WHILE the anesthesia team battled to keep the patient's lungs working and his blood pressure steady, the surgeon skillfully guided his scalpel. The patient's punctuated vital signs hovered between life and death. Would his body turn against the newly transplanted organ? Medical advancements — combined with powerful drugs — mean a human being no longer needs to die when one of his vital organs dies. Today organ transplantation and artificial "spare parts" have become daily news events. The human heart, long held as the symbol of life, might now be polyurethane or consist of parts from another species, such as pigs or monkeys. These developments in medical science highlight new ethical and economic issues: Who will receive the new technology? Who will live, who will die and who will pay?
The Path of Early Medicine
Replacing diseased or damaged organs (prosthetics) has long been a goal of physicians. The ancient Greeks and Romans, to repair faulty waste elimination in ill humans, used catheters, small tubes inserted into the urinary tract. Archaeological specimens of catheters have been unearthed in Ephesus, Asia Minor and Pompeii. While the later books of the Bible were being written, Hindu surgeons as early as the eighth century B.C. were performing skin transplants to replace noses lost because of syphilis, physical combat or punishment for crimes. Grafted skin, transplanted from convenient areas of the body, was left to regenerate, covered with a poultice of sappanwood, barberry and licorice root. Patients, without the benefits of modern-day anesthesia, obtained relief from pain by the application of pressure on nerves, by freezing the part to be operated on, inhaling the fumes of narcotics, or by alcoholic stupefaction. Scientific progress in the West declined after the Roman Empire collapsed in A.D. 476. Smatterings of preserved truth, mixed with superstition, were passed from generation to generation. Then came the Renaissance and medical research resurged. New "discoveries" were generally revivals of centuries-old concepts. Drawing from the work of the Hindu physicians, the Italian surgeon Gaspare Tagliacozzo acquainted Western medicine with nose grafting in the 16th century. Once started, scientific advances were furthered by renowned medical schools such as the University of Salerno in Italy — movements that would eventually carry medicine into the 20th century. These advances took place under a cloud of public censure. The chief surgeon of the U.S. National Heart Institute in 1863 hung a plaque on his wall that read, "Let no man who hopes to retain the respect of his medical brethren dare to operate on the human heart." At the start of the 1900s a French surgeon, experimenting on cadavers and animals, learned how to sew severed blood vessels end to end so they would carry blood as efficiently as they had before an operation. For this discovery, Dr. Alexis Carrel received the Nobel Prize for Medicine in 1912. A year later he transplanted a kidney from one cat to another, the first such scientific endeavor. Before World War I, unsuccessful attempts were made to transplant kidneys from pigs, goats, apes and monkeys into humans. Modern heart surgery was born when surgeons such as Dr. Dwight E. Harken of Harvard Medical School saved lives during World War II by repairing heart wounds. Then came the first "blue baby" operation in 1945 at Johns Hopkins University in America, to aid children born with defective heart passageways. Science moved another step forward in 1961 when Dr. Norman E. Shumway of the Stanford University Medical Center became the first to implant hearts into bodies of recipient dogs. The transplant proved successful until the exasperating rejection syndrome arose. Then a South African surgical team, headed by Dr. Christiaan Barnard, showed that the results of animal investigations could be applied to man. On December 3, 1967, the first human had implanted into his chest the heart of a 22-year-old auto accident victim. He survived 18 days before dying of a lung infection. The historic operation unleashed the floodgates of surgical enterprise. Headlines proclaimed: " Kidney Transplants Finally Come of Age," "Miracle Drugs Add to Success of Organ Transplants" and "The Year They Changed Hearts." In the present decade alone medical technology has defied all supposed limits. Last year in the United States 172 human hearts were transplanted, compared to only 36 in 1980. In that same time, liver grafts jumped from 15 to 145. Worldwide, about 800 hearts have been transplanted, according to the U.S. National Center for Health Services Research, with the success rate rising from 65 percent four years ago to more than 80 percent in 1984. Besides transplanting hearts, livers, kidneys, lungs and bone marrow and performing double-organ transplants, surgeons have even implanted permanent artificial organs made of synthetic compounds-albeit with varying degrees of success. Out of Pandora's box have sprung serious ethical and economic questions that confront doctors worldwide. As put by one author: "No victory comes as a free gift. All the wonders of medical science exact a price."
What Price "Progress"?
