Organ Farm - Part 1
Program #1912
Original Airdate: March 27, 2001

Produced by
Ben Loeterman
Frank Simmonds

Directed by
Frank Simmonds

NARRATOR: Two surgeons are about to attend a birth that could be one of the most significant developments for medical care in the new millennium. It will take organ transplantation into new areas of controversy, for these are veterinary surgeons, and the mother is a pig.

DAN SALOMON, M.D., Transplant Biologist, Scripps Research Institute: Successful xenotransplantation would essentially create a set of options for practicing physicians that would extend over such a remarkably broad range of diseases that it would fundamentally change the practice of medicine now and in the foreseeable future.

From end-stage kidney disease, liver disease and heart disease to multiple sclerosis, stroke, diabetes, the impact of the successful therapy based on xenotransplantation will be tremendous.

NARRATOR: Research scientists are developing techniques to rear pigs that are germ-free for the organ farms of the future. The aim is to supply animal hearts and kidneys for transplant into humans. The organs must be super- clean, uncontaminated by viruses and bacteria from the outside world.

DANNY BUTLER, D.V.M., Vet. Surgeon, Univ. of Guelph, Canada: In the mother's womb, those piglets are sterile. The minute we open that womb, we break that barrier. We do not want those piglets and the organs that those piglets are carrying to be contaminated with pathogens or other organisms that we are carrying. We're trying to protect them from us.

NARRATOR: Outside Toronto, a cesarean birth is shrouded in plastic. Next to the operating table is a resuscitation unit. Eight piglets are about to be delivered from their mother, a 500-pound sow. An airlock will ensure the newborns take their first breath in sterile air.

Far from ordinary, the sow and her piglets are "transgenic." This means they carry a human gene scientists hope will trick the human immune system so the pig organs won't be rejected. The pig holds considerable promise for pharmaceutical giants gambling fortunes on this new technology.

With each litter offering as many as 10 hearts and 20 kidneys, drug companies like Novartis have invested over a billion dollars in a quest to capture a market estimated to be worth over $10 billion a year.

If it works, it will take transplant surgery from a life-saving therapy for a lucky few and make it available to everyone.

DANNY BUTLER, D.V.M., Vet. Surgeon, Univ. of Guelph, Canada: You notice that I'm dropping the pigs into a tank. This is a tank that contains an essence of tincture of iodine. And new-born pigs, like other newborns, as soon as their head hits the water, they hold their breath, so they can be passed quite safely from the surgical site into the resuscitator isolator.

In essence, these piglets are being prepared as another product for human use. One can foresee almost tailor-making organs for a particular recipient because a pig could be manipulated to have organs that were for a particular person's needs. It almost verges on science fiction, in some ways, but we have really opened up a whole new frontier here.

It always takes, I think, longer than we sometimes think. And obviously, there are a lot of safety features that still have to be addressed. I would speculate we'll see this process in place probably three to five years maximum.

NARRATOR: If xenotransplantation achieves its full promise, this is what life will be like for the animals. The organ farm of the future will consist of a series of sterile living pods, a production line turning out a limitless supply of disease-free organs for human transplant.

The animals will live out their lives moving from one sterile living environment to another until doctors are ready to harvest their organs. The conditions are about as far away from the natural world of pigs as it is possible to imagine. Their first brief home is a nursery isolator.

Dr. DANNY BUTLER: Within the nursery isolator, they have the choice of areas in terms of temperature, they have freedom of movement, they are never separated one from another where they cannot see and touch one another.

These piglets have never been exposed to their mother, and so that aspect is missing. They will still display what's called "nosing behavior," but with the toys that we have available for them in the nursery isolators, they are able to perform that behavior and, in fact, these piglets behave comparably to a litter of piglets that would be present on a sow.

NARRATOR: Conditions are so sterile, the piglets must be fed yogurt to get some bacteria into their stomachs.

Every aspect of the pigs' life is neatly measured and strictly monitored. This organ farm is a one-of-a kind showcase experiment, the prototype for organ farms of the future. This is the first time it has been seen publicly. FRONTLINE agreed not to divulge its exact location because those who run it fear protests once its mission is divulged.

CAROLYN BELCHER, Project Manager, Imutran, Ltd.: These piglets are germ-free piglets. They will stay in here for 14 days. And they're uncontaminated when they leave these isolators, and they go into a secure barrier unit, which, obviously, is of a very high health status. That becomes their permanent home. They're not moved again after that unless they're, obviously, used for organ donation.

