Organ Farm - Part 2
Program #1913
Original Airdate: April 3, 2001

Produced by
Ben Loeterman
Frank Simmonds

Directed by
Frank Simmonds

NARRATOR: It's been called a medical miracle, emerging from science fiction to the operating room.

DAN SALOMON, M.D., Transplant Biologist, Scripps Research Institute: Successful xenotransplantation 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: It could answer the prayers of desperate patients, 15 of whom die each day for lack of a human transplant.

ROBERT MICHLER, M.D., Surgeon, Ohio State Univ. Medical Ctr.: 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.

NARRATOR: But there are risks.

Dr. DAN SALOMON: We got infection, living cells within an animal following a pig tissue transplant.

HUGH AUCHINCLOSS, M.D., Chmn., FDA Subcmte., Xenotransplantation: 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.

NARRATOR: It's a technology opposed on ethical grounds.

JIM FINN: Let them come down with a horrible disease and see how quickly they change their song and dance. I don't believe in animal testing for cosmetics or that kind of thing, but when a human life is involved, yes, you can go ahead with that.

NARRATOR: And the big question: Will it work?

CHARLOTTE PENNINGTON: Doctor Levy came and began talking to me, and telling me how critically ill Robert was. And he began presenting me this procedure.

NARRATOR: Tonight on FRONTLINE, an inside look into the secret, brave new world of the Organ Farm.

What would you say to school children if you were recovering from a terrible stroke and were volunteering for an experimental treatment to try and fix it? Today the 6th-grade class in Saratoga Springs, New York, are about to meet someone who is doing just that. Their teacher, Paul Cook, is driving to work with the day's guest speaker, his wife, Maribeth. She had a stroke six years ago which left the left side of her body paralyzed. After doctors told her it would be permanent, she became the first stroke victim to volunteer for a pig cell transplant.

MARIBETH COOK: [to class] The day I fell ill was October 4th, 1994. I was at work, setting up for my 7:00 o'clock in the morning patient, and I had a pain in my head, and I hit the floor. I was at the time 34 years old. This can't be happening to me. To lose part of your body, your whole life changes in an instant. I mean, I was at work and I never went back. That's it. Bam! It was over.

My doctor told my parents and my husband to put me in a nursing home, that I would never be able to do anything I'm doing now. I got rid of those doctors and got somebody else.

I thought I was in the middle of a science fiction movie when I was in the operating room, and I see all these people, all these scientists. I'm, like, "Wow." They just opened up my brain. The drill had already been on my head. It was amazing. I was just glad to be a part of it.

So I was awake. I was asking if I was turning pink yet. You know, "Just tell me I won't grow a tail." I was being silly. I didn't know how far they were going in. They were right above my brain stem. Had I known that, I think I would have been a little bit more serious.

STUDENT: Was it a hard decision when they asked if you wanted to do the surgery?

MARIBETH COOK: I get asked that all the time, and it wasn't. That's all I want to do is get better. I'm still young. I want to enjoy the rest of my life. My husband was a mess over this. I was, like, "Let's go. I'm packed." My doctor called, "I'm packed. Let's go."

STUDENT: Did you know the risks to have the operation?

MARIBETH COOK: Yes. Yes. I had a 12-page consent form I had to sign, so they laid out everything. I mean, the night before my surgery, I was planning my funeral, just in case. I mean, you have to do these things just in case.

I have to donate my brain back to science in the event I have an untimely death, or any way I die, my brain goes back to them so they can do an autopsy and see how far these cells have progressed.

NARRATOR: A year and a half ago, 30 million fetal pig cells were implanted into the stroke-damaged part of Maribeth's brain. Since then, she no longer needs her wheelchair and has completed a half-marathon.

Four out of the five stroke victims treated so far, including Maribeth, have shown real improvement. Other trials are now under way to see if pig cell implants can help patients with epilepsy and the neuro-degenerative diseases Huntington's and Parkinson's.

Maribeth still needs a leg brace to walk, but she is seeing remarkable gains at her twice-weekly physical therapy sessions.

[www.pbs.org: More about the clinical trials]

PAUL COOK: It's just amazing to see the condition she's in today, mentally and physically, since this pig cell transplant. Overall, her spirits are just better.

Maribeth's thought processes are much clearer than they used to be. Her grammar, her spelling and just the clarity of thought is much better. So that's an improvement. She couldn't move her ankle for years. It was frozen. Now- you'll see this at physical therapy- now it moves 28 degrees, so she's walking faster with greater safety than ever.

