1 00:00:00,360 --> 00:00:01,639 Speaker 1: I don't know if I told you about this show. 2 00:00:01,680 --> 00:00:04,320 Speaker 1: It's called Raised by Wolves, but the second season of 3 00:00:04,360 --> 00:00:06,360 Speaker 1: it just came out. It's Raised by Wolves too. Is 4 00:00:06,360 --> 00:00:09,160 Speaker 1: it a movie, No, it's a series, okay, But it's 5 00:00:09,160 --> 00:00:13,039 Speaker 1: basically living in three thy ninety nine. Okay, it's very different. 6 00:00:13,160 --> 00:00:15,280 Speaker 1: And it really made me think, like, all the stuff 7 00:00:15,320 --> 00:00:17,840 Speaker 1: that they're doing in that show, I'm like. 8 00:00:17,800 --> 00:00:20,160 Speaker 2: Could this really be possible? What are they doing? 9 00:00:20,400 --> 00:00:23,799 Speaker 1: They're using like droid robot things, but they look like 10 00:00:23,880 --> 00:00:27,040 Speaker 1: people and they're able to do all these biological functions. 11 00:00:27,320 --> 00:00:29,800 Speaker 1: And it reminded me of where we saw that pig 12 00:00:29,840 --> 00:00:32,320 Speaker 1: heart transplant story a couple weeks ago. 13 00:00:32,360 --> 00:00:34,760 Speaker 2: Do you remember? Yes, I do remember. 14 00:00:34,960 --> 00:00:37,240 Speaker 3: And that kind of blew me away because I remember 15 00:00:37,280 --> 00:00:39,199 Speaker 3: back in the day when they put the ear on 16 00:00:39,240 --> 00:00:40,520 Speaker 3: the back of the rat and that. 17 00:00:40,600 --> 00:00:43,280 Speaker 2: Was really big. Yes, that was in all the textbooks. 18 00:00:43,440 --> 00:00:48,760 Speaker 3: Yes, But putting a pig heart into Homo sapien rte 19 00:00:50,200 --> 00:00:52,680 Speaker 3: I was like, Man, we are really making leaps and 20 00:00:52,920 --> 00:00:54,480 Speaker 3: bounds in our lifetime. 21 00:00:54,720 --> 00:00:56,840 Speaker 1: I thought Raised by Wolves was three thousand ninety nine, 22 00:00:56,880 --> 00:00:58,320 Speaker 1: but maybe it's twenty ninety nine. 23 00:00:58,920 --> 00:01:00,279 Speaker 2: Maybe it's close with it, And I. 24 00:01:00,240 --> 00:01:29,600 Speaker 3: Thought, welcome to dop Labs, a weekly podcast that mixes 25 00:01:29,640 --> 00:01:32,880 Speaker 3: hardcore science, pop culture, and a healthy does of friendship. 26 00:01:33,000 --> 00:01:33,240 Speaker 2: T T. 27 00:01:33,440 --> 00:01:35,759 Speaker 1: I know I mentioned that I saw a pig heart 28 00:01:35,760 --> 00:01:38,880 Speaker 1: transplant and that it feels like we are living in 29 00:01:38,920 --> 00:01:42,240 Speaker 1: the year three thousand, that sci fi is upon us. 30 00:01:42,520 --> 00:01:43,200 Speaker 2: But I feel like. 31 00:01:43,160 --> 00:01:45,080 Speaker 1: I'm really blown away, Like how do we get here 32 00:01:45,080 --> 00:01:47,720 Speaker 1: with all these new transplants and all of this technology. 33 00:01:47,920 --> 00:01:49,520 Speaker 1: That wasn't the only one I saw. That's only one 34 00:01:49,560 --> 00:01:51,280 Speaker 1: I can remember right now. I think we got to 35 00:01:51,320 --> 00:01:52,120 Speaker 1: get to the bottom of it. 36 00:01:52,280 --> 00:01:52,920 Speaker 2: Absolutely. 37 00:01:53,280 --> 00:01:56,840 Speaker 1: This week we're talking about organ transplants specifically. We really 38 00:01:56,880 --> 00:01:59,080 Speaker 1: want to know more about the process of getting approved 39 00:01:59,080 --> 00:02:02,960 Speaker 1: for a transplant and how transplants actually work. Let's get 40 00:02:02,960 --> 00:02:15,040 Speaker 1: into the recitation, So let's start with what we know. 41 00:02:15,320 --> 00:02:18,440 Speaker 3: I feel like everything that I know about transplants is 42 00:02:18,480 --> 00:02:21,239 Speaker 3: based off of what I've seen in movies in television. 43 00:02:21,440 --> 00:02:23,160 Speaker 2: I think that's fine, is it. 44 00:02:23,320 --> 00:02:25,400 Speaker 3: I think that's an okay starting point because then we 45 00:02:25,440 --> 00:02:29,760 Speaker 3: can figure it out. Well now I feel empowered. I 46 00:02:29,840 --> 00:02:31,960 Speaker 3: think one of the things that I think I know 47 00:02:32,360 --> 00:02:35,280 Speaker 3: is that getting a transplant is not as easy as 48 00:02:35,360 --> 00:02:37,360 Speaker 3: saying that I need this new organ. There is a 49 00:02:37,440 --> 00:02:41,160 Speaker 3: process you have to see a number of doctors and 50 00:02:41,200 --> 00:02:42,320 Speaker 3: then be put on a list. 51 00:02:43,200 --> 00:02:44,720 Speaker 2: I think considering that list. 52 00:02:45,000 --> 00:02:48,239 Speaker 1: Sometimes getting a transplant is easy, though some people get 53 00:02:48,240 --> 00:02:50,800 Speaker 1: it from family members. But some people can't match with 54 00:02:50,840 --> 00:02:52,959 Speaker 1: their family members. So I don't know a lot about 55 00:02:53,160 --> 00:02:57,000 Speaker 1: the matching process. I know sometimes it's easy, or you know, 56 00:02:57,040 --> 00:03:00,160 Speaker 1: if you have family members who match with you. But 57 00:03:00,160 --> 00:03:01,800 Speaker 1: I got to save this for the next section because 58 00:03:01,840 --> 00:03:03,080 Speaker 1: I don't know how you match. 