CALCIPHYLAXIS, KIDNEY TRANSPLANT + LEXI REED?

NOTICE - the author has never met or examined Lexi Reed. This discussion is based solely on information available in the public domain.

Calciphylaxis, an awful and still mysterious complication of kidney failure, is reported to have affected Lexi Reed. A social influencer who shared her 300+ pound weight loss journey with more than 1 million followers, she unfortunately developed kidney failure and is being treated with dialysis. Rarely, dialysis patients develop calcium deposition in the fat and skin layers of defined patches on their body. Typical areas are the inner thighs, calves and abdomen. Relentlessly, the involved areas become extraordinarily painful and die. 

Although the typical treatment of dead tissue is debridement, or removal, in calciphylaxis, cutting away the dead material causes infection and expansion of the lesions. Reported mortality rates are as high as 80% in 1 year. 

We know that dialysis is not a biologic equivalent of normal kidney function. The  difference is clearly expressed as better long-term survival with a functioning transplant than continuing dialysis. Many other changes in the body are also dramatically improved with a transplant, including the health of blood vessels, overall, nutrition, heart function. So, why not do a kidney transplant to treat calciphylaxis?

Some cases have been done - with encouraging results! Nordheim et al reported resolution of the lesions within 4 months of transplant in 3 patients. 

Without having the privilege of knowing the details of Lexi's illness, it would be inappropriate to suggest that kidney transplantation is specifically appropriate for her. But, let's hope it is being considered. 

NOTICE - the author has never met or examined Lexi Reed. This discussion is based solely on information available in the public domain.

A Kidney Donor On Death Row?

How far will we go to accept another organ for transplantation? Our limit is currently being tested by a death row prisoner seeking to  altruistically donate his kidney before his execution in Texas. I am intentionally omitting the prisoner's name.

Most of us (in the developed world) think that China's documented execution of prisoners specifically for their organs is ethically unacceptable. And, permitting executions in the U.S. to be conducted so they produce transplantable organs has also been ethically avoided, even with the prisoner's consent. This current request is also not entirely without precedent. A prior death row prisoner was, indeed, permitted to donate a kidney to his mother. How is this new case different?

Organ donation to the general public has always been ethically challenging. Why would anyone want to undergo a serious operation with real complications (including the risk of dying) to save the life of someone they don't know? Well, it turns out that many people are truly good at heart. Even better, it turns out that some altruists have brains with anatomic differences from average subjects (controls). The amygdala (part of the brain that experiences emotion) in the rights side of their brains is enlarged, according to important work by Abigail A. Marsh.

Of particular relevance is Dr. Marsh's other finding that psychopaths have decreased activity in their amygdalas. Aha!

You certainly have doubt in the sincerity of a death row prisoner's motivation for donating a kidney, as do I. With donation would undoubtedly come delay in the execution. Even if you oppose the death penalty, it is doubtful that you endorse a prisoner's manipulation of the system. And, if you are opposed, consider the weight of potential organ donation on a jury being asked to determine whether or not to impose this penalty. Surely, it might serves as psychological salve for making such a decision. 

On the other hand,  perhaps the condemned man legitimately wants to be an organ donor. Maybe he dreams that such an act will change his everlasting fate - opening the gate to heaven, instead of hell? If this is so, who are we to deny him, especially if the life of someone on the wait list is saved?

Should we image his amygdala to ascertain the truth and make this judgment? 

They Still Don't Know Why The Pig Heart Failed

Denied access to the human heart he needed to replace his own, failing, heart, David Bennett pursued his only option for staying alive. So, when offered the opportunity to volunteer in an experiment in January 2022, he accepted the highly experimental transplantation of a genetically manipulated pig heart. Make no mistake, this took a huge amount of courage. 

No-one really expected him to live for very long. And he didn't. Just 2 months after the transplant, he died. Now 4 months after his death, the cause remains unknown. 

A few things are known. This is what has been publicly shared. First, the pig heart functioned very well until shortly before Mr. Bennett's death. Then, it failed - it became abnormally thick and stiff. Second,  typical human heart transplant rejection was not identified. Third, a pig (porcine) version of a virus called cytomegalovirus was detected in Mr. Bennett. This porcine cytomegalovirus has not previously been identified in a human. The significance of this finding is unknown. In other words, there not be any connection between this infection and the failure of Mr. Bennett's pig heart.

What comes next? It seems unlikely that the FDA will approve another clinical transplant with an organ from a pig, even a genetically manipulated pig, until some answers are identified. But, they aren't saying.