The University of Maryland Medical Center has a surgery room.
The first pig-heart transplant went to a man who wasn't on the waiting list for a human heart.
The patient had previously failed to follow doctors' orders.
Black and Hispanic patients receive organs at lower rates because of the subjective criteria.
The University of Maryland Medical Center in Baltimore performed the first human transplant of a genetically modified pig's heart this month.
Bennett had nothing to lose by the time his surgeon suggested the pig heart. More than 106,000 people in the US are on the transplant waiting list, waiting for the death of a registered organ donor who has a compatible organ, according to the Health Resources and Services Administration.
That is a risk. 17 people die each day waiting for an organ.
Bennett didn't make the list in the first place. Bennett was ineligible for a human heart because he had a history of being medically non compliant or failing to follow doctors' orders.
Bennett's son told The Washington Post that other hospitals wouldn't put Bennett on the national organ waiting list because he missed follow-up appointments and didn't take his prescribed medication consistently.
Bennett was convicted of a violent crime years ago, according to the Post's report. Criminal history doesn't factor into hospital decisions about who should get human-organ transplants, but the story stirred up ethical questions about who deserves access to the scarce supply of human organs in the US
Medical ethicists say the thornier question is not about crime. It's a question of whether a patient's failure to comply with their doctor's orders should disqualify them from the national transplant list.
On the other hand, human organs are very rare. Doctors would like to give organs to patients who will take care of them. Many patients struggle to follow doctor's orders due to structural barriers, such as poverty or limited access to health care. They could reinforce systemic inequalities if they were not allowed into life-saving organs.
Dr. Burgart said that relying on medical compliance to determine who gets care can be a problem.
Burgart told Insider that it gets used against women, people who are mentally ill, people who are not white, and teenagers. If you don't follow the doctors' orders, you're a bad person.
Black and Hispanic patients may be at a disadvantage because of compliance requirements.
A nurse puts an IV in a donor's arm in New York.
Each transplant hospital's selection committee is made up of surgeons, doctors, nurses, psychiatrists, social workers, and various specialists.
Burgart said that committees' criteria for organ candidates are often a "black box."
There is no national standard for how far a patient can stray from their doctor's orders.
The US Department of Health and Human Services doesn't have rules on the subject. The agency's organ-transplant ethics committee considered the question of compliance in a white paper.
Life expectancy, "injurious" behaviors like substance use and unhealthy eating, social support for recovery at home, and medical compliance are some of the common criteria for organ transplant candidacy.
The committee wrote that it's hard to predict which patients will follow a post-transplant treatment plan. Patients with a history of missing appointments may live far away from their doctor's office, lack access to transportation or time off work, or face financial constraints. The committee concluded that hospitals should consider barriers and offer support.
Burgart said that they can't be surprised if things don't work out 100% of the time.
Burgart and other experts fear that subjective measures reinforce racial inequality, because black and Hispanic patients receive organ transplants at lower rates than their white counterparts. Black patients on the waiting list received organ transplants at a higher rate than Hispanic and white patients.
Poverty and lack of transportation are structural barriers that disproportionately affect Black and Hispanic Americans. There could be bias among health workers. Black patients were more than twice as likely as white patients to have at least one negative word in their records.
Even if it's from a pig, a new heart requires a lot of care.
The Bennetts are in 2019. David Bennett Jr. is second from the left in the back row.
It's not clear how many appointments Bennett missed or how he failed to follow doctors' instructions. The University of Maryland Medical Center wouldn't say what its criteria were for organ transplants.
Bennett could endanger his own life and interfere with the study of his experimental procedure if he doesn't follow doctor's orders after his transplant.
Arthur Caplan, a professor at New York University, told Insider that Bennett is not the most likely candidate.
In order to prevent their immune system from attacking their new organ, transplant patients must take immunosuppressants for the rest of their lives. Follow-up appointments and lab tests are usually required for a transplant. Burgart said that a transplant is taking one chronic disease and trading it for another.
The University of Maryland Medical Center told Insider that Bennett will be closely monitored during his recovery in the hospital and later at a rehabilitation facility. Bennett will receive support from his family and medical professionals to make sure he takes his medicine and follows his medical plan, according to the University of Maryland Medical Center.
Organs could be more widely available if pigs were genetically modified.
The University of Maryland School of Medicine's surgical team performed a pig heart transplant on Friday.
Bennett was the right patient for the experimental transplant because he had no other options. He wouldn't have been a candidate for a pig heart if he'd been eligible for a human heart.
Previously, researchers only connected a pig to a brain-dead human. Bennett's transplant has been successful so far, but experimental procedures are at risk. It's not certain if he will live through the year.
Genetically modified pig organs may not be a viable alternative to the human waiting list for a long time. If the technology succeeds, it could save many lives.
Burgart said that it breaks their hearts to not be able to transplant someone. We want patients to live. We want patients to have a good life. I think transplant programs take this responsibility very seriously. One way to make that better is if we have more organs.
The original article is on Business Insider.
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