Her speech has significantly improved since this operation. So there's been a number of things that have improved. And we're- I'm very pleased with the progress, very pleased.

NARRATOR: Maribeth's trial is funded by the biotech firm Diacrin. Cell implants and organ transplants represent a market potentially worth billions of dollars. Although the trials are promising, there's a problem. Pigs carry a genetically inherited virus, a virus that could infect patients and perhaps others. So Maribeth's blood must be tested- for life.

MARIBETH COOK: They take blood samples every time I go in. And I've never heard anything back from my blood samples, so the nurse told me everything must be fine. And I think they're just monitoring for a pig virus that way.

NARRATOR: Each month, Maribeth's blood is sent to the Centers for Disease Control in Atlanta for screening under strict Food and Drug Administration guidelines.

HUGH AUCHINCLOSS, M.D., Chmn., FDA Subcmte., Xenotransplantation: We need to be collecting blood samples before the transplant, around the time of the transplant and at periodic intervals thereafter. We need to be watching carefully to determine whether unusual events happen to these patients, and if so, can we determine an explanation for them. And all of those things are happening in the FDA-monitored trials that are occurring right now.

NARRATOR: It wasn't always the case. When the risk from the pig virus was first reported in 1997, the FDA halted all cross-species trials in the U.S., and the companies which had been funding them scrambled to see if any patients had become infected.

DAN SALOMON, M.D., Transplant Biologist, Scripps Research Institute: A number of biopharmacy companies, including Novartis, went forward and did a trial of every patient they could get in the history of xenotransplantation, that they could get tissues and blood samples from, that had been exposed to pig cells. And when this was analyzed in close collaboration with government scientists at the U.S. Centers for Disease Control, the pig virus was not seen in any of those patients or any of these cells.

Now, this doesn't prove that this is safe, but it very important evidence to reassure scientists and physicians and regulatory agencies and the public.

NARRATOR: The FDA relaxed its ban and slowly restarted trials for cell transplants, which it considers less risky than the eventual goal of whole organ transplants. But some scientists have doubts about this distinction.

Dr. DAN SALOMON: There have been some people arguing that cell transplantation, because the dose is smaller, the dose of potential virus exposure is smaller, that there would be less risk. That might seem to be true if you just think about the size of an organ versus a few cells. But the reality is, is that if a cell is transplanted and survives long-term and day after day is putting out infectious virus, the risk is every bit as real as a bigger organ surviving for the same period of time putting out a little more virus every day. Once you reach a threshold of infectious exposure, you get infected.

NARRATOR: In England, the government agency regulating xenotransplants has said it may never be possible to protect the public from the danger of infection from viruses and suggests looking for alternatives.

[www.pbs.org: Alternatives to pig transplants]

NARRATOR: In the U.S., a few scientists have called for a moratorium until the risks are better known.

FRITZ BACH, M.D., Medical Ethicist, Harvard Medical School: One of the potential risks to the public is that we would transplant a pig organ which contains the genetic information, the genes, for a virus, a virus which is very much like the AIDS virus, that that pig virus would jump from the transplanted organ to the human cells, would change genetically, and that perhaps in a way similar to how the AIDS virus is transmitted, sexually or by blood, would then be passed to the general population.

The terrible problem with that, in terms of trying to evaluate this potential risk, is nobody can quantitate it.

NARRATOR: When those first concerns about a possible pig virus arose in 1997, they were investigated by Robin Weiss, a professor of virology at University College, London. Weiss and his then-colleague, Clive Patience, wondered if pig viruses had the potential to cause infection when pig cells were transplanted into the human body.

ROBIN WEISS, M.D., Virologist, University College London: Some viruses infect cells of what we call the germ line. That is the cells that are destined to become the eggs and the sperm of the host species. And that's a clever thing for a virus to do because it gets a free ride to the next generation. In this way, the virus becomes inherited as a genetic trait, just as we might inherit blue eyes or some other feature.

NARRATOR: Scientists know that the genes passed from an adult pig to piglet carry up to 50 copies of instructions to make slow-acting viruses. They appear to cause the pigs no harm, but Weiss and Patience concluded that every xenotransplant would also transfer the viruses to humans, where the potential harm is unknown.

