Lawrence Faucette, a 58-year-old United States veteran, was dying of heart failure and had explored nearly every avenue for a life-saving transplant. Amidst the uncertainty, a glimmer of hope remained: an unconventional yet promising possibility — the gift of a pig’s heart.
On Sept. 20, the married father of two became the second patient in the world to receive a successful transplant of a genetically modified pig heart, performed at the University of Maryland Medical Center (UMMC).
“I have been rejected by every human transplant institute on the East Coast. We are now down to my only real hope left is to go with the pig heart transplant,” Faucette told a spokesperson from UMMC before the surgery.
“Hoping for the absolute best,” he said. “My next step at that point would be to be deemed healthy enough to go home. … That would be the first miracle. The second miracle would be a month later, six months later, a year later. I’ll take whatever I can get at that point.”
Faucette received his miracle.
In this photo provided by the University of Maryland School of Medicine, Lawrence Faucette sits with wife, Ann, in the school’s hospital in Baltimore, Md., in September 2023, before receiving a pig heart transplant. Two days after the transplant, Lawrence was cracking jokes and able to sit in a chair, doctors said.
Deborah Kotz/University of Maryland School of Medicine)
A month later his body showed no signs of rejecting the pig heart, his doctors said in a video released by the hospital on Oct. 20. He is breathing on his own and his heart is functioning well without any assistance from supportive medical devices, they said.
“His heart is doing everything on its own,” said Dr. Muhammad Mohiuddin, UMMC’s cardiac xenotransplantation chief.
Dr. Marc Ruel, a heart surgeon and professor in the department of surgery at the University of Ottawa, called the pig transplant surgery “groundbreaking.”
“This is really out of the box,” he told Global News. “It’s a beautiful example of using immunology, transplant medicine concepts, and really applying them to something that I think we’re going to need in the future.”
“Genetically altered animals are a reality that’s supplying the food chain, but also providing organs that are deeply compatible for humans or even skin grafts,” he said.
What is xenotransplantation?
Xenotransplantation is the transfer of living cells, tissues, or organs from non-human animal species into humans, according to Health Canada. Pigs are commonly used in xenotransplantation research due to their biological similarities to humans.
The goal of xenotransplantation is to address the shortage of human donor organs, such as hearts, kidneys, and livers. However, attempts at animal-to-human organ transplants have failed for decades, due to organ rejection, the transmission of diseases and long-term viability, Health Canada said.
Because of the shortage of organs, the department said hundreds of Canadians die while waiting for an organ transplant. On average, around 4,300 people in Canada wait for a transplant every year, but only a fraction of Canadians are registered as donors.
But medical experts hope xenotransplantation may help one day offset the long waitlist.
The first successful transplant of a genetically modified pig heart into a human patient took place in January 2022 at the same medical centre — UMMC.
The 57-year-old patient, David Bennett, did not qualify for a traditional transplant and was in end-stage heart failure, nearing the end of his life. So he received a pig heart.
After the pig heart transplant surgery, Bennett experienced strong cardiac function with no obvious signs of rejection, according to a 2023 study published in the Lancet. But two months after the surgery, a sudden onset of heart failure led to his death. Signs of a pig virus later were found inside the organ.
In this photo provided by the University of Maryland School of Medicine, surgeons prepare for a pig heart transplant into Lawrence Faucette at the school’s hospital in Baltimore, Md., in September 2023.
Deborah Kotz/University of Maryland School of Medicine
For the most recent pig heart transplant, UMMC said in a media release the donor pig was routinely screened for viruses, bacteria, and parasites and the testing did not reveal any unexpected pathogens.
“We have learned a lot from our first patient,” Mohiuddin said. “The last time there was a concern of a latent virus in the pig. … The risk screening methods for the pigs were inadequate. They were not able to screen a latent virus. This time, we’ve made sure that this doesn’t happen.”
The heart used for the second surgery came from a genetically modified pig from Revivcor, a Virginia-based biotechnology company that specializes in genetically modifying pigs for organ transplants. A total of 10 gene edits were made in the donor pig heart in order for it to be more compatible with a human, UMMC said.
After hearing about the experimental procedure, UMMC said Faucette fully consented to it and was informed of all the risks. In addition, he underwent a full psychiatric evaluation and discussed his case with a medical ethicist.
“We were very appreciative that he accepted our offer for the experimental transplant in the hopes it would help him, but also because this is a field that’s just beginning and so much needs to be learned,” said Dr. Bartley Griffith, who surgically transplanted the pig heart into Faucette, told UMMC.
“I think he’s grateful to be alive,” he said. “In many ways, he went to sleep and didn’t wake up for literally 18 hours not knowing whether he was alive or dead. So you wake up after an experimental procedure and you see the lights on the ceiling and then your loved ones around you. That’s good news.”
Griffith added that science is still only on the “precipice of a potentially really important therapy, but it’s yet to prove itself.”
Could surgery come to Canada?
Xenotransplantation is not prohibited in Canada but to conduct a human clinical trial, a company or research institute would have to apply to Health Canada for approval before proceeding. No clinical trial involving xenotransplantation has yet been approved by Health Canada, the department said on its website.
Although this type of surgery has not yet happened in Canada, Ruel said he believes the country could be an “early adopter” of the practice “if it were to prove feasible.”
“Pretty much like the initial heart transplant, Canada was one of the first countries in the world to perform a heart transplant,” he said.
The first heart transplant in Canada was performed in 1968 at the Montreal Heart Institute. The world’s first heart transplant happened in South Africa in 1967.
Ruel is encouraged by the success of the second pig transplants in Maryland and believes that although it’s still early day, the patient seems to be doing well.
“Certainly, the technology is there now,” he added.
— with files from the Associated Press