The Organ Transplant Revolution Starts Here
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What you're about to hear is a story of history in the making. I think it's a historic day. This is many years in the making. It's a really big moment. There's a lot of emotions. A medical first. A story of survival, bravery, and heroism. I'm not a hero. I'm just a regular Joe. All of it to try and solve a crisis.

Taking the clamp off the artery. Nice and pink, yeah. You see, at any given moment, more than 100,000 people are waiting. Seven cardiac arrests before he became eligible for a heart transplant. He wasn't sick enough, believe it or not. Waiting for an organ. I was ready to die in this chair. It's hard to hear. And every day, 17 people, sadly, will die waiting.

For any organ that you name, only 10% make it on the list. There's just not enough of them. There's just not enough. Now, the potential answer to this problem might sound crazy to many. I have received a major, major, groundbreaking organ transplant. Controversial to some...

For that animal, this is a life of deprivation. It's an early death. It's much suffering. I don't think that's ever okay. Even blasphemous to others. Contacted the bishop and then the Vatican sent me a paper. Wow. But now more than ever, it's also incredibly promising. Could animals be the answer? Is it right? Is it wrong? Can it even work? That is an ultrasound of a pig kidney inside Tim.

something that very few people ever get to see. For the last two years, we've been searching for answers. It's powerful just to be here with these pigs. I'm Dr. Sanjay Gupta, and here is part one of Animal Farm. In the remote mountains of Patagonia, about as far from civilization as you can get, Robert Montgomery almost died. I had a cardiac arrest, and my son was doing CPR on me.

And they put me in the back of a truck and drove me to a hospital and they looked at me and said, "We can't take care of this." They brought an ambulance up and continued resuscitation and drove me five hours to the closest hospital. I've heard a lot of extraordinary stories throughout my career, but just the idea, the cardiac arrest, and then your son doing chest compressions on you. Yeah, he saved my life, for sure.

When I woke up, I couldn't do anything. I couldn't walk or talk. That he even survived, it really is just so extraordinary. But still, the underlying problem, something known as dilated cardiomyopathy, where the heart is just too weak to adequately pump blood, that was still with him, lurking, constantly threatening his life. My father died at 52 from cardiomyopathy, the same disease that I had.

Brother dropped dead at 35. Another brother got a heart transplant at 39. And then me. I basically accepted that I might not live a normal lifespan. Almost every single man in his family, sick or dying of this heart disease.

Was it your father's doctor who said that transplantation really wasn't going to be a solution or an answer? My mother was really begging him to come up with something. And he said, you know, he's too old and 52, 52 and it doesn't work anyway. So you wouldn't want that. That was 1976.

Now, even though the first successful heart transplant was back in 1967 in South Africa, it would take decades for it to become widely available. Not in time for Dr. Montgomery's dad. And so Robert Montgomery was given a mission: become a transplant surgeon and hopefully one day save people just like his dad. All right, how does that look with the camera? It wasn't easy.

By age 56, he had had three near-catastrophic cardiac arrests himself. The only cure, he was told, was a heart transplant. But... For any organ that you name, only 10% make it on the list. I wasn't sick enough to get on the list. You have to get so sick before you would even qualify to be in the running to receive an organ.

And it's just unacceptable. And that's all because we have to ration organs. There's just not enough of them. There's just not enough. But then it was the summer of 2018 when Robert Montgomery suddenly became sick enough. Once again, he was overseas. This time it was Italy with his wife Denise. He would go on to have four heart attacks that night. I just had one cardiac arrest after another.

They gave me the last rights. They revived him. He said, "I will die if I don't get out of here." They left my IVs underneath my shirt and they gave my friend a bundle of preloaded resuscitation drugs and syringes and flew back because I knew that was my ticket. The odds of survival were still not in his favor.

You see, even after making it on the list, 17 people die every day while waiting. Remarkably, just three weeks later, a heart became available. But it came with a catch. His donor had died of a heroin overdose, and the heart was infected with hepatitis C. In the transplant world, that is typically a no-go. In fact, thousands of hep C-infected organs are discarded every year.

But Dr. Montgomery insisted that his doctors still give it to him. We had just done a study showing that you could take a hepatitis C positive organ and put it into a hepatitis C negative recipient and treat them with these new antivirals. You could successfully treat the virus. Robert wasn't worried. I was. It was a risk, transplanting an infected organ into someone who had his immune system suppressed.

