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

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Junior doctors’ strikes: the greatest union failure in a generation

The first wave of junior doctor contract impositions began this week. Here’s how the BMA union failed junior doctors.

In Robert Tressell’s novel, The Ragged-Trousered Philanthropists, the author ridicules the notion of work as a virtuous end per se:

“And when you are all dragging out a miserable existence, gasping for breath or dying for want of air, if one of your number suggests smashing a hole in the side of one of the gasometers, you will all fall upon him in the name of law and order.”

Tressell’s characters are subdued and eroded by the daily disgraces of working life; casualised labour, poor working conditions, debt and poverty.

Although the Junior Doctors’ dispute is a far cry from the Edwardian working-poor, the eruption of fervour from Junior Doctors during the dispute channelled similar overtones of dire working standards, systemic abuse, and a spiralling accrual of discontent at the notion of “noble” work as a reward in itself. 

While the days of union activity precipitating governmental collapse are long over, the BMA (British Medical Association) mandate for industrial action occurred in a favourable context that the trade union movement has not witnessed in decades. 

Not only did members vote overwhelmingly for industrial action with the confidence of a wider public, but as a representative of an ostensibly middle-class profession with an irreplaceable skillset, the BMA had the necessary cultural capital to make its case regularly in media print and TV – a privilege routinely denied to almost all other striking workers.

Even the Labour party, which displays parliamentary reluctance in supporting outright strike action, had key members of the leadership join protests in a spectacle inconceivable just a few years earlier under the leadership of “Red Ed”.

Despite these advantageous circumstances, the first wave of contract impositions began this week. The great failures of the BMA are entirely self-inflicted: its deference to conservative narratives, an overestimation of its own method, and woeful ignorance of the difference between a trade dispute and moralising conundrums.

These right-wing discourses have assumed various metamorphoses, but at their core rest charges of immorality and betrayal – to themselves, to the profession, and ultimately to the country. These narratives have been successfully deployed since as far back as the First World War to delegitimise strikes as immoral and “un-British” – something that has remarkably haunted mainstream left-wing and union politics for over 100 years.

Unfortunately, the BMA has inherited this doubt and suspicion. Tellingly, a direct missive from the state machinery that the BMA was “trying to topple the government” helped reinforce the same historic fears of betrayal and unpatriotic behaviour that somehow crossed a sentient threshold.

Often this led to abstract and cynical theorising such as whether doctors would return to work in the face of fantastical terrorist attacks, distracting the BMA from the trade dispute at hand.

In time, with much complicity from the BMA, direct action is slowly substituted for direct inaction with no real purpose and focus ever-shifting from the contract. The health service is superficially lamented as under-resourced and underfunded, yes, but certainly no serious plan or comment on how political factors and ideologies have contributed to its present condition.

There is little to be said by the BMA for how responsibility for welfare provision lay with government rather than individual doctors; virtually nothing on the role of austerity policies; and total silence on how neoliberal policies act as a system of corporate welfare, eliciting government action when in the direct interests of corporatism.

In place of safeguards demanded by the grassroots, there are instead vague quick-fixes. Indeed, there can be no protections for whistleblowers without recourse to definable and tested legal safeguards. There are limited incentives for compliance by employers because of atomised union representation and there can be no exposure of a failing system when workers are treated as passive objects requiring ever-greater regulation.

In many ways, the BMA exists as the archetypal “union for a union’s sake”, whose material and functional interest is largely self-intuitive. The preservation of the union as an entity is an end in itself.

Addressing conflict in a manner consistent with corporate and business frameworks, there remains at all times overarching emphasis on stability (“the BMA is the only union for doctors”), controlled compromise (“this is the best deal we can get”) and appeasement to “greater” interests (“think of the patients”). These are reiterated even when diametrically opposed to its own members or irrelevant to the trade dispute.

With great chutzpah, the BMA often moves from one impasse to the next, framing defeats as somehow in the interests of the membership. Channels of communication between hierarchy and members remain opaque, allowing decisions such as revocation of the democratic mandate for industrial action to be made with frightening informality.

Pointedly, although the BMA often appears to be doing nothing, the hierarchy is in fact continually defining the scope of choice available to members – silence equals facilitation and de facto acceptance of imposition. You don’t get a sense of cumulative unionism ready to inspire its members towards a swift and decisive victory.

The BMA has woefully wasted the potential for direct action. It has encouraged a passive and pessimistic malaise among its remaining membership and presided over the most spectacular failure of union representation in a generation.

Ahmed Wakas Khan is a junior doctor, freelance journalist and editorials lead at The Platform. He tweets @SireAhmed.