59 00:03:05,000 --> 00:03:06,800 Speaker 3: One of the things that I know is that not 60 00:03:06,840 --> 00:03:11,040 Speaker 3: all transplants are created equal, and so getting a heart 61 00:03:11,080 --> 00:03:15,440 Speaker 3: transplant and getting a kidney transplant are two very different beasts. 62 00:03:15,680 --> 00:03:17,840 Speaker 1: The other thing I know is that there are a 63 00:03:17,880 --> 00:03:22,680 Speaker 1: lot of rumors about transplants and the medical system. I 64 00:03:22,720 --> 00:03:25,440 Speaker 1: think one of the most damaging things that has happened 65 00:03:25,480 --> 00:03:28,800 Speaker 1: when it comes to organ transplants is the myth and 66 00:03:28,919 --> 00:03:31,480 Speaker 1: rumor that went around that if you put that you 67 00:03:31,520 --> 00:03:34,760 Speaker 1: were an organ donor on your driver's license, that the 68 00:03:34,840 --> 00:03:36,280 Speaker 1: paramedics wouldn't try to save you. 69 00:03:36,280 --> 00:03:36,960 Speaker 2: Do you remember this? 70 00:03:37,720 --> 00:03:41,200 Speaker 3: Yes, I remember this, and I hate to say it frihim, 71 00:03:41,200 --> 00:03:43,160 Speaker 3: but I was actually one of those people who believed 72 00:03:43,160 --> 00:03:44,120 Speaker 3: it for a little while. 73 00:03:44,280 --> 00:03:47,600 Speaker 1: That's all right, you were not alone but it is 74 00:03:48,000 --> 00:03:50,280 Speaker 1: just that it's a myth, you know. I'm looking at 75 00:03:50,280 --> 00:03:53,280 Speaker 1: this page from penn Medicine, so the University of Pennsylvania, 76 00:03:53,440 --> 00:03:56,760 Speaker 1: the Perlman School of Medicine, and they're saying that you 77 00:03:56,800 --> 00:03:58,960 Speaker 1: would have to be in the hospital on a ventilator 78 00:03:59,000 --> 00:04:02,080 Speaker 1: and then pronounce dead in order to donate your organs. 79 00:04:02,440 --> 00:04:05,640 Speaker 1: So it's not even that your organs are harvested if 80 00:04:05,640 --> 00:04:07,600 Speaker 1: you're in a car accident, you know what I mean. 81 00:04:07,720 --> 00:04:11,280 Speaker 1: That myth plays on people's fears of not having adequate care, 82 00:04:11,560 --> 00:04:14,360 Speaker 1: but there are so many additional steps before you get 83 00:04:14,440 --> 00:04:18,480 Speaker 1: to the donation of your organs. Another myth is that 84 00:04:18,839 --> 00:04:21,000 Speaker 1: your family will be charged if you donate organs. 85 00:04:21,120 --> 00:04:23,440 Speaker 3: I've never heard that one, but I can understand why 86 00:04:23,480 --> 00:04:24,440 Speaker 3: people would think. 87 00:04:24,279 --> 00:04:26,919 Speaker 2: That because it's an additional process right. 88 00:04:26,760 --> 00:04:29,320 Speaker 3: Absolutely, And the medical care system it feels like a 89 00:04:29,320 --> 00:04:31,920 Speaker 3: black box. Sometimes you go to the doctor or you 90 00:04:31,960 --> 00:04:33,880 Speaker 3: have to rush to the hospital, and next thing you know, 91 00:04:33,920 --> 00:04:36,159 Speaker 3: you have this huge bill and you don't know where 92 00:04:36,440 --> 00:04:38,359 Speaker 3: these charges came from. You don't know how you're going 93 00:04:38,400 --> 00:04:40,360 Speaker 3: to pay for it. So I can definitely understand where 94 00:04:40,360 --> 00:04:41,720 Speaker 3: that confusion comes from. 95 00:04:41,920 --> 00:04:43,239 Speaker 2: So what do we want to know though? 96 00:04:43,440 --> 00:04:46,760 Speaker 3: What I want to know is how do they determine 97 00:04:46,800 --> 00:04:50,600 Speaker 3: whether or not somebody is able to receive a transplant? 98 00:04:50,640 --> 00:04:52,240 Speaker 3: Because I know, I mean, I don't know a lot 99 00:04:52,279 --> 00:04:54,600 Speaker 3: about this stuff, but I see on TV that there 100 00:04:54,600 --> 00:04:57,000 Speaker 3: are some folks who, you know, they get a transplant 101 00:04:57,400 --> 00:05:00,240 Speaker 3: and their body rejects it or something like that. I know, 102 00:05:00,680 --> 00:05:02,919 Speaker 3: what are the criteria that doctors are looking for to 103 00:05:02,960 --> 00:05:06,880 Speaker 3: determine whether or not someone is able to get a transplant? 104 00:05:07,160 --> 00:05:07,440 Speaker 2: Yes? 105 00:05:07,720 --> 00:05:11,159 Speaker 1: And along those same lines, are those criteria the reason 106 00:05:11,240 --> 00:05:14,320 Speaker 1: the waiting lists are so long? Why are there ninety 107 00:05:14,320 --> 00:05:17,080 Speaker 1: thousand people waiting for a kidney but then a little 108 00:05:17,120 --> 00:05:19,919 Speaker 1: over ten thousand four other organs? Is it related to 109 00:05:20,080 --> 00:05:23,960 Speaker 1: the difficulty of replacing the organ, the surgery, the tools 110 00:05:23,960 --> 00:05:27,480 Speaker 1: that are required, the costs. I'm just curious about, like 111 00:05:27,560 --> 00:05:30,080 Speaker 1: why the lists are so long and were they always 112 00:05:30,080 --> 00:05:32,599 Speaker 1: this long? Or is this like a backup from you know, 113 00:05:32,920 --> 00:05:34,360 Speaker 1: delays in our medical system. 114 00:05:34,520 --> 00:05:36,000 Speaker 2: Right, that's a good question. 