NARRATOR: Each litter of pigs destined for the operating table will live in a unit like this for six months. By then, their organs will be the optimum size for human transplant. Their handlers say they try to make their lives as pleasant as possible.

CAROLYN BELCHER: The pigs look quite happy. They're quite content. They obviously, you know, like human company, they're not running away from us. That, of course, makes life a lot easier when we have to handle them.

NARRATOR: Despite these reassurances, there may well be protests. In Britain, there has been widespread opposition to all forms of animal experiments. One of the newest groups targeting xeno research is led by Dan Lyons.

DAN LYONS, Uncaged Campaigns: People need to remember that pigs are exceptionally intelligent animals, they're considered to be at least as clever as dogs. Now, if we treated dogs like this, I think there would be, justly, an absolute outcry about what's going on.

One of the most important natural behaviors of pigs is rooting and foraging behavior, and they spend about three-quarters of their waking lives rooting and foraging for food. And none of this will be afforded to them, you know, if they're being factory farmed, so to speak, to be disemboweled for organ transplant experiments.

The market for pig organs themselves, on their own- that's been estimated at $6 billion a year. It's that huge pot of gold at the end of this which is driving this. It may look really nice and scientific and clean, but in terms of what we're actually doing to animals, it's barbaric.

Prof. DAVID WHITE, M.D., Univ. of Western Ontario: The environment in which these pigs are raised is really not grisly. It's a pig-friendly environment. But we have to be frank about this. We are exploiting these pigs. But I believe it's far more justifiable to exploit these pigs in order to save people's lives than for the production of food.

NARRATOR: Pigs were not the first animal donor of choice. Other primates, our closest relatives, were once considered the best source for organs humans wouldn't reject. In 1984, the world was stunned to learn a baby called Fae had received the heart of a baboon.

DAN SALOMON, M.D., Transplant Biologist, Scripps Research Institute: An infant was born with basically a life-ending defect in the formation of the heart. And to make an effort to save the life of this young baby, surgeons performed a dramatic transplant between a young baboon and this child. And that captured the imagination of the world.

NARRATOR: She should have been the ideal candidate, a newborn with an undeveloped immune system that wouldn't resist a foreign organ. But after just 20 days, despite anti-rejection drugs like cyclosporine, Baby Fae rejected the baboon heart and died.

LEONARD BAILEY: [press conference] She had, indeed, a rejection episode, and all of our objective data suggests that she had turned the corner with regards to her cardiac function, but in the process lost renal function. I don't believe it's related to cyclosporine. I think it's related to a combination of factors. And it's a combination of factors, I suppose, we'll elucidate as her final cause of death.

NARRATOR: Eight years later, in 1992, a team in Pittsburgh led by Dr. Tom Starzl tried again, this time with baboon livers. The graphic footage you are about to see was taken by the hospital to document the expected breakthrough.

Two patients with hepatitis B were dying of liver failure. They were not offered a human transplant because the hepatitis would destroy the new liver and thus waste a precious organ. Because of the baboon's natural resistance to hepatitis, they offered a last chance. The first patient's chronically diseased liver was replaced in an 11-hour operation.

The surgeons had high hopes for a transplant from a primate. But the whole direction of cross-species research was thrown into question when the liver was rejected.

THOMAS STARZL, M.D., Transplant Surgeon, U. of Pittsburgh Medical Ctr.: Well, he lived for 70 days, and eventually, I believe, he died of over-immunosuppression. And he also died of inadequate function of his baboon liver. We expected that we might be able to see something that looked like human-to-human transplantation from this baboon liver, but it wasn't the case.

We did another case, had the same general experience. And we concluded that we could not succeed with xenotransplantation. We could not give the patient a reasonable, if any, chance of being restored to a meaningful life and role in society. I was surprised the first time, and I was crestfallen the second time, to realize that the same thing had happened twice in a row.

INTERVIEWER: And you didn't feel you could go on with another transplant of that nature?

Dr. THOMAS STARZL: No. No.

NARRATOR: Today doctors are betting the pig will eventually be a more reliable and reproducible source of organs. They've already begun transplanting pig cells in a handful of experimental trials underway.

