Waste Not Want Not: Appendix Transplantation
Organ transplants save many human lives, and are vital to the health of many transplantation centers. However, there is a shortage of donor organs.
We have developed a procedure that will provide a safe and virtually unlimited supply of one kind of transplantable human organ. We believe that introducing this procedure into medical practice will protect the fiscal health of transplantation centers, especially small ones like ours.
Accordingly, we report here the first successful human appendix transplant.
The General Shortage
The shortage of donor organs has led some to suggest that underutilized transplantation centers should be shut down.1 The consolidation of resources would make transplantation more economical. Perhaps most important, it would improve patient outcomes by increasing the level of experience of the remaining transplantation teams, thereby increasing their competence.
We argue that transplantation centers should not be shut down.
There are good reasons for finding a way to keep underused transplantation facilities economically viable. Space limitations here limit us to mentioning the most important reason. Closing down smaller transplantation centers would decrease access for the poor. Many patients and their families would be compelled to travel to distant facilities and be forced to incur the expense of finding alternative housing, often for long periods while a donor organ is found and while the patient recovers following transplantation.
Down With Animals, Up With People
A good solution to this problem is to find new sources of transplantable organs.[2 ]
While xenotransplantation looks promising, several difficulties stand in the way of using animal organs for transplants. The most notable is the danger of launching pandemics of new diseases derived from animal viruses, some of them perhaps as deadly as ebola and human immunodeficiency viruses.[3,4]
Donated appendices would eliminate this hazard, because they come from donor human beings rather than from gorillas, pigs, or other non-human donors.
Here are the details of the first successful human appendix transplant.
The subject was a white, 30-year-old female, who underwent an appendectomy when she was 14 years of age. More recently, she has been treated at our center for breast, ovarian, and colon cancers, diabetes, chronic fatigue syndrome, asthma, ulcers, low back pain, carpal tunnel syndrome, migraine headaches, multiple chemical sensitivities, and suspected Munchausen syndrome.
After being counseled regarding the experimental nature of the procedure, the subject gave informed consent and underwent surgery as soon as a matched donor patient could be found who presented with unexplained abdominal pains and insurance. The subject was prepped while the donor patient underwent a standard appendectomy. The three-hour surgical transplant procedure was uneventful and the subject fully recovered, as did the donor.
The subject was followed up for 12 months with monthly CT and MRI scans. After a short period of mild rejection which was controlled by an increase in cyclosporin therapy, the transplant appeared to be healthy and presumably functioning normally, whatever the function of an appendix may be. It is important to note the center partially recovered transplantation costs with revenues from the donors appendectomy and extensive follow-up care.
A Copious Supply
As acknowledged by many authorities (perhaps most notably in a New England Journal of Medicine editorial5), from 15% to 40% of all appendixes removed in emergency appendectomies are healthy organs. At least 250,000 new cases of appendicitis are surgically treated each year in the United States. This means that as many as 100,000 healthy appendixes are removed unnecessarily and then discarded. Such a waste is hard to justify considering the difficulty transplantation centers have in finding viable donor organs for transplantation.
A Demand to Be Cultivated
Although obvious challenges remain to making the procedure commonplace, appendix transplantation appears to provide a welcome opportunity for transplantation centers. Unlike the situations with other organs, for which demand far exceeds supply, the supply of donor appendixes greatly exceeds current or even foreseeable demand. It is not scarcity of organs that limits the growth of this transplantation field, but scarcity of patients. At this time, the only patients likely to consider appendix transplantation are those with Munchausen syndrome. The prevalence of patients with this syndrome is unknown.
The problem of inadequate demand results largely from the widespread belief that the human appendix is a vestigial organ. However, not all authorities accept that view. Creation scientists argue that man is not some haphazard product of evolution, but the culminating work of an intelligent Creator. Because man was made in this Creators image, the human appendix cannot be the vestige of an organ once useful to his primitive ancestors. It therefore must have a purpose.
It may be possible to obtain funding from the Institute for Creation Research or similar antievolution foundation to conduct research aimed at establishing a function for this much maligned organ. Elucidation of that purpose would go a long way toward justifying insurance coverage of appendix transplants. However, until that purpose can be found, who is to say that the Creator did not give man an appendix solely to ease the growing donor organ supply problem? If so, to waste this opportunity and not transplant these organs would truly be a sin.
1. "Are There Too Many US Transplantation Centers? Some Experts Suggest
Fewer, Cheaper, and Better," A.A. Skolnick, Journal
of the American Medical Association, vol. 271, 1994, pp. 1062-4.
2. "Alternative Ways of Meeting Demand," Nature, vol. 391, 1998, p. 325.
3. "Call for Moratorium on Xenotransplants," F.H. Bach and H.V. Fineberg, Nature, vol. 391, 1998, p. 326.
4. "Last Chance to Stop and Think of Risks of Xenotransplants," Nature, vol. 391, 1998, pp. 320-4
5. "More Precision in Diagnosing Appendicitis," I. McColl, New England Journal of Medicine, vol. 338, 1998, pp. 190-1.
6. "Effect of Computed Tomography of the Appendix on Treatment of Patients and Use of Hospital Resources," P.M. Rao, New England Journal of Medicine, vol. 338, 1998, pp. 141-6.
© Copyright 2000 Annals of Improbable Research (AIR)