115 00:05:36,360 --> 00:05:39,200 Speaker 3: I think Another thing that we're both curious about is 116 00:05:39,760 --> 00:05:42,200 Speaker 3: because we always are interested in it, and that is 117 00:05:42,680 --> 00:05:46,400 Speaker 3: new technology. So what is the new technology and innovations 118 00:05:46,400 --> 00:05:47,799 Speaker 3: in transplant sciences? 119 00:05:47,880 --> 00:05:49,400 Speaker 2: Yeah, I'm sure they're not doing it the way they 120 00:05:49,400 --> 00:05:51,159 Speaker 2: always used to. Now they can't be. 121 00:05:51,320 --> 00:05:54,080 Speaker 1: Everything I know about how transplants work is pretty much 122 00:05:54,120 --> 00:05:54,800 Speaker 1: based on John Q. 123 00:05:55,040 --> 00:05:55,920 Speaker 2: You remember that movie. 124 00:05:56,120 --> 00:06:00,279 Speaker 3: Yes, that's all I know, and I know I don't 125 00:06:00,279 --> 00:06:02,000 Speaker 3: know if it was accurate, but that's what I feel like. 126 00:06:02,040 --> 00:06:05,039 Speaker 2: I know Denzel was young in that movie. So young, Denzil. 127 00:06:05,160 --> 00:06:06,360 Speaker 2: I'm expecting some changes. 128 00:06:06,440 --> 00:06:09,960 Speaker 3: That age is a let's jump into the dissection. 129 00:06:10,560 --> 00:06:23,960 Speaker 2: Yep, but its absolute. Our guest for today's lab is 130 00:06:24,000 --> 00:06:25,440 Speaker 2: doctor Dave low Hi. 131 00:06:25,480 --> 00:06:27,599 Speaker 4: My name is Dave low and I work for Thermo 132 00:06:27,680 --> 00:06:33,360 Speaker 4: Fisher Scientific and I am head of research and development 133 00:06:33,880 --> 00:06:36,039 Speaker 4: in our transplant diagnostics business. 134 00:06:36,360 --> 00:06:39,719 Speaker 3: Thermo Fisher is a supplier of laboratory equipment and supplies. 135 00:06:39,880 --> 00:06:42,760 Speaker 3: Me and Zekiah know them very well from all of 136 00:06:42,839 --> 00:06:47,360 Speaker 3: our years in the lab. Their transplant diagnostics business focuses 137 00:06:47,400 --> 00:06:50,880 Speaker 3: on developing and producing products with applications in both the 138 00:06:50,920 --> 00:06:54,440 Speaker 3: clinical and the research side of organ transplants. 139 00:06:54,680 --> 00:06:57,800 Speaker 1: Doctor Lowe's specialty is in histo compatibility, which is a 140 00:06:57,839 --> 00:07:00,240 Speaker 1: word that isn't typically used, so we asked to to 141 00:07:00,279 --> 00:07:01,520 Speaker 1: explain what it means. 142 00:07:01,960 --> 00:07:04,040 Speaker 5: It's a hell of a mouthful, isn't it. 143 00:07:04,120 --> 00:07:07,520 Speaker 4: If you've ever watched a medical drama on TV and 144 00:07:07,600 --> 00:07:11,000 Speaker 4: somebody needs a transplant and they run around and they say, Okay, 145 00:07:11,000 --> 00:07:13,440 Speaker 4: we've got a match. Then that's kind of the histo 146 00:07:13,520 --> 00:07:15,120 Speaker 4: compatibility bit right there. 147 00:07:15,240 --> 00:07:19,000 Speaker 3: Histo Compatibility means tissue matching, that the tissues of different 148 00:07:19,080 --> 00:07:22,360 Speaker 3: individuals will be compatible. And by compatible, we mean that 149 00:07:22,560 --> 00:07:26,560 Speaker 3: fusing tissues from two different people, so your donor and 150 00:07:26,600 --> 00:07:30,680 Speaker 3: your recipient won't trigger a reaction from the immune system. 151 00:07:30,800 --> 00:07:32,440 Speaker 1: I think it's important for people to remember when we 152 00:07:32,480 --> 00:07:35,960 Speaker 1: talk about tissues. Tissues are just superstructures of cells. We 153 00:07:36,000 --> 00:07:38,640 Speaker 1: can think about individual cells, but tissues are just a 154 00:07:38,680 --> 00:07:41,760 Speaker 1: conglomerate of individual cells, and so at a cell to 155 00:07:41,800 --> 00:07:44,160 Speaker 1: cell level, if those cells are not going to be compatible, 156 00:07:44,400 --> 00:07:47,080 Speaker 1: then definitely those tissues aren't going to be compatible. And 157 00:07:47,120 --> 00:07:49,880 Speaker 1: the thing that brings those tissues the nutrients that they 158 00:07:49,960 --> 00:07:52,640 Speaker 1: need in the oxygen that they need to stay alive, 159 00:07:52,760 --> 00:07:55,239 Speaker 1: that's the blood system, right. So you need your blood 160 00:07:55,320 --> 00:07:58,120 Speaker 1: to match between your donor and your recipient. All of 161 00:07:58,120 --> 00:08:01,120 Speaker 1: these things are physically interacting. You also need your tissues 162 00:08:01,240 --> 00:08:03,360 Speaker 1: or the cells that make up the tissues to match 163 00:08:03,400 --> 00:08:05,760 Speaker 1: between the donor and recipient too. And once you have 164 00:08:05,840 --> 00:08:07,960 Speaker 1: all those things in your body, your immune system may 165 00:08:08,000 --> 00:08:10,200 Speaker 1: recognize that donor tissue and in the case of a 166 00:08:10,200 --> 00:08:12,600 Speaker 1: transfusion donor blood and say okay, I'm not going to 167 00:08:12,640 --> 00:08:16,200 Speaker 1: attack it. Essentially, that's what histo compatibility is. They get 168 00:08:16,240 --> 00:08:17,480 Speaker 1: together and they get along. 