Two years ago, 21-year old Amanda Davis suffered a massive stroke to the right side of her brain. Now she and her boyfriend, Sean, face the future knowing her paralysis will only get worse. She walks with a leg brace under her jeans.

But Amanda has decided to gamble for a chance to get better. Tomorrow she will receive an experimental transplant of pig cells to her brain, in hopes of reversing her fate.

AMANDA DAVIS: It started when I was up in college in Maine. And I started losing my coordination, and my lower lip started to fall aside, started to droop down, and I started to have migraines. And I didn't relate it to being that I was having a stroke.

And I was driving home for my birthday with my friend, and I went off the road. So she took over and we drove the rest of the way home, and I was throwing up a lot. I was pretty sick. And then, finally, they took me to the hospital. I just remember being woken up the next day and told that my left side was paralyzed because I'd had a stroke.

And hopefully, I won't wake up tomorrow being a vegetable. That's my biggest fear, is xeno won't work or I'll be worse. But they can't guarantee anything. So I just kind of hope.

GALEN HENDERSON, M.D., Neurologist, Brigham & Women's Hospital: Especially over the last six or eight months, Amanda has been talking about whether or not there is something else out there, anything experimental that could be done. She wanted the limits of mankind's knowledge, where the science is, the cutting edge. She wanted to be at that level. Even though we may not have wanted all of this for her, she definitely wanted it for herself.

NARRATOR: Using a portable ultrasound scanner, a research scientist checks the development of fetuses in a pig sow. Those he selects will become the raw material in Amanda's operation. But Amanda's gamble involves a risk beyond her own. She could become infected with a pig virus, which, if it spread to other people, could become a major public health risk. That risk means she must make at least one huge personal sacrifice.

AMANDA DAVIS: Dr. Henderson, my neurologist, said it wouldn't be a wise idea to have children. Right? Isn't that what they said?

SEAN SULLIVAN: If she feels comfortable with it and she's willing to do it, I'm willing to back her 100 percent. You know, and that was the most important thing, you know? If anything like that does happen there is always, like, adoption or something like that, you know, so-

NARRATOR: Dawn at Boston's Brigham & Women's Hospital, where a medical team of 20 surgeons and technicians are preparing the body scanner for the cross-species transplant.

NURSE: Do you have any questions about anything?

AMANDA DAVIS: Not really. Am I going to wake up?

NURSE: That's our plan.

AMANDA DAVIS: OK.

NURSE: You need to go to sleep thinking you're going to wake up better than you are now, with a great shot for the rest of your life, all right?

NARRATOR: Twenty-four hours before Amanda's operation, the pregnant sow was killed in order to collect the fetal cells. The upcoming footage is a rare glimpse of the process. It is very graphic.

DOUGLAS JACOBY, M.D., Director of Research, Diacrin Inc.: The pigs enter the program and they're artificially inseminated, and then we collect the fetuses from those pigs. They're extracted under very clean conditions. And during that procedure, we dissect out specific areas of the fetal brain.

In the case of stroke, we will dissect out the particular area of the brain which is developing into those neurons which are lost due to the stroke. And that way, these cells of fetal origin will develop into those areas of the brain.

Once we've dissected out that part of the brain that we're interested in, we then very lightly break apart the tissue and release the single cells. And these are the cells that are then used for the treatment.

NARRATOR: But transplanted pig cells inside the human body could endanger all of us.

HUGH AUCHINCLOSS, M.D., Chmn., FDA Subcmte., Xenotransplantation: Almost all animal species, and certainly the pig, have incorporated in their genetic material potential viruses.

Now, the issue is supposing some of that genetic material from a pig cell living in a human body gets transferred to a human cell? Now, as far as we can tell at this point, there's nothing about that event that would cause a disease. But let's go further and suppose that this genetic material could recombine with some of the genetic elements that exist within the human cell and, in that recombination event, create a virus that doesn't exist right now, so we can't screen for it, we don't know what it would do because it doesn't- it's not there. But could one be created by the pig cell living in a human body?

NARRATOR: The cells destined for Amanda's brain are preserved on ice at the hospital. In the final moments before the operation, she is asked to re-sign the medical research consent form that will govern the rest of her life. It's been approved by the Food and Drug Administration, which oversees all xeno clinical trials.

