Posted on 05/08/2005 7:04:03 PM PDT by Investment Biker
If xenotransplantation - animal-to-human transplantation - were to offer a person with Type one diabetes a life without insulin dependency - would that make it OK?
This is a proposition people with diabetes are being encouraged to consider by Toi te Taiao: the Bioethics Council and Martin Wilkinson, chair of the Council's xenotransplantation working group, who is a key-note speaker at this weekend's annual Diabetes New Zealand Conference.
"People with Diabetes will understand, perhaps better than anyone, the pros and cons of xenotransplantation because it has the potential to affect them personally. There are in fact several xenotransplantation procedures but one involves the insertion of cells, like pig pancreatic islet cells, into humans. This has the potential to treat Type one and severe Type two diabetes.
"A key question is, if xenotransplantation can relieve significant suffering or even save lives, does this outweigh the potential hazards, such as transferring diseases from animals to humans and onto other humans? "If xenotransplantation were simply a risky trial treatment, it might be that individual consent would be enough to justify the risk. But the risk of xenotransplantation to public health cannot be justified merely on the grounds of individual consent. If this were the case we would have a set of techniques that potentially helps a large number of badly-off people but potentially threatens the health of a very large number. "The risk of disease spreading might be reduced by forcing xenograft recipients to submit to lifelong monitoring and treatment, breaching confidentiality, preventing their reproducing, and compulsorily quarantining them. These measures appear to infringe on rights, so the ethical question is: would this be justified?" says Wilkinson. Alternative uses of xenotransplantation include using brain cells to treat Parkinson's disease (which is currently untreatable) and inserting whole organs like pancreas, kidneys and hearts. It is also possible to undertake therapies outside the body, such as sending the blood of a person with acute liver failure through a type of dialysis machine and back. Growing human cells on layers of animal cells is also an option for treatment of such conditions such as motor neurone disease. All of these are at an experimental stage - some much further along than others.
Xenotransplantation is effectively blocked in New Zealand at the moment, largely for reasons of public safety. Australia has recently blocked xenotransplantation research for at least five years. Canada has also blocked it. The US and the UK permit it, although the UK has a very high barrier. China and Mexico are doing xenotransplantation on a relatively large scale.
"Concerns about xenotransplantation do not stop with public health risks. There are cultural considerations about animal cells introduced into humans, particularly live cells. Does this affect our essential humanness? Is it part of a desperate grab for immortality that humans cannot possibly achieve?" says Wilkinson. The Bioethics Council is encouraging public discussion around the cultural, ethical and spiritual dimensions of xenotransplantation and is looking at the individual and community points of view. It will provide independent advice to Government on its findings. The deadline of 20 May for the online forum and submissions process is fast approaching and the Council will then enter the final stage of assessing the feedback.
Results will contribute towards a report on the cultural, ethical, and spiritual aspect of xenotransplantation in September.
For further information about diabetes see www.diabetes.org.nz and www.bioethics.org.nz
ENDS
To stimulate discussions and inform people of the issues around xenotransplantation before the dialogue process, the Council launched a discussion document in February entitled "The Cultural, Spiritual and Ethical Aspects of Xenotransplantation: Animal-to-Human Transplantation" - it can be found at www.bioethics.org.nz .
Public are also invited to become involved in one or more of the following activities which will be taking place between March and 20 May 2005:
* Visit www.bioethics.org.nz for background info and links to more detailed background research
* Join the online discussion forum, to register, log on to www.bioethics.org.nz/dialogue/forum/
* Make a submission by mail, email or online. There is a submission form on our website, or just send a letter or email.
* Get together with whanau, friends or workmates and have a discussion. We want people thinking and talking about these topics, even if you do not end up writing anything down. Our website has links to ideas on running dialogue groups.
You are of course correct that the immediate ethical decisions lie with "xenotransplantation", broadly defined.
As for cloning though, I suspect though that you may be a bit pessimistic about the prospects, at least for hybrid “technologies”.
For example I would not be surprised if a 10-12 years hence we were seeing experiential therapeutic use of entire “non-human” organs harvested from cloned animals which had been genetically modified to become sources of much more tractable transplant material.
How does an insulin pump work? Does it contain a device that measures your blood sugar and then dispense insulin based on the level? Or does it just dispense a constant flow of insulin? Can you remove it easily, or do you even need to?
I hope my questions aren't too intrusive. I know several diabetics, but none of them use the pump, so I'm curious.
Ah yes, the transplants are usually for the "roller-coaster" diabetics--goodness knows they need them.
I've had the sugar for 12 years so far...so good...so what! (sorry, Megadeth fan). I've had a pump for about 7 (has it been so long...where has my life gone, LOL), and am quite a fan of it. I received word that one will soon be available that is constantly monitoring blood sugar levels and adjusting the basal rate of insulin in order to compensate. I have my fingers crossed that the pump will include glucagon so that I don't have to carry 4 rolls of Lifesavers with me everywhere (yes, I really do use lifesavers--for the poetic irony, and the taste!).
I forgot to mention that many diabetics do not use them because they are expensive, about $6,000 plus expensive supplies (infusion sets and insulin cartridges).
Thanks for the info. Does the supply of insulin or the infusion line last about three days? Do you have a port in your skin where the pump attaches?
Does insurance typically cover it?
And God blessed them, and God said unto them, Be fruitful, and multiply, and replenish the earth, and subdue it: and have dominion over the fish of the sea, and over the fowl of the air, and over every living thing that moveth upon the earth.
There. That should about answer that question.
Does extended periods of physical exercise cause your blood sugar to go low, or can you compensate by changing the setting on the pump?
Instead of creating/conceiving a severely disabled human from whom to harvest organs and tissues, why not use DNA splicing to grow human islet cells in porcine hosts, then harvest the cells from the pig? ... It is no more wrong than killing pigs for bacon and it avoids the cannibalism of 'decephelated human clones' ... BTW, just when would the branecase be emptied and what is the being prior to the 'decephelating'?
Investment Biker did a good job answering, but check one my post 26 (they're doing wonders with technology these days, I tell you!).
The level of insulin in the reservoir will hold out about 3 days, and then you have to refill it and attach it to a new infusion set. The infusion set has a catheter in the end that fits into the subqutaneous layer, but it is not permanently attached. You rotate the site every time you refill the pump. I use my ample belly for the infusion site.
There is a way to remove the pump itself if you need to, and then you can reattach with ease.
Pumps operate on a basal rate, which I program in advance. It will deliver a certain amount of insulin every hour (that I figured out from trial and error). I can put it on a lower temporary level if I am going to do a little light exercise (such as jogging).
The, if I am going to intake carbs, I program a bolus based on the amount of carbs (I give 1 unite for every 10g of carbs). Most food items will tell you the total carb level, and those that don't I have learned to guess.
I periodically need to readjust the basal settings on my pump if I find I am going too low or too high on a consistent basis at a similar time each day. If I exercise, I will usually put on a temporary low basal rate, or turn the pump into suspend mode, depending on how strenuous the exercise is. Plus, it never hurts to down a glass of orange juice before preparing to exert oneself.
Thanks to you both for the information. This sounds like a great piece of technology.
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