169 00:08:17,760 --> 00:08:21,360 Speaker 3: Doctor Lowe's laboratory essentially develops and provides the tools that 170 00:08:21,440 --> 00:08:25,040 Speaker 3: labs use to figure out how risky a transplant would 171 00:08:25,040 --> 00:08:27,800 Speaker 3: be for each patient and how easy it would be 172 00:08:28,000 --> 00:08:29,280 Speaker 3: to get them a transplant. 173 00:08:29,480 --> 00:08:33,720 Speaker 1: So histel compatibility has multiple components, and one way that 174 00:08:33,800 --> 00:08:37,480 Speaker 1: we already think about compatibility is in blood type, so 175 00:08:37,600 --> 00:08:42,720 Speaker 1: ABO and then AB and O can be positive or negative. 176 00:08:43,040 --> 00:08:46,680 Speaker 1: Blood type compatibility is certainly important for transplants, but there's 177 00:08:46,760 --> 00:08:50,600 Speaker 1: a lot more to it with transplants. Compatibility or being 178 00:08:50,600 --> 00:08:53,040 Speaker 1: a match is really framed in the context of the 179 00:08:53,280 --> 00:08:57,800 Speaker 1: HLA system or human leukocyte antigens, and that's all about 180 00:08:57,880 --> 00:08:58,680 Speaker 1: tissue matching. 181 00:08:58,880 --> 00:09:02,040 Speaker 4: When we have people told about getting a match or 182 00:09:02,120 --> 00:09:05,920 Speaker 4: not being a match, we're really talking about these specific 183 00:09:06,040 --> 00:09:10,240 Speaker 4: antigens and what they are are proteins that are present 184 00:09:10,440 --> 00:09:13,560 Speaker 4: on pretty much all of our cells and tissues, but 185 00:09:13,840 --> 00:09:17,440 Speaker 4: they're highly diverse. Some of them are very common, and 186 00:09:17,600 --> 00:09:21,240 Speaker 4: some of them are incredibly rare. So if a patient 187 00:09:21,400 --> 00:09:25,480 Speaker 4: is unfortunate enough to have an incredibly rare tissue type, 188 00:09:25,920 --> 00:09:28,680 Speaker 4: it's going to be much more difficult to get that 189 00:09:28,920 --> 00:09:30,199 Speaker 4: patient donor. 190 00:09:30,520 --> 00:09:34,280 Speaker 1: Another main factor in histo compatibility is antibodies, and we've 191 00:09:34,280 --> 00:09:37,920 Speaker 1: talked a lot about antibodies before in various different contexts. 192 00:09:38,120 --> 00:09:40,439 Speaker 1: Most recently we talked about it in Lab forty seven 193 00:09:40,520 --> 00:09:43,640 Speaker 1: when we explore the immune system, and in that context 194 00:09:43,679 --> 00:09:48,120 Speaker 1: we talked about antibodies really being these protectors to shield 195 00:09:48,160 --> 00:09:52,120 Speaker 1: our bodies from invaders and foreign particles. That's generally a 196 00:09:52,160 --> 00:09:56,120 Speaker 1: good thing, but in the context of transplantation and histo compatibility, 197 00:09:56,400 --> 00:09:58,840 Speaker 1: antibodies can be a huge problem. 198 00:09:59,080 --> 00:10:02,360 Speaker 3: Oh no, everything I thought I knew out the window. 199 00:10:05,640 --> 00:10:08,360 Speaker 1: They're part of your immune system and they can trigger symptoms. 200 00:10:08,400 --> 00:10:11,440 Speaker 1: We would generally categorize a sickness that's just your immune 201 00:10:11,480 --> 00:10:15,360 Speaker 1: system responding, right, So if you have a lot of antibodies, 202 00:10:15,360 --> 00:10:17,560 Speaker 1: they can recognize a lot of different things. That means 203 00:10:17,600 --> 00:10:21,520 Speaker 1: they might recognize your donor tissue and give you a 204 00:10:21,520 --> 00:10:22,480 Speaker 1: pretty bad reaction. 205 00:10:22,920 --> 00:10:26,400 Speaker 3: So they're like, I, I this was not here before. Yes, 206 00:10:26,520 --> 00:10:28,800 Speaker 3: that is not us attack. 207 00:10:30,440 --> 00:10:33,199 Speaker 1: Yeah, you know what this reminds me of what in 208 00:10:33,280 --> 00:10:35,760 Speaker 1: the matrix were like the mister Smith agents, like they're 209 00:10:35,880 --> 00:10:37,440 Speaker 1: checking constantly for your signature. 210 00:10:37,520 --> 00:10:39,480 Speaker 2: Yes, yes, this is so good. 211 00:10:39,520 --> 00:10:41,440 Speaker 1: And so if you come back in like the same doors, 212 00:10:41,440 --> 00:10:44,160 Speaker 1: like they're constantly looking for you, Like they were constantly 213 00:10:44,200 --> 00:10:47,000 Speaker 1: looking for NEO in the matrix, that specific part of 214 00:10:47,040 --> 00:10:52,520 Speaker 1: the matrix scared meat. That was terrifying, mister Smith, always 215 00:10:52,520 --> 00:10:54,480 Speaker 1: in the same spots, just constantly looking for you. 216 00:10:55,120 --> 00:10:56,199 Speaker 2: It was like a horror film. 217 00:10:56,240 --> 00:11:00,240 Speaker 3: But that sounds exactly like what's happening in our immune system. 218 00:11:00,280 --> 00:11:01,480 Speaker 2: Like those antibodies are. 219 00:11:01,360 --> 00:11:05,480 Speaker 1: Just like right, But really it's great for your body 220 00:11:05,520 --> 00:11:07,920 Speaker 1: if you have a FORID invader, a low level of virus, 221 00:11:08,000 --> 00:11:09,960 Speaker 1: or a low level of bacteria, mister Smith, and mune 222 00:11:10,000 --> 00:11:12,480 Speaker 1: system is constantly looking, constantly finding them, reading those green 223 00:11:12,520 --> 00:11:15,760 Speaker 1: little characters scrolling down through your blood system. Okay, it's 224 00:11:15,840 --> 00:11:17,840 Speaker 1: great to have antibodies looking for things on the surface 225 00:11:17,880 --> 00:11:20,120 Speaker 1: of a bacterial cell or things on the surface of 226 00:11:20,160 --> 00:11:24,120 Speaker 1: a virus. Not so great if those things appear on 227 00:11:24,120 --> 00:11:26,880 Speaker 1: the surface of a donor tissue right right, they don't 228 00:11:26,880 --> 00:11:28,959 Speaker 1: know those antigens, so they're like, yo, we got to 229 00:11:28,960 --> 00:11:30,000 Speaker 1: get them out of here. 230 00:11:29,920 --> 00:11:32,200 Speaker 3: And your antigens are defenseless essentially. 