But you're probably starting to see a pattern here. Montgomery was once again willing to take the chance and prove that these infected hearts could be used safely. Hello to all my friends. And it worked. Thank you for your kind thoughts and your prayers and making a very nice recovery. Within weeks, he was able to walk out of the hospital. Today, he wants to show me the place he comes to treat patients just like him. I was in this room right around the corner.

So I have good feelings about this place, actually. It's like hope. Yeah, it's hope. Behind that door, yeah. He is a man on a mission. He wants to see this eradicated. If this were like a cancer drug, we wouldn't allow something to be rationed like this, right? We just don't have any choice right now. So we need another choice. Another choice which Montgomery is now racing to find. I'll help you down. Another choice, hopefully, for this man.

Tim Andrews has been living with diabetes since the 1990s, successfully managing it with insulin. Retired and happily married to his second wife, Karen, these empty nesters had big plans for their new life together, traveling the world until one day in 2022. I got tired. I was like, "Oh my God, I'm going to fall asleep or something." So I was checked and they said, "Stage three, kidney failure." "Oh, okay."

And a month later they're telling me I am at end stage. Wow, just one month? Just one month. Just quit on me. What were you feeling like at that point? I mean, I was told, literally told, you have dialysis or you pick a box. It was a false choice. Certain death or dialysis, meaning being dependent on a machine for the rest of his life. The first couple of months was like, hey,

This is not going to be so bad. As time went on, like six months in, I had a heart attack. It takes a toll on you emotionally and physically. For more than two years, three days a week, like clockwork, this dialysis clinic kept him alive. Here we are. It was a well-set routine. That's the machine. This is where I get to sit.

Without it, six weeks, eight weeks later, I'd be dead. It's a necessary evil. Necessary at least until he could get a kidney transplant. But again, just as with Montgomery, he knew that could take a while, might never happen. And the clock was ticking. I was ready to die in this chair. And that is when he learned about another option. Brand new, still relatively untested.

Some people said, "There's not enough information. Don't do this yet. Don't do this shit."

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so you can find the right job for you. Get started at linkedin.com slash jobs. Finding where you fit. LinkedIn knows how. You can't really tell by looking at them, but these tiny piglets have been genetically engineered to make their organs more acceptable for transplantation into humans. It's something known as xenotransplantation.

So Mike, how unusual is it for us to even be here? It's very unusual. We usually try to limit this to only the staff that takes care of the animals. Mike Curtis is the CEO of biotech company eGenesis. Never before has he let cameras onto this very special pig farm. Everything's controlled, like all the feed is clean, water's clean, the staff is clean.

I should just point out that I walked into a room, turned on a filter, essentially cleaned the air for five minutes before I could then go shower. That's why my hair is wet. I put on everything new here, including underwear, socks, shoes. The goal is to protect the pigs from us.

You know, I gotta tell you, I did not know what to expect. But it's powerful just to be here with these pigs. After all, these pigs are among the most genetically modified mammals on the planet. These piglets carry a total of 69 edits to their genome. All alterations to their DNA.

We're trying to reduce the risk of disease transmission from the porcine donor to human. We're editing in a way that reduces or eliminates hyperacute rejection. And then we add human regulatory transgenes to control rejection. Now to do that, scientists take the unedited pig cells and use a gene editing tool called CRISPR. They add special CRISPR fluids to the cells, which splices out certain genes and adds other genes.

You can't really see anything with the naked eye and it takes only seconds. But what is happening in this vial is truly remarkable. Let me take a second and explain.

First of all, remember that all DNA is made up of four chemical bases: A, C, G, and T. Think of that as your genetic blueprint. Now, a pig's DNA and a human's DNA, they actually look pretty similar, but there are some important differences. For example, the GGTA1 gene

That is responsible for a carbohydrate that forms around a pig cell known as alpha-gal. Now if you put that into a human, it would cause almost instantaneous rejection. But by knocking out that specific sequence and then adding in others, scientists can make the pig's organs much more compatible for humans.

So in the freezer are all these cells that we've edited. We thaw that vial, we grow those cells, and then we take the nucleus from that edited cell and we transfer it. It's akin to what was done with Dolly back in the 90s, cloning. And that is the process by which they have created a modern-day assembly line of genetically modified pigs.

We've selected the Yucatan mini pig because fully grown they're about 70 kilos, 150 pounds. So the organs are correctly sized for human recipients. Ultimately you got to get the size right. That's right.