Dr. HUGH AUCHINCLOSS: Lifestyle restrictions that have been established for patients who are receiving xeno transplants, at this point, really mirror those that you would expect somebody who is HIV-positive. So there's no blood donation, and safe sex, and recording of partners so that the FDA in the future could potentially go find those people and determine whether transmission had occurred.

DAN SALOMON, M.D., Transplant Biologist, Scripps Research Institute: The contract with the patient is a remarkable one, one that literally is unprecedented in medicine. What we're actually asking patients to do up front is to agree to follow-up for life and to access to their tissues after death for the kind of research studies that are going to be required to determine if their death had anything at all to do with the xenotransplant, or even if the death wasn't directly caused by the xenotransplant, if in this patient that died, there is any evidence for spreading infection or a tumor or any sort of complication of xenotransplantation.

Dr. HUGH AUCHINCLOSS: And the expectation is that it would not be transmissible. The expectation is that it wouldn't cause a disease. But the concern is that- the ultimate concern is that you create AIDS II by doing xenotransplantation, and nobody is quite capable of saying that that's impossible.

[www.pbs.org: More on xenotransplant risks]

NARRATOR: Because the FDA believes the benefits of cell transplants outweigh the risks, it has allowed a few trials like Amanda's to move forward. She is about to become the fifth person to have a cell transplant after a stroke.

PHILIP STIEG, M.D., Neurosurgeon, Brigham & Women's Hospital: Amanda's been left devastated by her stroke. Here she is, 21 years old, not ever having a real chance for a significant improvement in the use of the left side of her body. So I think that for her, the compelling issue is, "Might I get better?" And obviously, the answer is, yes.

[to surgical team] She's awfully flexible, so we won't need a shoulder roll. We'll just put her head in a holder. And we'll be going in right here, so we'll try to get that as the high point, so that it's perpendicular.

GALEN HENDERSON, M.D., Neurologist, Brigham & Women's Hospital: We talked about the potential dangers of having those pig cells in her brain, because once they're there, they're there forever. There is no way to retrieve those. And it shocked her. It shocked her. And it made her very uncomfortable. And that's what I wanted to do. I wanted to make her uncomfortable. I wanted to make everyone uncomfortable and think about the big picture and how there are so many unknowns out there.

It's quite scary. You know, 10 years from now, could something bad happen as a result of her transplantation? Yes. Will there be any treatment for her? I told her that it's possible, but probably not. We don't know. We just don't know. And we want her to understand and the rest of the family to understand that we don't know.

UNIDENTIFIED PHYSICIAN: We're treading on ground that no one has ever treaded before.

Dr. PHILIP STIEG: You will see about 80 million cells in a total volume of .8 CCs injected into Amanda's brain right at the junction between where her stroke is and the normal brain tissue, in hopes that those cells will engraft and either provide some connectivity or growth factors that may provide improvement in her function.

SCANNER OPERATOR: Let's look at the trajectory with this [unintelligible] because I think it's much more important to get proper placement. OK, so right here. That's where you're at.

SURGEON: The image that I can see here is right at the junction of the infarct and the basal ganglia.

SCANNER OPERATOR: Correct. Right where I have the crosshairs.

SURGEON: I'm on the brain's surface now. I feel it.

SCANNER OPERATOR: In general, it's in the area that we want. It's a touch short, maybe, but it's still in the border zone. Coming in here we can see some gas where the cells have been injected, and this is the trajectory with the catheter position in an additional area of the gas where cells have additionally been injected, at this point.

Dr. PHILIP STIEG: After we had injected the cells and I was waiting for the images to come back, all of a sudden it struck me, this is astounding. If it turns out to be this simple, in terms of being able to help somebody and inject cells, this is truly a marvelous breakthrough.

Dr. GALEN HENDERSON: We would like to believe that we all have a right to a cure, if there is one out there. But dealing with genetics and xenotransplantation, it's very scary and there is a slippery slope. And where the line should be drawn, I don't know. But we're coming close to the edge.

NARRATOR: If the experiments on Amanda and others work, millions of stroke victims worldwide could benefit. Just after the operation, though, Amanda had a seizure. The clinical trial was halted while doctors began to search for the reason why.

Ten Months Later

NARRATOR: Even though Amanda has had no new seizures and can walk easily without her brace, the clinical trial she was part of remains on hold. Still, Amanda's quality of life has improved.