231 00:11:32,320 --> 00:11:34,400 Speaker 1: Yeah, they're just things that they don't recognize. They say, hey, 232 00:11:34,400 --> 00:11:35,440 Speaker 1: this is not part of the code. 233 00:11:35,520 --> 00:11:37,880 Speaker 3: So the antigens, they can't even do the matrix thing 234 00:11:37,960 --> 00:11:38,440 Speaker 3: that neo. 235 00:11:38,559 --> 00:11:39,680 Speaker 2: Yeah, they can't do the Sierra. 236 00:11:39,800 --> 00:11:41,600 Speaker 1: You know, Sierra was able to go back like that 237 00:11:41,840 --> 00:11:44,439 Speaker 1: to do the neo and yeah, she's the only one. 238 00:11:44,480 --> 00:11:46,800 Speaker 2: Those antigens are not doing that. Bruh. I remember trying 239 00:11:46,800 --> 00:11:49,920 Speaker 2: to do that in high school. I was close. Really, 240 00:11:50,000 --> 00:11:50,240 Speaker 2: I was. 241 00:11:50,240 --> 00:11:54,880 Speaker 3: A different human being back then, not so different, just 242 00:11:54,920 --> 00:12:00,120 Speaker 3: a different mobility. 243 00:12:01,440 --> 00:12:04,440 Speaker 4: That's one thing that we find is on our transplant 244 00:12:04,440 --> 00:12:08,240 Speaker 4: waiting lists, the more antibodies you have, the harder it 245 00:12:08,360 --> 00:12:11,200 Speaker 4: is for you to get a transplant, and usually that 246 00:12:11,320 --> 00:12:12,680 Speaker 4: means you will wait longer. 247 00:12:12,920 --> 00:12:17,080 Speaker 3: So why would somebody have more antibodies than someone else. 248 00:12:17,280 --> 00:12:20,640 Speaker 3: How do we even get the antibodies? We ask doctor 249 00:12:20,720 --> 00:12:23,960 Speaker 3: Low how people who are on the waiting list for 250 00:12:24,000 --> 00:12:27,360 Speaker 3: a transplant got so many antibodies that made them have 251 00:12:27,440 --> 00:12:29,720 Speaker 3: to be on the waiting list for so long. Doctor 252 00:12:29,760 --> 00:12:32,320 Speaker 3: Low says that there are three main ways. 253 00:12:32,320 --> 00:12:35,160 Speaker 4: And the first is if you have a previous transplant, 254 00:12:35,360 --> 00:12:39,839 Speaker 4: and quite often our patients when they have these previous transplants, 255 00:12:40,120 --> 00:12:44,000 Speaker 4: they will form antibodies against some of those la and 256 00:12:44,040 --> 00:12:47,880 Speaker 4: then the antibodies persist basically almost for the rest of 257 00:12:47,880 --> 00:12:50,959 Speaker 4: that patient's life. So if you're then faced with a 258 00:12:51,040 --> 00:12:54,320 Speaker 4: patient who has antibodies to HALA, all it does is 259 00:12:54,360 --> 00:12:59,199 Speaker 4: it further reduces the number of potential donors for that patient. 260 00:12:59,440 --> 00:13:02,680 Speaker 1: So if you have a previous transplant, remember that's cells 261 00:13:02,720 --> 00:13:05,840 Speaker 1: that make up multiple different structures and that forms a tissue. 262 00:13:05,880 --> 00:13:10,440 Speaker 1: That previous transplant will have antigens from the donor, and 263 00:13:10,480 --> 00:13:13,959 Speaker 1: so your body, naturally, your immune system will make antibodies 264 00:13:14,400 --> 00:13:17,320 Speaker 1: to that transplant. So now you have the antibodies that 265 00:13:17,360 --> 00:13:19,440 Speaker 1: you already had that were part of your immune system, 266 00:13:19,440 --> 00:13:23,040 Speaker 1: plus a new subset that have developed in response to 267 00:13:23,080 --> 00:13:26,679 Speaker 1: your first transplant. So when it's time to get another transplant, 268 00:13:26,960 --> 00:13:30,360 Speaker 1: you have an expanded set of antibodies, which could increase 269 00:13:30,360 --> 00:13:32,280 Speaker 1: the likelihood that you would have a reaction. 270 00:13:33,200 --> 00:13:36,680 Speaker 3: So is there a critical mass of antibodies where once 271 00:13:36,720 --> 00:13:40,199 Speaker 3: it gets to that amount that your body automatically starts 272 00:13:40,200 --> 00:13:40,720 Speaker 3: to react. 273 00:13:40,960 --> 00:13:43,120 Speaker 1: I think that's a very good question. TT It is, 274 00:13:43,440 --> 00:13:47,000 Speaker 1: I think two things. So it is volume of antibody 275 00:13:47,040 --> 00:13:53,079 Speaker 1: and type of antibody. So you could have a variety 276 00:13:53,120 --> 00:13:55,440 Speaker 1: of different types of antibodies, but if some of them 277 00:13:56,000 --> 00:13:59,480 Speaker 1: are lower in number, it's less likely that you will 278 00:13:59,520 --> 00:14:03,439 Speaker 1: have a strong immune reaction. Okay, does that make sense. 