept our eventual death. We speak of “saving” lives rather than merely “extending” them. We want all cancers to be cured in our lifetimes, so we won’t die of cancer. If we have enough porcine hearts, people would no doubt believe that they shouldn’t die of heart disease either. A futurist-oriented health guru has already claimed that some child alive today will live to be 150 years old.
Our tendency to deny death will likely be encouraged by those who supply porcine hearts, by doctors and their assistants who perform the surgery, and by still others who produce and sell the expanded inventory of equipment and medicines that heart transplantation requires. But if 3 million people were to receive heart transplants each year, the cost would exceed our current annual expenditures for all of health care.
How will we contain costs? The government will probably privatize the procedure, allowing private insurance to cover the procedure in its more expensive policies, but not in those that are publicly funded. Thus, the availability of porcine hearts will almost surely increase the already significant longevity gap between rich and poor. Because life itself is the ultimate gift, this disparity could exacerbate the tendency toward social upheaval that stems from one percent of households having advantages that ninety-nine percent can’t afford.
You can respond by e-mail at wenz.peter@uis.edu.
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