{"id":4319,"date":"2022-08-12T11:25:27","date_gmt":"2022-08-12T10:25:27","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4319"},"modified":"2022-08-12T11:25:27","modified_gmt":"2022-08-12T10:25:27","slug":"the-ethics-of-organex","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2022\/08\/12\/the-ethics-of-organex\/","title":{"rendered":"The ethics of OrganEx"},"content":{"rendered":"

By Richard B. Gibson.<\/p>\n

Nature<\/a> recently published a study by a team at Yale University in which the circulation and cellular activity of a pig\u2019s vital organs \u2013 pancreas, liver, kidney, heart, lungs, and even brain \u2013 were restored over an hour after death. While exploratory, the study\u2019s results are nonetheless remarkable, challenging the intuition of death\u2019s irreversibility and having potential severe downstream implications for organ donation practicalities and policies.<\/p>\n

In short, the researchers developed OrganEx from the 2019 BrainEx system<\/a>. While BrainEx demonstrated the potential to preserve anatomical and neural cell integrity, this 2022 update develops this potential, seeking to maintain cellular function within multiple vital organs within the porcine body posthumously. OrganEx comes in two parts, an infusion device and a synthetic solution. An hour after the pig\u2019s demise from an induced cardiac arrest, the Yale team connected the animal\u2019s body to the infusion device. It then began circulating the perfusate \u2013 containing an artificial oxygen carrier, vitamins, amino acids, and a complex drug cocktail \u2013 around the pig\u2019s body, alongside its blood. After six hours, the team observed that oxygen had begun flowing to multiple tissues and that the heart had demonstrated some electrical activity. Additionally, tissue integrity appeared preserved, there was a decrease in cell death, some cells were metabolising glucose and synthesising proteins, and some cellular repair mechanisms appeared active. In other words, compared to the control groups, OrganEx successfully initiated posthumous cell repair in damaged organs.<\/p>\n

Nevertheless, OrganEx raises multiple ethical issues. So, I want to give a snapshot of two of them. The first being the use of animals in research and the second being our understanding of death.<\/p>\n

Animal ethics<\/h1>\n

As with all research involving animals, we need to acknowledge concerns regarding the avoidance of harm and respect for autonomy. In the OrganEx case, simply put, was it right to use pigs as the objects of the study?<\/p>\n

As far as can be told, the pigs didn\u2019t suffer subjective harm due to their participation. Following recommendations from Yale\u2019s Institutional Animal Care and Use Committee, in addition to external advisory and ethics groups, the pigs were fully sedated before death. As such, they never experienced the heart attack, any pain resulting from it, or the rest of the experiment. Additionally, the pigs didn\u2019t demonstrate any neural activity measurable via an EEG whilst connected to OrganEx.<\/p>\n

However, beyond the animal\u2019s subjective experience, the fact that they were deliberately killed for this experiment might cause some consternation as death itself can be considered harmful, especially given the abundance of evidence suggesting that pigs have complex internal worlds<\/a>.<\/p>\n

A slaughterhouse provided the brain for the 2019 BrainEx study. So, the animal would have died regardless of study participation. But, this is not the case in OrganEx, as the pigs used here were killed explicitly for the study\u2019s purposes. If not for their participation, they could have continued living. So, we might want to question whether this was necessary and whether an alternative to the porcine model could have been used, thereby sparing the pigs\u2019 lives. One counterintuitive option could have been to jump straight to posthumous human experimentation. This might seem odd given that research structures typically place human experimentation at the latter stages, after animal involvement. However, the OrganEx study had, as its focus, a corpse. And, given that a live pig arguably has a stronger claim to moral consideration than an already dead person, it seems reasonable to skip the former and go straight for the latter. After all, a deceased person has already experienced the harm of death.<\/p>\n

And death is?<\/h1>\n

Death\u2019s often considered irreversible. This makes someone who\u2019s just drowned different from Napoleon \u2013 the former\u2019s demise might be undone while the latter\u2019s cannot. So to say that someone is dead is to say they will remain so. This idea is even reflected in legal and regulatory contexts, with irreversibility invoked in legislation like the USA\u2019s 1981 Uniform Determination of Death Act<\/a> and codes of practices like that of the UK\u2019s Academy of Medical Royal Colleges<\/a>.<\/p>\n

OrganEx, however, potentially shifts what we understand to be irreversible radically. Previously, it would seem evident that a body kept at around 36\u00b0C for over an hour without any medical intervention would be unrevivable. Yet, as OrganEx demonstrates, albeit in a specific context, this doesn\u2019t seem necessarily accurate. Posthumous cellular degradation doesn\u2019t seem as inevitable as once thought. While the OrganEx study\u2019s application is geared towards cellular activity, further research might reveal similar revelations concerning tissues and whole organs.<\/p>\n

Now, OrganEx isn\u2019t the first innovation to demonstrate a capacity to challenge commonly held ideas of death. For example, the advent of ventilators and heart transplants did the same concerning the cardiopulmonary criterion<\/a>. Nevertheless, its potential to alter our perception of irreversibility presents a significant challenge regarding our understanding of mortality. After all, we ascribe different social, ethical, and legal considerations based on whether someone\u2019s alive or dead. Ensuring that such considerations \u2013 like when to harvest organs or when defiling a corpse becomes murder \u2013 are assigned correctly is of fundamental importance.<\/p>\n

Ultimately, OrganEx seems to have displayed the potential, like many innovations before it, to highlight irreversibility not as a concrete fact of biology but as a medical perspective seen through the lens of technological capacity.<\/p>\n

 <\/p>\n

Author<\/strong>: Richard B. Gibson<\/p>\n

Affiliation:<\/strong> University of Texas Medical Branch<\/p>\n

Competing interests<\/strong>: None declared<\/p>\n

Social media accounts of post author<\/strong>: @RichardBGibson<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

By Richard B. Gibson. Nature recently published a study by a team at Yale University in which the circulation and cellular activity of a pig\u2019s vital organs \u2013 pancreas, liver, kidney, heart, lungs, and even brain \u2013 were restored over an hour after death. While exploratory, the study\u2019s results are nonetheless remarkable, challenging the intuition […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":354,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8050,397],"tags":[],"class_list":["post-4319","post","type-post","status-publish","format-standard","hentry","category-death-and-or-dying","category-research-ethics"],"yoast_head":"\nThe ethics of OrganEx - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2022\/08\/12\/the-ethics-of-organex\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The ethics of OrganEx - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Richard B. Gibson. 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While exploratory, the study\u2019s results are nonetheless remarkable, challenging the intuition [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2022\/08\/12\/the-ethics-of-organex\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2022-08-12T10:25:27+00:00\" \/>\n<meta name=\"author\" content=\"Hazem Zohny\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Hazem Zohny\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2022\\\/08\\\/12\\\/the-ethics-of-organex\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2022\\\/08\\\/12\\\/the-ethics-of-organex\\\/\"},\"author\":{\"name\":\"Hazem Zohny\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/e73152f6aa4e164c7d625d77cf4fed35\"},\"headline\":\"The ethics of OrganEx\",\"datePublished\":\"2022-08-12T10:25:27+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2022\\\/08\\\/12\\\/the-ethics-of-organex\\\/\"},\"wordCount\":918,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"articleSection\":[\"death and\\\/or dying\",\"Research Ethics\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2022\\\/08\\\/12\\\/the-ethics-of-organex\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2022\\\/08\\\/12\\\/the-ethics-of-organex\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2022\\\/08\\\/12\\\/the-ethics-of-organex\\\/\",\"name\":\"The ethics of OrganEx - 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