Now if the idea of using animals for human transplants sounds familiar to you, it's because the concept has been around for a long time. There have been at least 48 cases reported in the medical literature since the 1900s. You may remember one of the most famous. This is Baby Faye. Little Baby Faye in 1984. She had a baboon heart that kept her alive for 20 days. But there was always the stubborn issue of rejection.

And so for a long time, xenotransplants faded into the background. I think we've turned up the throttle significantly. What's led to that, do you think? What we did is transplanted one of these organs into someone who had wanted to donate their organs was brain dead. You heard that right. The first human patients to receive the gene-edited pig kidneys were brain dead. Why? In order to move the field forward without moving too fast.

First, the scientists just wanted to prove that pig organs could survive in a human body. Dr. Robert Montgomery performed that operation on Maurice Miller, who was brain dead. We took the clamps off to let the blood go into the organ and it turned this beautiful pink color and started to make urine immediately. Pretty looking kidney. That was mind blowing. So it looks a lot like a human kidney.

In fact, when I first met Dr. Montgomery a few years ago, he was reviewing Maurice Miller's kidney biopsy. Here's what they learned. About a month into the transplant, the pig kidney did begin to show signs of rejection. See that red? That's hemorrhage. But importantly, standard anti-rejection drugs did work. And the kidney function is okay? Now it's back to normal.

It gave, I think, the FDA some confidence that this was going to work in humans. With all that research in the background, in 2022, the University of Maryland School of Medicine announced the first xenotransplant into a living recipient, someone who is not brain dead. It would be a pig heart into 57-year-old David Bennett. Give me a high five, buddy. That was awesome.

We saw two months survival of that patient and now incrementally seeing longer and longer survival in these compassionate use patients. David Ayers is a giant of a man. Seeing him on this farm in Blacksburg, Virginia, you may not know that he is also considered one of the most widely regarded geneticists in the world.

We have about 300 research animals here. We grow the designated pathogen-free pigs that were ultimately used for the decedent studies as well as the patients that have received our organs for transplant, both hearts and kidneys. Today, he's taking me to meet some of the farm's newest arrivals. Watch your head. Maybe that's just me. Hey, mama. Oh, there's a little piglets. Yeah. Do you want to hold one? Yeah, sure.

So these are 10 gene clone piglets. Here at United Therapeutics, they perform 10 gene edits on their pigs. Now remember, eGenesis in Wisconsin performed more than 60.

If you're doing six times as many edits, does that make it much better? I don't think more edits is necessarily better or worse. The additional 50 edits that eGenesis has done are to inactivate an endogenous pig virus. We've actually addressed that by breeding

In 2024, the first pig kidney transplant was announced. My name is Dr. Leo Riella. I'm medical director of the kidney transplant program at Mass General. Today, we announce the successful gene-added pig kidney transplant into a living human. Tim Andrews, still on dialysis, was watching all of this unfold.

I'm like, "Oh, they're doing it at Mass General." And I was like, "I have to be part of this. I'm not going to make it, but I'll make it to this. And I'll tell you right up front, if it's one day and you learn something, thank God." His eyes really sparked up and he said, "Tell me what I need to do. I'll do it." And they said, "Prepare your body for battle."

because it's going to be a battle. He had to do dental work, he had to go to physical therapy. We signed up for the gym. When he came back to see Dr. Riala, he had lost 22 pounds. Did you have any doubts along the way? You know, there's always doubt with it, but I'm like, this is my chance to do something. You're going to be in medical history books forever. Kids are going to be

taught how to do it watching me have one put in me. They're gonna know your name. They're gonna know your name. It's a crisp January morning back at the Eugenesis pig farm in Wisconsin.

It's been more than a year since our first visit. This is many years in the making. So Raphael, she'll be able to donate one of her kidneys to a man who's in dire need and essentially she's saving his life. Go Raphael! It's a really big moment. There's a lot of emotions. We love our piglets like our own.

Thinking about the purpose that Raphael is serving, like getting to go and give someone a new lease on life is just such a gift. That someone is Tim Andrews. Raphael will be his donor. Given life, what a gift. As Raphael departs for the 17-hour trip to Boston, Tim settles in at Mass General.

I knew I was in great hands. These guys are just so good. Were you nervous the morning of? A little. We'll see you on the other side. Awesome. As a new man. Yes. We're all anxious and nervous about going through a procedure that has not been done before. And having that reassurance from him also brings a lot of positivity to the entire team.