Look at the toll such rapid advancements have levied. All along has been the great barrier of organ rejection. If body tissues aren't matched precisely, the body's immune system, designed to defend against invading bacteria and viruses, attacks the "foreign" tissue. Doctors went to work to find some way to neutralize the immune response, to penetrate the body's armor. But they soon found that immunosuppression, as the technique came to be called, was a two-edged sword. It opened the body not only to foreign tissue transplants, but to marauding bacteria and viruses as well. The "magic threshold" was crossed with the development of cyclosporine, a new drug that prevents rejection of organs in the human body, at the same time keeping the immune system on alert to fight infection — a leading cause of death among transplant patients. Cyclosporine is considered the first of a new generation of powerful wonder drugs that has prompted doctors to proclaim confidently that heart transplants are "just the beginning." Yet the unpleasant side effects of cyclosporine are that it contributes to kidney and liver damage and perhaps to the development of certain cancers. Some medical writers say it is "like calling in Satan to drive out the devil." Another problem facing medical science is acquiring body parts. There aren't enough to go around. Even if an organ is found it must be in excellent condition, and the donor's immune system must match that of the recipient. That combination is hard to find. Others waiting for replacement organs often must depend for years on lifesaving machines that are also in short supply. One U.S. publication reported that at Stanford University Medical Center about one out of three candidates for a heart transplant dies before a suitable heart becomes available. According to Fortune magazine, about 14,000 people each year need heart transplants in the United States. Last year 172 got new hearts. Organs that could be procured from traffic accident victims are often too old, or damaged or incompatible. Moreover, doctors in the emergency room may sometimes appear "pushy," "greedy," or "cold," causing some families to refuse to allow physicians permission to extract an organ for transplanting. A brother of a possible donor described one doctor's pursuit of body parts as "almost like stripping a car." To combat the dearth of organs, physicians at hundreds of transplant centers in 40 countries have set up communications networks stretching from Brazil to Belgium. And a new source was devised: patients declared officially dead when their brain waves stopped — even if their internal organs were still functioning. No longer would the time-honored definition of death be "when the heart and circulation no longer function." The heart and lungs can be kept going by machines. What controversy this change has caused! How can a brain-dead person sign a waiver granting permission to remove vital organs? So Canadian law now allows the removal of corneas during autopsies without prior consent of the deceased. Sweden, Israel, Italy and France presume that people are willing to donate body parts at the time of death unless they, or their next of kin, have filed an objection. But even if a matched donor is found, hitches in transportation persist. "We have a lifesaving surgical technique with a horse-and-buggy delivery system," said one person waiting for a donor. Then come the price tags for transplantation — about US $135,000 for a liver, US $100,000 for a heart — far beyond the reach of most. Such surgical transplants are still considered experimental and are not covered by most insurance policies or public aid programs.
Who Lives, Who Dies?
While patients waiting for donors continue to die around the world, unnerving questions remain: Who will receive the new technology? Who will judge who is medically worthy? And who will judge the judges? Potential organ recipients must undergo an almost ruthless medical screening, including their worth to society and the loss their death would cause — "in competition, so to speak, with other dying patients." How should factors such as age, productivity, number of children, earning power, and value as a citizen be considered? Often the only way a person can make his need public is by enlisting the help of the media to spread the news. "The trend seems to be that whoever gets the most publicity gets to live," said the assistant director of bioethics at the U.S. National Institute of Health. Committee members who weigh the value of one's life have a strange responsibility to their fellowman. "They always think of themselves as choosing in favor of one, not against anyone. They have the gift of life to bestow on someone," said author Harold M. Schmeck Jr. Is science giving life? "No, that's a hyperbole," D. Jack Provonsha, director of the Center of Christian Bioethics at Loma Linda University, told this writer. "Science is prolonging life that has already been given. Only God can give life." The greatest protests, nevertheless, have always been over the idea of men taking the power of life into their own hands. Many say the moral decision should hinge on who has been waiting the longest or even be decided by lottery. If human heart transplants aren't posing enough ethical knots to untie, then the frightening prospect of brain transplants will. At the beginning of this decade brain cells from infant rats were for the first time successfully transplanted into aging rats. Within three to six years, said the University of Rochester Medical Center, tests on humans can begin, to treat such disorders as Parkinson's disease. Dr. Provonsha told The Plain Truth: "When you start playing around with brains... you deal with meaningful quality of life. Even now scientists are working with psychosurgery, and the ethical issues are very great." Indeed they are! But, regardless of the moral, ethical and spiritual ramifications, science won't stop there. Noted Dr. Provonsha: "Science is running the danger of outstripping its morals. When one's technology outstrips its morals there's a breakdown of that technology Science cannot be depended upon to be morally sensitive. That's why we need ethicists." Yet it takes more than ethicists to lifeboat medical science, adrift in the middle of a treacherous technological current. Who will judge the ethicists? What, then, is the future of man? To be one day a "completely artificial, replaceable bionic human"? If Dr. Willem Kolff of the University of Utah predicts accurately, then in the near future, "we will be able to replace or assist most functions of the body with artificial parts." Another medical professor opined less assertively: "The present goal of medicine seems to be indefinite life, perhaps in the end with somebody else's heart or liver, somebody else's arteries, but not somebody else's brain. Should transplants succeed, those with senile brains will form an ever-increasing fraction of the inhabitants of the earth. I find this a terrifying prospect."