CLIVE PATIENCE, M.D., Virologist: Essentially, we challenged the human cells with the complete mixture of 50 viruses and waited to see which one of those, if any, could grow in a human cell. And it now turns out that we probably have somewhere between one, maybe three of the fifty copies that can grow in human cells.

Dr. ROBIN WEISS: Then we found that about half the different human cells we tested were susceptible to infection. And that really did show us that this virus had the potential to infect humans. I think it's going to struggle to infect patients. But life is full of surprises. It might well adapt inside the first patient as, presumably, HIV had to adapt when it got into the first human, and then take off.

NARRATOR: A pig cell transplant offers the virus a unique pathway to reach its new human host. It could stay dormant for years, but scientists fear what could happen if a particle of virus mutates and then escapes from the pig cell.

Dr. HUGH AUCHINCLOSS: Let's 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 feature of a pig cell living in a human body and the genetic material having the opportunity to cross over into the human cell? Then you'd have to go still further and imagine that this new virus that we've never seen before actually causes a human disease and is actually transmissible from one human being to another.

So the sequence of steps, each of them, is probably very, very unlikely. But how unlikely do you want it to be before you allow xenotransplantation to proceed ahead?

NARRATOR: Four years ago, Jim Finn had 12 million fetal pig cells injected into his brain. He was one of the first people to do so. At the time, his medical condition was desperate. Like stroke, Parkinson's is a disease scientists hope this procedure could help alleviate.

JIM FINN: I was what they call end-stage Parkinson's, which means there's nothing left that they can do. They tried all the medications, and they weren't working. I couldn't walk. I couldn't talk. I couldn't use my hands. It was- and it was just getting worse as time went by.

INTERVIEWER: How long have you actually had the disease?

JIM FINN: Twenty years. I was diagnosed at age 32.

NARRATOR: Jim's physician made a before and after video of his xenotransplant experience.

SAMUEL ELLIAS, M.D., Neurologist, Boston Univ. Medical Center: So before the operation was done, when he's 12 hours off medicine, he's turning his hand very, very slowly. He's actually trying to move his hand as fast as he can, and that's as fast as he can go. And he's having a lot of difficulty with it. And while he's reading, you can tell that his voice isn't very well modulated.

Now, when we try to have him get up from a chair all on his own, he has great difficulty doing it, and he needs assistance from a nurse to stand up. And she's going to ask him to take a step forward, but in fact, he's unsure of himself, and he'll easily fall backwards with the lightest touch. But we warn him before we tap him backwards, and he can't control his balance. And at this point he's trying to take the largest step he can, and he can't move his feet.

JIM FINN: Just before the surgery, I had deteriorated so badly that I was contemplating suicide. I was immobile. I was vegetative, almost. It was just awful. There was no hope left. This operation gave me some hope.

NARRATOR: Surgeons injected pig cells into the area of Jim's brain that was failing to produce a chemical called dopamine. The results were dramatic.

Dr. SAMUEL ELLIAS: Now, this is six months after surgery's performed, and he's moving his hand much more rapidly. And he's walking independently on his own- again, 12 hours off of medication. And he's able to get up from a chair and sit down spontaneously on his own, executing his own turns. And then when he reads, you can see that he has more facial expression. There's more modulation of his voice.

It's clear that he's feeling much better, even 12 hours off of medication. His mood is much lighter. It's very unusual to see this level of improvement in someone who's already been on most of the treatments for Parkinson's disease, which have begun to fail and are not working well.

We've now seen Jim for over three-and-a-half years, and his gains have been really remarkable.

JIM FINN: Within three months, I was starting to see little things, that I could butter my bread. I couldn't do that before. I could do shopping, drive my car, walk to the grocery store. I can walk on two feet rather than crawling on all fours to get from room to room. I was able to take a trip to Russia, which I never could have done before this operation. It was a very demanding trip. Little things, several things, finger taps like this, which I could not do before. See how well I do them right now?

NARRATOR: When another patient in the Parkinson study died, the scientists were able to answer an important question: Were the cells still working?

DOUGLAS JACOBY, M.D., Director of Research, Diacrin Inc.: There were surviving pig cells located where we had delivered them, dopamine-producing cells, which are the cells that we would need to replenish in Parkinson's disease. So we believe that even in the face of on-going disease progression that these cells have a chance of surviving long-term.

NARRATOR: Despite Jim's promising results, last week Diacrin reported an unwelcome surprise. In a controlled trial there were improvements, but there was no difference between patients injected with pig cells and those who received a placebo.