AMANDA DAVIS: Sean and I went for a little vacation and he proposed, so we're engaged.

INTERVIEWER: Congratulations.

AMANDA DAVIS: Thank you.

INTERVIEWER: So the future's a lot better than it was.

AMANDA DAVIS: Yeah. Definitely.

NARRATOR: If Amanda had needed a pig organ instead of cells, she would have faced the difficult problem of cross-species rejection. While pig cell transplants have had a few experimental successes, no organ transplant will be possible until the problem of rejection can be solved.

In 1985, two scientists in Britain set out to address that problem. They set up a small biotech firm called Imutran and began work at a secret research farm. Their goal was to alter the pigs genetically in order to make their organs more human-like.

DAVID WHITE, M.D., Co-Founder, Imutran, Ltd.: We make these pigs transgenic in order to trick the human immune response into thinking the pig heart or the pig kidney is from a human being. What we do is introduce DNA sequences that have originally come from the human to really solve immunological problems that face animal-to-human transplants.

JOHN WALLWORK, M.D., Co-Founder, Imutran, Ltd.: We know that on the surface of our cells there's little flags that basically say, "Don't attack me. I'm me. I'm human." So we genetically engineer these animals so that they express on the surface of their cells human flags, so that the part of the immune system that instantly destroys them doesn't see them as being pig, it sees them as being human and doesn't attack them. And to do that, we had to make one very small genetic change in the pig.

NARRATOR: Using microscopic needles, White and Wallwork injected human DNA into pigs' eggs and then placed them back into a surrogate mother pig. They hoped the human DNA sequences would be integrated into some of the piglet's chromosomes.

Dr. DAVID WHITE: The bottom line is that we produce an animal one-millionth of which has DNA derived originally from a human in it.

NARRATOR: The world's first transgenic pig was born on Christmas Eve, 1992. Astrid arrived among the very first litter of pigs produced by Imutran.

Dr. JOHN WALLWORK: One of the daily newspapers phoned up and said, "We've got a picture of Astrid. Can you confirm it?" I said, "Does it look like a pig?" They said yes. I said, "Well, it could be. I mean, Astrid was a pig."

NARRATOR: Imutran's preliminary success in breeding transgenic pigs made it an attractive acquisition target. In 1996 the company was purchased by Novartis, the pharmaceutical giant based in Switzerland. But by 2000 its fortunes had changed. One reason was the revelation that Imutran had killed 10,000 pigs in its research program.

ANIMAL RIGHTS PROTESTER: This place is about pain! This place is about poison! That's what it's all about! And it's about, above all, money! Money, money, money!

[www.pbs.org: More on animal rights/xeno issues]

NARRATOR: These days, animal activists regularly blockade Huntingdon Life Sciences, an animal research facility. Since 1995, Huntingdon carried experiments for Imutran designed to test the survivability of pig organs in primates. The experiments would prove to be controversial when they became public. Over 420 monkeys and nearly 50 baboons died.

This video, shot by Imutran, has never been seen before outside the scientific community. It features baboon X201M, which survived for 39 days after his own heart had been removed and replaced with one from a genetically modified pig. Most of these pictures were taken on day 30, and he is to date the longest surviving primate with a life-supporting pig heart. For Imutran, it is the chronicle of a stunning success. But others see it differently.

DAN LYONS, Uncaged Campaigns: Baboon X201M was the animal that Imutran highlighted in their published study. But what Imutran haven't mentioned are the dozen or so other baboons who were subjected to a similar procedure, who endured experiments that were, you know, an unmitigated failure.

NARRATOR: Last year the entire log of these experiments was leaked to the British-based Animal Rights organization Uncaged.

DAN LYONS: It would be impossible to try and portray them as any form of success. A quarter of the primates have died within a day or two, just as a result of the complications of these surgical procedures, because they are so drastic and severe.

NARRATOR: Imutran maintains that none of the primates die in vain: something new is always learned. These animals were used to develop the anti-rejection drugs that could one day sustain a pig transplant in humans.

But animal activists question whether primates are meaningful predictors how pig organs will perform in humans. Of those primates who received a pig heart or kidney, the average survival time was just 13 days.

