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

Photo: Getty
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What is the New Hampshire primary, and why does it matter?

Although the contest has proved less influential in recent years, the New Hampshire primary is still a crucial event.

While the Iowa caucuses are the first electoral event in the US’s presidential process, the New Hampshire primary is the candidates' most important early test before the action explodes across the rest of the country.

The stakes are high. If the nominations aren’t decided soon, the campaigns will be damned to a marathon of costly state primaries and caucuses; New Hampshire is their first best chance to avoid that fate. But it didn’t always work this way.

Primaries only became the key element of the nomination process relatively recently. Until the postwar era, presidential candidates were chosen at the national conventions in the summer: in the run-up to the 1960 election, future president John F Kennedy famously entered only one primary (West Virginia’s) to prove that a Roman Catholic could win a Protestant state.

It was only after the turmoil of the 1968 nomination, widely perceived as an establishment fix, that the McGovern-Fraser Commission changed the Democratic party’s rules to end the power of the “smoke-filled room” over the nominating process, prompting many states to adopt meaningful primaries for both parties' nominations.

First in the nation

Unlike caucuses, which generally are used in smaller states that would rather not pay for full-scale ballots, primaries are secret-ballot elections that allow voters to choose who will be their preferred nominee. But not all primaries are the same.

The parties sometimes hold their votes on the same day, as they do in New Hampshire, or on different ones. A primary may be open (allowing any voter to register a preference) or closed (allowing only pre-registered party supporters to vote). New Hampshire has a mixed system which allows voters to register in a primary on the day before voting without declaring a party affiliation.

That means that while all voters registered with a party must vote in that party’s ballot, the New Hampshire result often hinges on these unaffiliated voters. Because they can vote in whichever ballot they like and can register so close to primary day, the state is notoriously difficult to poll.

New Hampshire has cemented its first-in-the-nation status by passing a law that requires its lawmakers to move the state’s primary to pre-empt any other state’s, no matter how early. That means it’s traditionally been not just an important indicator of how candidates are faring, but a way of winnowing the field and generating or killing funding. Candidates who perform poorly generally find their access to money suddenly dries up.

The arguments against New Hampshire’s outsize role are many. Like Iowa, it’s hardly representative of the US as a whole, being a small state with an overwhelmingly white population. And while (unlike Iowa) it has no powerful evangelical Christian element, it retains a very distinctive tradition of small-town New England politics that demand a particular kind of face-to-face, low-to-the-ground campaigning.

But this time around, other factors have cut into New Hampshire’s significance.

On the Republican side, the primary’s winnowing role was in large part pre-empted when the TV networks holding debates allowed only the higher-polling candidates on stage, effectively creating a two-tier system that tarred lower-polling candidates as also-rans long before voting began. Meanwhile, the financial calculations have been transformed by campaign finance reforms that allow for almost unlimited outside fundraising – allowing candidates to build up the reserves they need to withstand a humiliating defeat.

Nonetheless, a truly surprising New Hampshire result could still change everything.

Shuffling the deck

New Hampshire hasn’t always chosen the winner in either the nomination contests or the general election. But it has provided more than its share of political upsets and key turning points, from persuading Lyndon Johnson not to stand again in 1968 to resurrecting the candidacies of Hillary Clinton and John McCain in 2008.

The incremental campaigns for the nominations are all about the perception of momentum, and a notional front-runner can be dislodged or destabilised by a poor performance early on. That’s especially true in this year’s cycle, in which both major parties are grappling with huge surges of support for outsider, anti-establishment candidates.

Mainstream Republicans have spent months trying to end Donald Trump’s noisy domination of their crowded field. Trump was indeed defeated in Iowa, but not by a moderating force: instead, it was radical conservative Ted Cruz who overturned him.

Cruz is loathed by the party establishment, and he stands little chance of appealing to mainstream voters. Marco Rubio’s strong showing in Iowa briefly made him something of a standard-bearer for the party’s moderates, but a disastrous turn at the last debate before New Hampshire has thrown the future of his candidacy into doubt.

The primary will also reveal who, if any, of the more moderate Republican candidates – among them Jeb Bush, John Kasich and Chris Christie – will survive. While Bush has a massive funding advantage (albeit with precious little to show for it), Kasich and Christie both need a strong showing in New Hampshire to reinvigorate their financial reserves.

On the Democratic side, the key question is whether Bernie Sanders can make good on the surprising energy of his populist, grassroots challenge to Hillary Clinton. He is currently the heavy favourite in New Hampshire: even if Clinton somehow pulls off a miracle win there as she did in 2008, the closeness of the race is already stimulating both campaigns' national organisation and spending. And with what could be a long race between them heating up, the two’s growing mutual acrimony may yet start to undermine the Democrats' national appeal.

Gillian Peele Associate Professor in Politics and Tutorial Fellow at the University of Oxford.

This article was originally published on The Conversation. Read the original article.