[www.pbs.org: Update on Parkinson's trials]

NARRATOR: And scientists remain concerned with potential spread of virus. In one of the latest experiments to track the transfer of viruses into another animal, pig cells were implanted into mice with severely weakened immune systems. Dr. Dan Salomon figured the mice would mirror the condition of a human transplant patient.

Dr. DAN SALOMON: What we found was that pig cells continued to produce infectious virus after the transplantation and, in fact, actually increased their production of virus. We got infection. This was the first example of infection of living cells within an animal following a pig tissue transplant.

ROBIN WEISS, M.D., Virologist, University College London: The significance of this new report is that the infection was seen not just for cells in culture, but in the living animal, in the mouse. So it's significant really, in both ways, that the cells on xenotransplantation really do start to release virus, and that that virus can take in the living animal. And this again leads us to say, well, if it can happen in mice, can't it happen in humans?

NARRATOR: The pig virus would have to mutate inside its new human host to cause a rapid infection. Current knowledge suggests it will be slow-acting, but there are clues to the sort of disease that it might cause.

Dr. ROBIN WEISS: The closest animal relatives to the pig virus are viruses of mice and dogs. The most common disease that occurs is a type of cancer, usually a lymphoma lymphoid cancer. They develop lymphoma or leukemia. The disease only appears after quite a long period, incubating as a silent or inapparent infection, perhaps for years before it came out and caused the disease.

[www.pbs.org: More on the virus threat]

NARRATOR: At a waterfront animal research facility in Boston, scientists are trying to learn if the possibility of disease might have been eliminated through an accident of breeding. With government funding, this herd of miniature swine was inbred over 20 years by Dr. David Sachs, then brought to Boston where he joined the company Biotransplant. Though no one is sure why, in the process of inbreeding, the pigs may have become safer for humans.

CLIVE PATIENCE, M.D., Virologist: People are very interested in these animals because this is the first breed of pig which has been identified which seems to lack any pig virus that will infect human cells. The results are preliminary, but we're obviously going on very excited.

If these animals really do lack the infectious virus, then I would see them as, ultimately, the safest breed of pig to use for xenotransplantation.

NARRATOR: If it proves to be true, these pigs would be extremely valuable, especially to the pharmaceutical giant Novartis, which is forming a new joint venture with Biotransplant. Novartis has long backed animal experiments to develop new medicines. It sees xenotransplantation as a logical extension of its business.

But using animals as spare parts for humans has run into strong opposition in Europe. In England, a recent poll showed 41 percent of the people opposed animal experiments, even to help humans. Such popular opinion has helped keep xenotransplants from becoming a reality in England.

[www.pbs.org: Explore the animal rights issues]

NARRATOR: One of the new activist groups is led by Dan Lyons.

DAN LYONS, Uncaged Campaigns: 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: Such sentiments anger those who have been helped by a xenotransplant.

INTERVIEWER: What do you say to hose people who say we have no right to exploit animals in this way?

JIM FINN: Let them come down with a horrible disease and see how quickly they change their song and dance. I don't believe in animal testing for cosmetics or that kind of thing, but when a human life is involved, yes, I think we can go ahead with that.

NARRATOR: In North America, where Novartis has found a friendlier regulatory environment and fewer animal rights protesters, scientists are preparing a model production line for xenotransplants. This animal holding room, where a donor pig is being anesthetized, is designed to be next door to a hospital operating room.

Prof. DAVID WHITE, M.D., Univ of Western Ontario: We can have the animals close to where the transplant is going to be taking place, and so really reduce the travelling time, which keeps the organ in much better condition.

There are a number of big advantages to taking the organ from the animal. Firstly, of course, we're not going to have to be taking organs from people who might have died in their late 50s, 60s. These are young, healthy pigs. We can certainly give a guarantee of quality of the organ to be transplanted, and no limit on the numbers. We can potentially help very, very many people.

NARRATOR: These transplant surgeons are practicing harvesting pig kidneys to see how the procedure would work.

DAVID GRANT, M.D., Transplant Surgeon, Toronto General Hospital: The purpose of this elaborate set-up is to make sure that there's no contamination from this environment to that environment. The pigs are kept in as healthy a state as possible, no contamination from the outside.

NARRATOR: Although no organ transplants have been permitted, doctors are filled with hope for the future.