DAN LYONS: One of the most unfortunate animals had a piglet heart transplanted into his neck. Now, what happened with him, it was a particularly disturbing example, I think, because for several days he was holding the heart, the transplanted heart. It was swollen. It was seeping blood. It was seeping pus as a result of the infections that often occur in the wound site where the operation has taken place. He suffered from body tremors, vomiting, diarrhea. And the animal just sat there.

I think living hell is really the only sort of real way you can get close to describing what it must be like to have been the animal in that situation. I don't think that animal experiments can ever be justified because the deliberate infliction of violence, suffering and death on another is wrong, you know, be it a human or any kind of animal.

NARRATOR: Now the focus of animal experiments has shifted to America. These baboons will soon receive genetically modified pig kidneys. A Food and Drug Administration committee is suggesting that they should survive up to six months before going forward with human clinical trials.

[www.pbs.org: Read the FDA guidelines]

DAN SALOMON, M.D., Transplant Biologist, Scripps Research Institute: The reality is that we rarely are seeing anyone report data beyond two months of survival in such a model. Therefore, we aren't anywhere near achieving the sort of survival that these federal committees have advised the government should be necessary. Therefore, we're still quite a ways from the implementation of these new technologies in human patients for organ transplantation.

NARRATOR: Pig organ transplants will likely happen first at a major center for human transplantation. At the Ohio State Medical Center in Columbus, 27 year-old George Ullman has been waiting five months as his life ebbs away. A virus has destroyed the muscles of his heart, and he is waiting to see if the lottery of human heart transplants will deliver him a new one.

GEORGE ULLMAN: The last thing I remember was going into the hospital for about three hours. Then I fell asleep. And I woke up six days later with a left ventricle assist machine, which is basically giving my heart the strength to pump the blood throughout my body.

NARRATOR: No mechanical device can match the performance of the human heart, which beats 30 million times a year. Because of his age, George is one of the few lucky enough to be offered the chance of a human transplant. But after five months on the device, he is fading fast.

ROBERT MICHLER, M.D., Surgeon, Ohio State Univ. Medical Ctr.: Well, in the United States, we know that every year there are between 60,000 and 70,000 new patients with heart failure who could benefit from a heart transplant. The number of patients who receive a heart transplant in the United States every year is around 2,000, and that number has remained static for the last five, seven years. Unfortunately, we do not anticipate any major changes in the number of transplants that we're able to perform from one human to another,

GEORGE ULLMAN: You get prepped to get a heart and then- I've actually gone down to the operating room and made it that far and, you know, gone under the knife, so to speak, and woken up from the anesthesia still hearing this. At that point, you know something went wrong. But you can't help to feel, you know, negative sometimes, like, "Why me?" or ask those kind of questions. It's- I'm still waiting five months, you know, but my time will come.

NARRATOR: George's surgeon, Robert Michler, is scrubbing up to carry out a heart transplant, but this time his patients are not human. Ohio State is at the forefront of xenotransplant research. An experiment is underway which involves attaching a pig's heart to one of the main blood vessels in the neck of a baboon. This is similar to the work done by Imutran in England.

The baboon is one of a class of apes whose biology and immune response mimic that of humans. The scientists want to study the way in which the killer immune cells in the baboon's blood will recognize the pig organ as foreign and destroy it.

This rejection response only occurs in the cross-species transplant of whole organs, and happens so quickly, it's been given a special name, "hyperacute rejection." It must be overcome in order to transplant pig organs into humans.

Dr. ROBERT MICHLER: These kinds of experiments are absolutely required. There is no way around this. There has been no major innovation or therapeutic breakthrough in the history of medicine without animal experimentation. It is absolutely necessary.

NARRATOR: But some disagree.

ALAN BERGER, Director, Animal Protection Institute: You have the biotech industry, you have medical centers, you have transplant surgeons that have invested a lot of time and money to figuring out a puzzle that they don't want to give up.

The procedures that we've been following in terms of animal research are the same procedures that have been used since the beginning of time, almost. In many cases, it's taken us down the wrong path. It's kept us from developing other techniques and other methods to be able to test medical research because we're so tied into the animal model. And it just seems to me that there's something inherently wrong with taking a group of living things and say, "We can do whatever we want to because you don't have a way to stand up for yourself."

NARRATOR: Despite this concern, Michler feels we should press ahead.

Dr. ROBERT MICHLER: I would envision that, in the future, what we will see is a sort of strategic plan as to who might best be served by the limited number of human hearts, who might best be served by a mechanical heart or who, in fact, might best be served by a pig heart.