279 00:14:03,280 --> 00:14:05,800 Speaker 3: Yeah, that makes sense. The next problem that some patients 280 00:14:05,800 --> 00:14:09,000 Speaker 3: may run into that will cause them to have more antibodies, 281 00:14:09,000 --> 00:14:11,679 Speaker 3: which makes it difficult for them to receive a transplant, 282 00:14:11,960 --> 00:14:13,720 Speaker 3: is if they've had a blood transfusion. 283 00:14:14,000 --> 00:14:17,839 Speaker 4: A lot of transplant patients get transfused quite a lot, 284 00:14:17,960 --> 00:14:23,160 Speaker 4: and if there are cells in the transfused units that 285 00:14:23,280 --> 00:14:27,520 Speaker 4: express HLA that is different, then there's a possibility in 286 00:14:27,560 --> 00:14:30,000 Speaker 4: that way they can form antibodies as well. 287 00:14:30,080 --> 00:14:32,440 Speaker 1: So a transfusion is having blood from a donor and 288 00:14:32,480 --> 00:14:34,880 Speaker 1: putting it into a recipient. You know, and when we 289 00:14:34,920 --> 00:14:37,360 Speaker 1: think about blood, you may just think, oh, red liquid, 290 00:14:37,440 --> 00:14:40,080 Speaker 1: but it's not. It has cells in it, and those 291 00:14:40,080 --> 00:14:43,840 Speaker 1: cells have antigens on their surface. So if I am 292 00:14:43,840 --> 00:14:47,680 Speaker 1: a recipient and I initially didn't have antibodies that would 293 00:14:47,760 --> 00:14:50,280 Speaker 1: react to those antigens that are on the surface of 294 00:14:50,320 --> 00:14:53,440 Speaker 1: those cells. In my transfusion, there are components of my 295 00:14:53,480 --> 00:14:56,560 Speaker 1: immune system that will recognize those antigens and begin to 296 00:14:56,600 --> 00:15:01,440 Speaker 1: make antibodies. So now my antibody profile is expanded because 297 00:15:01,440 --> 00:15:04,280 Speaker 1: my immune system has detected these other antigens, and now 298 00:15:04,320 --> 00:15:08,640 Speaker 1: I have antibodies against those antigens plus whatever antibodies I 299 00:15:08,680 --> 00:15:09,320 Speaker 1: initially had. 300 00:15:13,680 --> 00:15:17,040 Speaker 3: Another way that folks can acquire antibodies that might keep 301 00:15:17,080 --> 00:15:20,480 Speaker 3: them from being able to receive an organ transplant is 302 00:15:20,480 --> 00:15:23,880 Speaker 3: a really tricky reason, and that is because your antibody 303 00:15:23,920 --> 00:15:27,000 Speaker 3: profile can expand through giving birth. 304 00:15:27,400 --> 00:15:31,560 Speaker 1: That sounds really wild, right, yes, but basically you have 305 00:15:31,600 --> 00:15:34,320 Speaker 1: to think of when a baby is. 306 00:15:34,280 --> 00:15:36,360 Speaker 2: Born magical times. 307 00:15:36,560 --> 00:15:40,160 Speaker 1: Yeah, if a baby is born, the baby is not 308 00:15:40,200 --> 00:15:44,600 Speaker 1: your clone, so it's gonna have half the genetic information 309 00:15:44,680 --> 00:15:48,800 Speaker 1: from the other parent. And if that genetic signature causes 310 00:15:48,840 --> 00:15:52,160 Speaker 1: the baby to express antigens that the birthing parent doesn't 311 00:15:52,200 --> 00:15:54,760 Speaker 1: already have. As soon as that parents given birth, their skin, 312 00:15:55,280 --> 00:15:59,320 Speaker 1: their womb, all of that is in contact with new antigens. 313 00:15:59,600 --> 00:16:02,960 Speaker 1: We talk about that, right, And so then that immune 314 00:16:03,000 --> 00:16:05,920 Speaker 1: system is like, hey, here's some foreign particles I've never seen. 315 00:16:05,960 --> 00:16:06,760 Speaker 2: This wasn't with me. 316 00:16:06,760 --> 00:16:11,240 Speaker 1: Before, and so at that moment, the birthing parents immune 317 00:16:11,240 --> 00:16:15,920 Speaker 1: system makes antibodies to those antigens that are on the 318 00:16:15,960 --> 00:16:18,360 Speaker 1: baby that came from the father that don't match with 319 00:16:18,600 --> 00:16:21,000 Speaker 1: the birth and parents antigens that they already had. Now 320 00:16:21,040 --> 00:16:23,800 Speaker 1: let's go back to early genetics. We know that when 321 00:16:24,120 --> 00:16:27,520 Speaker 1: a parent birth's a child, it is not a clone. 322 00:16:28,040 --> 00:16:31,160 Speaker 1: The other thing we know is that siblings are not clones. 323 00:16:31,440 --> 00:16:33,360 Speaker 1: So every time there's a new birth, there's a new 324 00:16:33,400 --> 00:16:37,720 Speaker 1: possibility of the birthing parent generating antibodies in response. 325 00:16:37,360 --> 00:16:37,920 Speaker 2: To the baby. 326 00:16:38,200 --> 00:16:42,880 Speaker 1: So let's say you are a parent of three, you've 327 00:16:42,880 --> 00:16:45,960 Speaker 1: birthed three children. You are going up for a kidney 328 00:16:46,000 --> 00:16:48,040 Speaker 1: transplant and they may say, have you ever had a 329 00:16:48,080 --> 00:16:51,400 Speaker 1: blood transfusion? No, have you ever had a previous transplant? No, 330 00:16:52,040 --> 00:16:53,760 Speaker 1: have you ever had kids? And it's like, whoa, And 331 00:16:53,840 --> 00:16:56,480 Speaker 1: you know your antibody profile could be off the charts 332 00:16:56,520 --> 00:16:58,080 Speaker 1: because I've been exposed. 