Dr. DAVID GRANT: Transplantation makes people better, and I want to see that my patients get the chance to have a transplant and enjoy the rehabilitation that that can provide them. We're only transplanting probably about 20 percent of people that might actually benefit from transplantation.

As we speak here, there's a patient who's dying in the hospital because he missed the opportunity to have a transplant in time. So that pig kidney offers the hope and the potential that we can help these people in a way that's not possible now with human donor organs.

The pig is the answer to my prayers, in the sense that it's the only way, I think, that we're going to really be able to achieve the full benefits of transplantation.

NARRATOR: Dr. Grant allowed our cameras to record the operation.

Dr. DAVID GRANT: We recognize that this has important implications for all of society. There'll be costs to be borne. There will be social issues, in terms of who will qualify for this kind of therapy. And there are concerns about the potential for infectious diseases and the importance of putting in place safeguards and procedures to monitor for that.

So I think everyone working in this field accepts that it's not something that's going to be done by a surgeon in a little town somewhere in isolation. It's going to be done in a much broader context.

[in surgery] I'm doing this exactly the same way that we would in a patient. Perfectly normal appearing kidney. These organs really look very similar to human organs.

That kidney represents hope for us working in the field because we get tired and disappointed by the fact we can't help our patients the way that we would like to. And I think for our patients, it offers the hope of a future that may not otherwise be available to them.

NARRATOR: After the operation, the animal is killed. The two kidneys are taken away to have human blood pumped through them to test their performance.

To some, the whole idea still smacks of science fiction. Until now, xeno research has mostly taken place behind closed doors, but some inside the industry see the need to address the issues publicly.

DAVID WHITE, M.D., Co-Founder, Imutran, Ltd.: I think there are a lot of people who will be watching this program who will sort of have an uneasy feeling that, well, it's not natural. I mean, we've been using pig insulin to treat diabetes for generations. We've been using pig heart valves to treat people in heart failure for decades. We've used pig skin. We're starting to use pig cells. And I think it's essential that we take the public with us at every step because, after all, if they reject it, then xenotransplantation will never be a success.

NARRATOR: Besides the threat of virus, the biggest obstacle holding back organ transplants remains the issue of cross-species rejection. In this graphically filmed operation, a doctor attached a pig heart to the neck of a baboon. The effects of were immediate.

ROBERT MICHLER, M.D., Surgeon, Ohio State Univ. Medical Ctr.: 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.

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

NARRATOR: If hyperacute rejection is to be overcome, it will likely happen in Wisconsin, at this research farm of a company called Infigen. Here Novartis is backing efforts to solve the problem by genetically creating a new type of pig.

Infigen's president, Mike Bishop, is one of the leading animal cloners in the country. He's genetically modified these piglets in ways unimaginable just five years ago. Once a prototype pig containing the right combination of human genes is cloned, a limitless supply of spare parts for humans can be bred.

MICHAEL BISHOP, Ph.D., President, Infigen, Inc.: In effect, we're able to humanize those organs by making certain genetic modifications, by adding certain genes to the cells that we clone, or knocking out certain genes so that they don't express, so that you have greater immuno-acceptance of those organs.

NARRATOR: In order to create pigs whose organs can be used in man, the scientists need to reprogram these pig cells. One method is by putting human genetic material in with the cells and then firing an electric current through the mixture. The current drives the human gene into the pig cell. The mixture then goes back to the incubator, and the cells are left to multiply.

MICHAEL BISHOP: The real art in the selection process is to be able to identify which cell culture has specifically taken up the correct humanized DNA. We are looking for a needle in a haystack, but in an event that happens maybe once in every 100 million cells, we can find it.

NARRATOR: But fooling the human immune system and thus solving the first stage of rejection may increase the threat from pig viruses.

Dr. DAN SALOMON: Now, the interesting irony in that is if we go at genetic engineering approaches to essentially prevent rejection, you could create a situation in which you've hidden the virus, much like a Trojan horse, by hiding it under the guise of all this genetic engineering you did to successful evade the standing army's immune response.

NARRATOR: Scientists are also trying another method: to "knock out" the pig gene that causes hyperacute rejection. All animals except certain primates make a protein the human immune system recognizes as foreign and attacks. If the scientists could knock out the gene that makes the protein, pig organs might become invisible to the body's immune system.

These piglets, born last month, are the breakthrough first step in that process. They carry the gene construct capable of knocking out the protein, an advance thought to be years away.