NARRATOR: FRONTLINE was given unusual access to film this cutting-edge experiment, which is graphic in nature.

Dr. ROBERT MICHLER: OK, you see the heart there? And that's the extractor. Now all we have to do is just prepare the heart so that we can sew it in to the neck of the baboon.

NARRATOR: This type of animal experiment, which leaves the baboon's organs functioning normally, enables researchers to study the rejection response as it happens. In many cases, the tiny pig heart is put under the skin of the neck to test the baboon's reaction to a range of human anti-rejection drugs.

After two hours, the pig heart has been stitched into place. It begins to work immediately once the blood supply is restored. But within moments, the heart is under attack from the killer cells in the baboon's blood that recognize it as foreign. The attack focuses on the network of blood vessels in the pig organ. It causes swelling and starves the organ of oxygen.

Dr. ROBERT MICHLER: The level of energy of the heart has suddenly and dramatically dropped. The heart is being killed right now by an aggressive rejection. So what we're actually seeing is, before our very eyes, this heart is dying. This is what termed hyperacute rejection, but is the same kind of rejection that would occur in a human.

OK. Now, this is the heart, we'll put this aside for a moment.

I think that it's a tremendously graphic demonstration of what we want to overcome.

Suck in here. Now, see how the wall is thick? That's normal. But what's not normal is this appearance of black and blue everywhere. Do you see that? This is quite abnormal.

There's a tremendous amount of swelling, inflammation within the heart. This is the problem that we have to overcome. And really, it's a matter of time and ingenuity and intellect that's preventing us from doing this. This is a surmountable problem.

NARRATOR: Good news comes to George's father. After an agonizing wait, a human heart is suddenly available.

Dr. ROBERT MICHLER: Hi. How're you feeling?

GEORGE ULLMAN: Good.

Dr. ROBERT MICHLER: You ready for this?

GEORGE ULLMAN: Yeah.

Dr. ROBERT MICHLER: Congratulations. Wonderful news.

GEORGE ULLMAN: Well, let's just hope it's wonderful all the way through.

Dr. ROBERT MICHLER: Yes. And you're absolutely right, because this is- it's a big moment, but it's risky. I'm talking to the team about 8:00 o'clock, have you downstairs. We'll probably get started some time around 9:00, and it's going to be a long night.

GEORGE'S FATHER: Do they know that the heart's OK?

Dr. ROBERT MICHLER: Heart looks great. We've- it looks absolutely fantastic. It's a young heart, about your age, as a matter of fact. It's in excellent function. We're going to send the team to take a look at it in a couple of hours.

GEORGE ULLMAN: Fantastic.

Dr. ROBERT MICHLER: All right, George. We're in this together, OK?

GEORGE ULLMAN: Thanks.

Dr. ROBERT MICHLER: All right. We'll take good care of you. You know that.

All right, Dad? You ready?

GEORGE'S FATHER: I'm ready.

Dr. ROBERT MICHLER: OK. He and I- I had been his heart surgeon. He had bypass surgery.

GEORGE'S FATHER: He did my heart surgery.

Dr. ROBERT MICHLER: Yeah. So this is- we'll take good care of him, all right?

[in surgery: I'm having to open up the breastbone and the belly, get the device out, then take the heart out, and then put the new one in.

OK, off with the device.

NARRATOR: This is the point of no return. After five and a half months, George is taken off his heart-support machine, and his own heart is being allowed to die. He allowed FRONTLINE to film the operation.

Dr. ROBERT MICHLER: Our focus is to provide therapies that will restore life, restore quality of life to hundreds of thousands of patients who could benefit from a procedure that becomes daily, routine, common.

[in surgery] It's all grown in. This is what tissue does. OK. Ah! Voila! Very smooth. This is heart surgery. It's ridiculous how difficult that is. Most heart surgery is very clean, very pristine.

The tragedy of this area of medicine is extraordinarily powerful. We rely on tragedy to save lives.

And that's the heart. That's the old heart. So you know you did right. All right, could I have the heart?

The young man who gave his organ last night to George was a working 29-year-old who died in a motor vehicle accident. And the sheer magnitude of a family's tragedy and the ability for a family to- in a moment of such despair, to be able to think of organ donation and to consent to organ donation, in my mind, is absolutely heroic.