333 00:16:58,200 --> 00:17:01,360 Speaker 2: That's so tough. Wow, it was really tricky, you know. 334 00:17:01,640 --> 00:17:03,480 Speaker 1: So if you think about that, that feels like that 335 00:17:03,480 --> 00:17:06,480 Speaker 1: can really increase your antibody profile. Now here's the good news. 336 00:17:07,119 --> 00:17:10,359 Speaker 1: This only happens about thirty percent of the time. So 337 00:17:10,440 --> 00:17:12,359 Speaker 1: only thirty percent of the time do we see this 338 00:17:12,440 --> 00:17:14,520 Speaker 1: type of antibody response after birth. 339 00:17:15,800 --> 00:17:17,760 Speaker 2: But it's good to know. Yeah, it's good to know 340 00:17:17,800 --> 00:17:19,440 Speaker 2: about that. Is this something that. 341 00:17:19,359 --> 00:17:22,040 Speaker 3: We should be testing ourselves for or getting tested. 342 00:17:21,720 --> 00:17:23,639 Speaker 2: For or is that like not until it's time to 343 00:17:23,640 --> 00:17:24,480 Speaker 2: have a transplant. 344 00:17:24,600 --> 00:17:28,040 Speaker 3: Okay, So we've talked about three main ways someone can 345 00:17:28,040 --> 00:17:30,680 Speaker 3: get antibodies that makes it harder for them to match 346 00:17:30,720 --> 00:17:35,800 Speaker 3: with a donor, like previous transplants, blood transfusion, and giving birth. 347 00:17:35,960 --> 00:17:40,840 Speaker 3: But doctor Low told us about an even more unusual case. 348 00:17:41,160 --> 00:17:45,520 Speaker 4: A patient many years ago who came for transplant and 349 00:17:45,960 --> 00:17:48,800 Speaker 4: it was a male. He was a really big guy actually, 350 00:17:49,080 --> 00:17:52,960 Speaker 4: and he'd never had a previous transplant, and he'd never 351 00:17:53,280 --> 00:17:58,800 Speaker 4: had a transfusion either, so we were really confused because 352 00:17:58,840 --> 00:18:03,040 Speaker 4: he had a ton of anti so we were trying 353 00:18:03,040 --> 00:18:04,960 Speaker 4: to work out where he could have got these from. 354 00:18:04,960 --> 00:18:07,320 Speaker 4: And it was only just one day that he told 355 00:18:07,400 --> 00:18:09,959 Speaker 4: us that he used to be a bare knuckle cage fighter, 356 00:18:10,480 --> 00:18:15,720 Speaker 4: so he'd been fighting for years and exchanging blood, which 357 00:18:16,440 --> 00:18:20,640 Speaker 4: sounds horrible that he'd been exchanging bloods and other fluids 358 00:18:20,680 --> 00:18:23,960 Speaker 4: I guess with his opponents, and he'd had a lot 359 00:18:24,040 --> 00:18:27,400 Speaker 4: of antibodies. So don't do cage fighting if you ever 360 00:18:27,440 --> 00:18:28,920 Speaker 4: want to get a kidney. 361 00:18:29,960 --> 00:18:31,440 Speaker 2: I think these are things they don't tell you on 362 00:18:31,520 --> 00:18:32,040 Speaker 2: Fight Club. 363 00:18:32,240 --> 00:18:36,359 Speaker 3: Tyler Durton didn't say this so after the tissue type 364 00:18:36,440 --> 00:18:40,840 Speaker 3: has been identified correctly in the antibodies confirm, the last 365 00:18:40,840 --> 00:18:44,359 Speaker 3: step in checking a patient for histo compatibility is a 366 00:18:44,359 --> 00:18:45,040 Speaker 3: cross match. 367 00:18:45,320 --> 00:18:48,400 Speaker 4: You would get material from the donor, so you would 368 00:18:48,400 --> 00:18:52,480 Speaker 4: get cells and tissue, and you would test for reactivity 369 00:18:53,280 --> 00:18:56,919 Speaker 4: from your patient and if it's positive, then that usually 370 00:18:56,920 --> 00:18:59,760 Speaker 4: means you don't go ahead. So I would often be 371 00:19:00,080 --> 00:19:03,480 Speaker 4: performing these cross matches, and it usually turned out to 372 00:19:03,520 --> 00:19:08,080 Speaker 4: be at three am, because often transplantation happens when you 373 00:19:08,160 --> 00:19:10,480 Speaker 4: can when you have the donor. The cross match is 374 00:19:10,520 --> 00:19:11,560 Speaker 4: absolutely crucial. 375 00:19:11,840 --> 00:19:14,239 Speaker 1: Okay, So it seems like initially we're just looking at 376 00:19:14,240 --> 00:19:16,240 Speaker 1: small things like the antibodies. Now we're pulling clumps of 377 00:19:16,280 --> 00:19:18,560 Speaker 1: sales so tissues and saying, all right, are y'all gonna 378 00:19:18,560 --> 00:19:20,960 Speaker 1: play well together? On paper, you look good together, but 379 00:19:21,040 --> 00:19:23,680 Speaker 1: are y'all gonna play well together? And that cross match 380 00:19:23,720 --> 00:19:25,879 Speaker 1: is where things can really start to look up. 381 00:19:25,960 --> 00:19:26,200 Speaker 2: Right. 