It's early morning, January 25th, when Dr. Riella and the surgical team travel about 50 miles outside of Boston to meet Rafael. It was an OR, very similar to what we see in the hospital, and the surgery to retrieve the organs occur there. They look very similar to how we do procurements. I think uniqueness is really that, you know, who was a donor, who was coming, was a pig. By 8 a.m., it's go time. It's a dance to get in.

the pig kidney there and get him in the operating room. Got to coordinate it. So a nurse came and said, "Okay, you've got to go." I'm like, "Wait, wait, we haven't said goodbye." "You can't say goodbye." "Oh yes, I can." So I actually made them wait and they said, "We've got to go. I'm saying goodbye to my husband before he leaves for surgery and he may not come back."

It's a little chilly in here, okay Tim? I like cold. The operation lasts a little over two hours, around the same as a traditional transplant and the pig kidney. It looks, feels and functions very much like a human kidney. And here is when surgeons connect the pig kidney to Tim's artery and vein. After that, the moment of truth.

Surgeons release the clamp so blood can flow into the kidneys and the organ turns pink. And now this: urine successfully flowing through the kidney. Wow, look at that. We were very surprised. We were hoping that we would start making urine within a day or two, but seeing the urine being produced right away was not what at least I expected to be happening that close. Everything went well.

They said they put the kidney on the table and started connecting him to the kidney and he actually peed across the room. So they were very, very excited. Of course, I started bawling like a baby. We were all crying. I mean, we were all like, "Oh my goodness." I mean, this is not the end, but we're getting there. We're getting there. I felt great and all of a sudden I had the energy and I was like, "This is beyond what I thought I was going to get."

So right away you felt that good? Right away I felt that. I was like, look at me, I'm like a new man. It was like a new birth. I said, I have a new birthday. 12525 is my new birthday. Is that your birthday? Because I was alive and I hadn't been for a long time. And I'm like, this is amazing. But there was still a long way to go. This is still so experimental after all.

And Tim and Karen knew how quickly things could change. It was just a year earlier that Lisa Pisano also needed a kidney. Did you and your mom used to walk around here? Yes. Her daughter, Brittany Rydell, remembers just how sick her mother was. It means no more dialysis, hopefully. Like Tim, she was an end-stage kidney disease. But Lisa's heart was also failing. And that is why a traditional kidney transplant was not an option for her.

So in some way she was too sick to get a transplant. Lisa Pisano was on death's door. I mean, she was not going to live. She was, you know, days to weeks from dying. So Dr. Montgomery, who was her surgeon, suggested a pig kidney. There are some people who are willing to take that chance, and she was one of them.

In the spring of 2024, Lisa Pisano became one of the first two patients in the world to receive a gene-edited pig kidney transplant. I got more energy. I feel energized. After her kidney transplant, I have to say she looked the best that she looked in so long. I've seen her so happy. It was definitely the healthiest I had seen her in a while. She was doing well at that point.

Yeah, we were so hopeful because I had seen her so much better and I figured if anything was going to go wrong, it would have went wrong at that moment and not months later. Bassano developed several infections and never recovered enough to leave the hospital. I don't have regrets about the surgery. I just wish that she could have had the opportunity to really enjoy it more. I know it's probably...

hard to sort of think of it this way, but she was a real pioneer. One of the first things she said to me was, "Even if this doesn't work for me, it can work for someone else." And I think about that a lot. The first patient that we did was in this bed, in the bed that I was in, Lisa Pisano, you know, taking care of that one life. And if there were just that, that would be great, but then you have this opportunity to really impact maybe thousands, maybe millions of lives.

Now Tim knew Lisa's story. He knew that there was a tremendous amount of uncertainty. Stepping forward, you're going to do something for humanity. This is a way that we can bring this forward. And this is the hope for all these people that it's going to be okay. We're going to find a way, which is amazing to me. It was just, I have to be part of this. So would this be a success for Tim?

And what does it all mean for the 100,000 people currently waiting? There's bumps in the road. We'll dive into that when we come back next week with part two of Animal Farm. Thanks for listening. This week on The Assignment with me, Adi Cornish. For a moment there, the phrase body positivity was everywhere. And then Ozempic entered the chat.

The pendulum has swung back to the glamorization of thinness. And the American Society of Plastic Surgeons announced we're entering the ballet body era. Are the drugs the real reason thin is in? Can body positivity and the ozempic era coexist? Listen to The Assignment with me, Audie Cornish, streaming now on your favorite podcast app.