MIKE BISHOP: Once you've identified the correct combination of genes to put in and genes to knock out, then you have a cell culture that is an unlimited genetic source of material from which you can make piglets of the same genetic genotype over and over again.

NARRATOR: These ever greater genetic leaps and bounds toward human compatibility require manipulation of cell lines by the thousands. Traditional animal husbandry has been replaced by high-tech scientific methods. These techniques include cloning, which will help scientists create a pig whose genetic makeup is optimal for transplants of the future.

This is how cloning works.

MIKE BISHOP: The eggs are retrieved from ovaries that are brought into the laboratory from abattoirs. The process of removing the DNA requires that the DNA be illuminated, so under the microscope, under low-light fluorescence, you can see the DNA. It's removed by making a small hole in the side of the egg with a small, fine tool. The DNA is sucked out of the egg using a vacuum.

What you end up with is an egg that has no DNA that directs it in what to do. So we replace the DNA with the humanized cell, and we place that cell inside of that egg, and the DNA materials become the driving machinery. At that point the cell begins to divide,

The pig cells multiply, and you develop into a developing embryo and eventually a fetus, and then, hopefully, into a live piglet. These eggs are surgically implanted, and the animal acts as an incubator and develops these embryos into fetuses, and eventually, live piglets are born.

NARRATOR: Infigen has successfully cloned a pig carrying a human gene. Ten recent litters have produced cloned transgenic piglets, marked with a "T" on their backs. Because the pigs are transgenic, humans might not reject their organs. And because they are clones, there now exists a living production line of animal organs that potentially could be used as spare parts for humans.

MIKE BISHOP: We finally have the tools, the physical tools, to explore a multiple array of genes that can produce animals with the same universal genotype, so that organs can be universally transferred from the pig to any human who has a need for any type of organ.

NARRATOR: It's a technology that many still consider years away from being common clinical practice. Even if the hurdle of hyperacute rejection is overcome, there remain other levels of chronic rejection to treat, not to mention the threat of viruses. Still, organ transplants are no longer just a theoretical idea.

Although organ transplants cannot be performed in the U.S., two people have had their lives saved by organs from a humanized transgenic pig. Both were treated at the Baylor University Medical Center in Dallas, Texas. The first was 20-year-old Rob Pennington. He was an emergency admission for liver failure in the autumn of 1997, just weeks before such experiments were halted by the FDA.

RAY PENNINGTON: We thought we would have time to prepare ourselves for a regular, normal transplant, and we had no idea that he would go downhill so quickly. And that's the part that we didn't expect.

CHARLOTTE PENNINGTON: It was an 80 to 90 percent chance he could die that night. On the second night, Doctor Levy came and began talking to me and telling me how critically ill Robert was, that he was on the most life support there was available to keep him alive at this point. And he began presenting me this procedure. He said it was a research project. It was not anything that had been done before. We were in uncharted territory. But it was a possibility of saving his life.

NARRATOR: There was no human transplant organ available for Robert, so the surgeons proposed hooking him up to a series of pig livers outside his body. This, they hoped, would keep him alive until a human donor could be found.

CHARLOTTE PENNINGTON: They told us that there were only seven pigs available for the whole procedure. They did not know how long one pig liver would last. It's much like the kidney dialysis. The toxic blood is pumped through the liver and cleaned, and then warmed and put back into the body. And we were told that they did not know how quickly this pig's liver would disintegrate with all of the toxins that were in his blood at the time. So they said at the end of that seven pigs, if it hadn't worked, that's all they had. It's called a bridge to life, and that's truly what it was.

Within hours of being on the pig, the blood being cleansed, we could already begin to see a change in his color. I remember holding his arm. Whether he was aware of it or not, we were telling him, "Hold onto Jesus because he's holding on to you. And just hang in there, Bob. You're fighting, and keep fighting." Ours is a story of hope and miracles from the very beginning of arriving at the hospital. And God had real specific plans in place to save this young man's life.

NARRATOR: The pig organ gave Robert Pennington the three days' grace his doctors needed to find a human liver. He is now fit again, after a long recovery period, and training to become a computer Web site designer.

RAY PENNINGTON: [to church members] I just want to give everyone an update. It seems like it's been more than two years. Well, I guess it has been more than two years. And we're so thankful that the prayers have been there when they were needed, and the prayers were answered. And he's doing well, and he continues to do well. So we want to thank the church family for all their prayers.