It Could All Have Been Avoided
Now consider this. Humans need never have had faulty internal organs, disease or malnutrition in the first place! Sickness, pain and suffering are the result of broken laws, the penalty nature exacts because natural and spiritual laws that regulate the physical body and mind have been broken. People seldom call in the physicians until they are ill. Then medical science attempts to nullify or remove the penalty. Surgeons have demonstrated that they can accomplish the transplant. They can do the repair job. But medical science pays little attention to causes and treats only the effects. Dr. Arnold Reiman, editor of the New England Journal of Medicine, says rightly: "It is a big mistake to put too much emphasis on transplants. The real drama lies in conquering the disease, not in a technological tour de force that prolongs life a bit for the relative few." Mankind, beginning with the first man, Adam, has spread all sails in voyages of experimental discovery, rather than revealed knowledge. This the Creator knew would happen, seeing the example of Adam. God also knew that mankind, once civilization had begun, would advance, unrestrained (Gen. 11:6) — right into extinction unless God intervened in time to stop the nuclear extinction of humanity (Matt. 24:22). If Adam had taken of the symbolic "tree of life" (Gen. 1-3), he would have received spiritual as well as physical knowledge directly from the Creator God, telling him how to solve his problems. Without this revealed spiritual knowledge mankind has, as one author put it, "'slowed to groping its way into a fog-bound future, taking soundings as it goes." This world, lost without God, has been for nearly 6,000 years reaping the wearying results of human confusion under the invisible rule of Satan, the god of this age (II Cor. 4:4). Fortunately, the Creator will step in soon — and restore contact with God' worldwide by sending Jesus Christ the second time. When he came the first time, he told those who would submit to the authority of God and reject Satan's sway that he would keep them in good health (John 10:10). God wants us to lead active, vibrant lives of abundant health and well-being (III John 2). He is the same God "who forgives all your iniquities, who heals all your diseases" (Ps. 103:3, Revised Authorized Version). His offer has stood even since the days of Moses in 1443 B.C.: "If you diligently heed the voice of the Lord your God and do what is right in His sight, give ear to His commandments and keep all His statutes, I will put none of the diseases on you.... For I am the Lord who heals you" (Ex. 15:26). A new world is soon to appear on earth — a world wherein no one will have to live for the rest of his days connected to the end of a plastic tube. God says disease and sickness will be conquered. When his kingdom rules, people will learn to obey nature's laws. Instead of doctors today having little or no time to educate t4eir patients against the causes of sickness and disease, people will be taught to avoid the cause of disease: broken laws, many of which are already revealed in the Bible. Ailments and infirmities will become a thing of the past when people stop transgressing the divinely created spiritual and natural laws — in other words, stop sinning (I John 3:4). The Bible reveals that people in the world tomorrow will learn about sanitation, hygiene, proper diet, sensible amounts of sleep, the importance of pure water, fresh air, sunshine and adequate exercise. Trained professionals will still have their role — in assisting the birth of children, repairing accidental physical injuries and giving advice. When the entire world begins to learn and practice God's revealed laws, other unbelievable promises will follow: "Then the eyes of the blind shall be opened, and the ears of the deaf shall be unstopped. Then the lame shall leap like a deer, and the tongue of the dumb sing... " (Isa. 35:5-6). In describing the conditions of good health and plenty to overtake this earth, God says: "For I will restore health to you and heal you of your wounds... " (Jer. 30:17). That's real progress!