OK, that's his new heart. His EKG is normal. There's no evidence of injury occurrence. This is all really very, very nice for this part of the operation because it really is fairly magnificent to see that new heart functioning.

[recovery room] Open your eyes, George, OK? Talk to us. How are you feeling?

GEORGE ULLMAN: Can I sit up?

Dr. ROBERT MICHLER: No, just- yeah, we can help you sit up.

GEORGE ULLMAN: I did wake up, so that was a plus right there. I didn't hear the pump, and so I knew it was a success.

INTERVIEWER: Does the heart feel like your heart yet to you?

GEORGE ULLMAN: Yeah. Yeah. Possession is nine tenths. It's mine, so-

Up until, you know, last year, I was as healthy as any other 26-year-old person. And by no means did I ever think that this would happen. And so I think people watching this show should know that, just know that their health is very fragile. And no one's invincible.

INTERVIEWER: Would it put you off if it was an organ from an animal?

GEORGE ULLMAN: Well, I'm not going to tell you that I would want a pig organ more than a human. But in that circumstance, I guess you would have to look out for your best interests, because who's to say when that human is going to come around, when there's a pig organ sitting on the sideline right there.

Organ Farm - Part One

DIRECTED BY
Frank Simmonds

PRODUCED BY
Ben Loeterman
Frank Simmonds

SENIOR ASSOCIATE PRODUCER
Michael Chrisman

EDITOR
Andy Kemp

NARRATOR
Will Lyman

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Laura Longsworth

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Paul Cox
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COORDINATOR
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POST PRODUCTION
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SECRETARY
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DESIGNER
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Robin Parmelee

SENIOR PRODUCER
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STORY EDITOR
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EDITORIAL DIRECTOR
Marrie Campbell

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Louis Wiley Jr.

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Jim Bracciale

EXECUTIVE PRODUCER
Michael Sullivan

SENIOR EXECUTIVE PRODUCER
David Fanning

A Carlton Television Production for WGBH/FRONTLINE in
Association with Lion's Den Productions and
Ben Loeterman Productions, Inc.

© 2001
CARLTON TELEVISION, LIMITED AND WGBH EDUCATIONAL FOUNDATION ALL RIGHTS RESERVED

ANNOUNCER: Next time, on Part 2 of Organ Farm, see what pig cell transplants are already doing for Alzheimer's and Parkinson's patients.

JIM FINN: Before the surgery, I couldn't walk. I couldn't talk. I couldn't use my hands. And it was just getting worse as time went by.

Dr. SAMUEL ELLIAS, Neurologist, Boston Univ. Med. Ctr.: This is six months after surgery's performed. He's walking independently, on his own.

ANNOUNCER: Meet a young man who is one of only two in the world to undergo a revolutionary procedure that saved his life.

CHARLOTTE PENNINGTON: Within hours of being on the pig, we could see a change in his color. It's called a bridge to life.

ROB PENNINGTON: The pig did save my life.

ANNOUNCER: And learn new information about the risk of a deadly pig virus being unleashed on the public. Don't miss the compelling second part of Organ Farm next time on FRONTLINE.

This report continues on our Web site with more about why the U.S. has turned to xenotransplantation and England hasn't, a deeper look at the animal rights issues, interviews and reports on risks surrounding these procedures for the individual and society, a closer look at the regulatory questions and ethical issues, and what about alternatives to xenotransplantation? More on that, too. Then join the discussion. See what others thought about the program and add your own thoughts at pbs.org or send us an email at frontline@pbs.org, or write to this address: DEAR FRONTLINE, 125 Western Ave., Boston, MA 02134.

In two weeks on FRONTLINE: Nicholas can't sit still. Alex is depressed.

ALEX: If I get rid of the ADD, I get rid of the depression.

ANNOUNCER: Noelle can't concentrate.

NOELLE: Fifth grade is, like, when it all crashed.

ANNOUNCER: Robin is rebellious.

PARENT: We tried Ritalin, then Cylert, then Wellbutrin.

ANNOUNCER: Should these children be given drugs to change their behavior, or are they just being kids? ["Medicating Kids"] In two weeks on FRONTLINE.

To order tonight's program on videocassette, call PBS Home Video at 1-800-PLAY-PBS. [$19.98 plus S&H]

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