ROBERT PENNINGTON: I woke up in the intensive care unit real confused about the whole thing. It was probably a week and a half later when I did start to realize and understand what I'd been through, and that the pig did save my life. Hearing how I was kept alive was just amazing, really.

INTERVIEWER: Did you sort of mentally check yourself out, you know, "Am I still me?"

ROBERT PENNINGTON: Yeah. It was a unique experience. Yes.

Once I got over all that, I was just real happy for the longest time, and just felt real peaceful about everything and just felt like I had like a new life or something, like I was given a second chance.

RAY PENNINGTON: I recall that he- did he ask the question, "Can I still eat bacon?"

CHARLOTTE PENNINGTON: Yeah. Or ham.

RAY PENNINGTON: Or ham. It was very strange to Bob.

NARRATOR: The animal that saved Robert's life came from a quarantined herd of transgenic pigs. His parents were so curious about the animals that they asked to see the research facility where they were kept. Robert was also curious. But because he was too ill, he couldn't go until now.

RAY PENNINGTON: It looked like a very normal pig.

INTERVIEWER: Did it have a name or a number?

RAY PENNINGTON: Yeah. Well, Sweetie Pie was the name that they used. And subsequently, we had a name change. We changed the name to Wilbur. A very exceptional and special pig. So that's just something we did. And I carry a wallet- a photo of Wilbur in my wallet just as a reminder.

INTERVIEWER: This was a transgenic animal, an animal whose organs have been modified to be human-compatible. Do you see that as meddling with God's design?

RAY PENNINGTON: I don't think so. I think that everything we have comes from God. And what we do with it, what mankind does with it, of course is up to us.

CHARLOTTE PENNINGTON: It's God and mankind and science together working that will someday better all of our lives.

ROBERT PENNINGTON: Someday they'll want to be able to raise a pig organ to be able to actually be transplanted into a human, and for them to have a healthy, normal life from it. And I think this was the first step towards that.

There are really no side effects to the pig's liver, bad ones, at all, nothing. There's no special medications, nothing like that, you know, as a result of it. You know, the only thing, as with a normal liver transplant, I just take one pill twice a day for probably the rest of my life. But that's the only difference in my life, really. If it's going to save somebody's life, then I'm all for it. It saved my life.

INTERVIEWER: What do you say to people who feel that we just shouldn't use animals in this way?

CHARLOTTE PENNINGTON: They've never had a son die. And as sick as our son was, we were grasping for whatever chance he had at life.

NARRATOR: Robert was attached to the liver for only seven hours over three days, but the risk from the pig virus remains. Live cells from the pig liver were undoubtedly flushed into his body, where they may survive to this day. Robert's blood has so far tested negative for any unusual infections. But since the organ bridge, his personal health is also a matter of public health.

MARLON LEVY, M.D., Transplant Surgeon, Baylor Univ. Med. Ctr.: Well, I think there is a risk to the rest of us. I think the big question is how large is that risk? Is it justified to continue with experiments such as this one that we performed or other actual cross-species transplantations?

Robert and patients like him are being watched very closely. Their blood is being banked. And when new tests or more sophisticated testing methods for viral infections or otherwise are discovered, then their blood will be taken through those tests. There's a very close scrutiny of the patient, and ultimately, of their families.

Robert has done well. The other patient that we have experimented with in this way has also done well. Their family members continue to be alive and well. Our staff doesn't seem to be- to have been infected with any unknown or strange disease. And so as we look back on this experience, we- you know, we have to tell ourselves we still haven't found any reason for us to stop.

INTERVIEWER: Can you guarantee that that situation wouldn't change over time?

Dr. MARLON LEVY: Guarantee's a strong word. Guarantee's a very strong word. I'm a very biased person in this whole process. I've seen the results of the work, and I'm enthusiastic about it.

FRITZ BACH, M.D., Medical Ethicist, Harvard Medical School: Xenotransplantation, while a wonderful therapy for the patient who needs a transplant, poses a potential risk on the public. The Hippocratic Oath today, I think, should at least imply or explicitly cover the responsibility that we carry, the duty that we carry to consider both the patient and others who might be affected. And it's a very difficult problem.

We have to go to the public. We have to inform that public and say, "Under which conditions are you willing to have us go ahead and put the public at that potential risk?"

Organ Farm - Part Two

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ANNOUNCER: 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.

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