Medical futurology is no excuse for the UK's organ failures

A mouse with a human liver is extraordinary indeed, but we should do better with what science has provided.

We can create a mouse with a human liver. So, no longer any need to face up to the tricky subject of organ donation, right? Wrong. One of the dangers of such achievements is that we begin to think that a solution to the organ crisis is just around the corner.

The Japanese mouse-human chimera involved taking adult stem cells from human skin and chemically inducing them to return to their “pluripotent” state, where they can become any kind of cell. Further treatment guided them to take the form of liver cells, which were then grafted into the mouse. There, they connected to the blood vessels and formed into a functioning human liver.

The work built on an idea first put forward by the US geneticists Tim Townes and Thomas Ryan in 2000. They spotted that knocking out certain genes and inserting genetic material from an afflicted patient allowed you to rear an animal whose heart, liver, pancreas or blood or skin cells were human – that were genetically matched to the recipient and were in every way perfect for transplantation.

By coincidence, Townes and Ryan submitted their patent application on the day after Sally Slater was discharged from a hospital in Newcastle. Slater, aged six, had undergone an emergency heart transplant after a virus attacked her cardiac tissue. Her donor was a recently deceased, middle-aged woman whose family came forward to help after Slater’s father issued an emotional appeal through the national media.

Every year in the UK, a hundred or so families go the other way and overrule the wishes of a deceased relative who had wanted to donate his or her organs. In the decade that it might take for the Japanese success to make any headway into patient treatment, more than a thousand families could dash the hopes of the desperately ill. That’s in this country alone, where more than 7,000 people are waiting for transplants. A thousand of them will die this year because of a lack of organs. Slater, now a thriving 19-year-old with a 62-year-old heart, has been vocal and active in drawing attention to the shortfall, encouraging more people to sign up for organ donation.

Things might get a little better after the 2 July decision by the Welsh Assembly to adopt “presumed consent” for organ donation. After 2015, people in Wales who don’t want their organs recycled will have to sign the opt-out register. Somewhat perversely, organs from Wales will be available to patients in the rest of the UK, which remains opt-in after a 2008 review concluded that opt-out was unlikely to increase the number of donated organs and risked reducing their availability IN THE FRAME by undermining trust in the medical profession.

Britain has one of the highest refusal rates in Europe, with half of all families denying organs if the deceased’s wishes are not known. In some ways this is understandable. It is only 45 years since the first UK liver transplant and 30 since our first heart-and-lung transplant. That is a very short time, in human terms, in which to contemplate changes to our death rituals.

Nonetheless, we should do better with what science has provided – regardless of what is coming. A mouse with a human liver is extraordinary indeed. But scientists have also made great strides in learning how to perform transplants, how to suppress the immune system’s rejection of foreign tissue and how to care for those who have gone through such traumatic procedures.

It would be a terrible shame if the advances of stem-cell research were to provide any further excuse for refusing to save a life.

Japanese scientists have grown human liver cells in mice. Photograph: Getty Images

Michael Brooks holds a PhD in quantum physics. He writes a weekly science column for the New Statesman, and his most recent book is At the Edge of Uncertainty: 11 Discoveries Taking Science by Surprise.

This article first appeared in the 15 July 2013 issue of the New Statesman, The New Machiavelli

Getty
Show Hide image

I worked as a teacher – so I can tell you how regressive grammar schools are

The grammars and "comprehensives" of Kent make for an unequal system. So why does Theresa May consider the county a model for the future?

In 1959 my parents moved me from a Roman Catholic primary school to the junior branch of King Henry VIII, Coventry’s most high-profile grammar. The head teacher berated my mother for betraying the one true faith, but although she was born in Galway, my mum was as relaxed about her religion as she was about her native roots. Any strong feelings about the English Reformation had disappeared around the same time as her Irish accent. Her voice gave no clue to where she was from and – as a result of a wartime commission – the same was true of my father. Together, Mrs and Mr Smith embodied postwar Britain’s first-generation upwardly mobile middle class.

Their aspiration and ambition were so strong that my mother saw no problem in paying for me to attend a Protestant school. Why, you may ask, did my dad, a middle manager and by no means well off, agree to pay the fees? Quite simply, my parents were keen that I pass the eleven-plus.

King Henry VIII School benefited from the direct grant scheme, introduced after the Education Act 1944. In Coventry, the two direct grant schools were centuries old and were paid a fee by the government to educate the fifth or so of boys who passed the eleven-plus. When secondary education in Coventry became comprehensive in the mid-1970s, King Henry VIII went fully independent; today, it charges fees of more than £10,000 per year.

A few years ago, I returned to my old school for a memorial service. As I left, I saw a small group of smartly dressed men in their late seventies. They had strong Coventry accents and intended to “go down the club” after the service. It occurred to me that they represented the small number of working-class lads who, in the years immediately after the Second World War, were lucky enough to pass the eleven-plus and (no doubt with their parents making huge sacrifices) attend “the grammar”. But by the time I moved up to King Henry VIII’s senior school in 1963 there appeared to be no one in my A-stream class from a working-class background.

From the early 1950s, many of the newly affluent middle classes used their financial power to give their children an advantage in terms of selection. My parents paid for a privileged education that placed top importance on preparation for the eleven-plus. In my class, only one boy failed the life-determining test. Today, no less than 13 per cent of entrants to the 163 grammar schools still in the state system are privately educated. No wonder preparatory schools have responded enthusiastically to Theresa May’s plans to reverse the educational orthodoxy of the past five decades.

Nowhere has the rebranding of secondary moderns as “comprehensives” been more shameless than in Kent, where the Conservative-controlled council has zealously protected educational selection. Each secondary modern in east Kent, where I taught in the 1970s, has since been named and renamed in a fruitless attempt to convince students that failing to secure a place at grammar school makes no difference to their educational experience and prospects. That is a hard message to sell to the two-thirds of ten-year-olds who fail the Kent test.

Investment and academy status have transformed the teaching environment, which a generation ago was disgraceful (I recall the lower school of a secondary modern in Canterbury as almost literally Edwardian). Ofsted inspections confirm that teachers in non-grammar schools do an amazing job, against all the odds. Nevertheless, selection reinforces social deprivation and limited aspiration in the poorest parts of the south-east of England, notably Thanet and the north Kent coastline.

A third of children in Thanet live in poverty. According to local sources (including a cross-party report of Kent councillors in 2014), disadvantaged children make up less than 9 per cent of pupils in grammar schools but 30 per cent at secondary moderns. University admissions tutors confirm the low number of applications from areas such as Thanet relative to the UK average. Though many of Kent’s secondary moderns exceed expectations, the county has the most underperforming schools in the UK.

When I began my teaching career, I was appallingly ignorant of the harsh realities of a secondary education for children who are told at the age of 11 that they are failures. Spending the years from seven to 17 at King Henry VIII School had cocooned me. More than 40 years later, I can see how little has changed in Kent – and yet, perversely, the Prime Minister perceives the county’s education system as a model for the future.

This article first appeared in the 22 September 2016 issue of the New Statesman, The New Times