382 00:19:26,400 --> 00:19:28,359 Speaker 1: The question is, you know, are you two gonna play 383 00:19:28,400 --> 00:19:31,480 Speaker 1: well together? And so I think a cross match physically 384 00:19:31,480 --> 00:19:34,719 Speaker 1: putting those tissues together is so important because if somebody 385 00:19:34,720 --> 00:19:37,560 Speaker 1: made a mistake at the early stages of the antibody panel, 386 00:19:37,600 --> 00:19:39,920 Speaker 1: or if there's something that wasn't detected. If you were 387 00:19:39,960 --> 00:19:43,560 Speaker 1: to move forward with that transplant and they are not 388 00:19:43,760 --> 00:19:47,040 Speaker 1: a good match, instantly the body will reject it, like 389 00:19:47,119 --> 00:19:51,200 Speaker 1: within minutes seconds, even the organ begins to turn black. Wow, 390 00:19:51,320 --> 00:19:54,840 Speaker 1: that's just how strong the immune response is in the body. 391 00:19:56,400 --> 00:19:58,920 Speaker 3: Okay, let's take a quick break and when we get back, 392 00:19:58,920 --> 00:20:02,320 Speaker 3: we'll get into another important part of organ transplants with 393 00:20:02,400 --> 00:20:18,119 Speaker 3: doctor Low, and that's immunosuppression. We're back and we've been 394 00:20:18,160 --> 00:20:21,560 Speaker 3: talking with doctor Dave Low all about organ transplants and 395 00:20:21,640 --> 00:20:24,880 Speaker 3: how important the PROSS match is to make sure tissues 396 00:20:24,920 --> 00:20:27,159 Speaker 3: will be compatible in an organ transplant. 397 00:20:27,480 --> 00:20:29,400 Speaker 1: And I think that really gets us to the importance 398 00:20:29,440 --> 00:20:33,119 Speaker 1: of another component of transplants, and that's immunosuppression. When a 399 00:20:33,119 --> 00:20:36,440 Speaker 1: transplanted organ is rejected by the body, it's because of. 400 00:20:36,400 --> 00:20:40,639 Speaker 3: A really strong immune response. And this is the worst 401 00:20:40,680 --> 00:20:41,400 Speaker 3: case scenario. 402 00:20:41,920 --> 00:20:45,239 Speaker 4: So when you have that antibody response that sort of 403 00:20:45,359 --> 00:20:49,000 Speaker 4: floats onto that organ, the downstream effects of that antibody 404 00:20:49,560 --> 00:20:52,119 Speaker 4: there are many different ways that that could lead to 405 00:20:52,600 --> 00:20:53,480 Speaker 4: tissue damage. 406 00:20:53,560 --> 00:20:55,359 Speaker 5: One of them is complement activation. 407 00:20:55,640 --> 00:20:59,679 Speaker 4: So those antibodies bind to that target if you like 408 00:20:59,760 --> 00:21:02,600 Speaker 4: that that foreign kidney or heart, whatever it may. 409 00:21:02,480 --> 00:21:04,840 Speaker 5: Be, and they kind of group together and. 410 00:21:04,760 --> 00:21:10,119 Speaker 4: They start this insane immunological cascade. They recruit lots of 411 00:21:10,119 --> 00:21:14,480 Speaker 4: other proteins, and it ultimately forms a complex called the 412 00:21:14,600 --> 00:21:18,840 Speaker 4: membrane attack complex, which basically just pumps holes in the tissues. 413 00:21:19,080 --> 00:21:20,919 Speaker 1: And even though there's all of this testing that we 414 00:21:20,960 --> 00:21:24,320 Speaker 1: talked about earlier for histocompatibility, most patients who end up 415 00:21:24,320 --> 00:21:28,320 Speaker 1: receiving a transplant are not fully matched. They're compatible, but 416 00:21:28,359 --> 00:21:31,159 Speaker 1: there is some degree of mismatching, which is usually okay. 417 00:21:31,680 --> 00:21:36,440 Speaker 4: So we need to dampen down any potential immune response 418 00:21:36,800 --> 00:21:39,919 Speaker 4: to help to make sure that that kidney or heart 419 00:21:40,000 --> 00:21:43,720 Speaker 4: doesn't reject. But the immune system usually finds a way, 420 00:21:44,200 --> 00:21:49,560 Speaker 4: so quite often the iminosuppression that is administered is really 421 00:21:49,640 --> 00:21:54,040 Speaker 4: there to prevent the patient's T cells. The T cells 422 00:21:54,080 --> 00:21:57,280 Speaker 4: are the kind of conductor of the immune response, so 423 00:21:57,840 --> 00:22:02,280 Speaker 4: a lot of the iminosuppression is tailored to targeting those cells, 424 00:22:02,440 --> 00:22:07,240 Speaker 4: and that enables you to transplant safely. It is effective 425 00:22:07,400 --> 00:22:10,280 Speaker 4: in preventing the organ being rejected. 426 00:22:10,480 --> 00:22:12,919 Speaker 1: And something I didn't realize is that once you receive 427 00:22:12,960 --> 00:22:16,800 Speaker 1: a transplant, immunal suppression can be a lifelong commitment. Most 428 00:22:16,840 --> 00:22:19,800 Speaker 1: patients continue on immunosuppressants for their whole lives. 429 00:22:20,119 --> 00:22:26,240 Speaker 4: The holy grail is to achieve what we would term tolerance. 430 00:22:26,600 --> 00:22:29,400 Speaker 4: So if you can get to a point where you 431 00:22:29,480 --> 00:22:34,959 Speaker 4: can remove yourself from all help, so all your imminosuppression 432 00:22:35,080 --> 00:22:38,159 Speaker 4: is taken away and your immune system is tolerant of 433 00:22:38,240 --> 00:22:41,960 Speaker 4: that graph, that's extremely difficult to achieve. 434 00:22:41,680 --> 00:22:44,720 Speaker 1: Once you receive a transplant. Immuno suppression is a lifelong 435 00:22:44,760 --> 00:22:46,760 Speaker 1: commitment and there's a lot that comes along with that. 436 00:22:47,080 --> 00:22:50,400 Speaker 1: You're taking a ton of medicine, and when you're taking 437 00:22:50,400 --> 00:22:52,600 Speaker 1: that medicine, that means it can make you more susceptible 438 00:22:52,640 --> 00:22:54,760 Speaker 1: because you're suppressing your immune system. It means it can 439 00:22:54,800 --> 00:22:57,239 Speaker 1: make you more susceptible to colds, It can make you 440 00:22:57,240 --> 00:23:01,640 Speaker 1: more susceptible to getting really sick from exposures that wouldn't 441 00:23:01,680 --> 00:23:04,960 Speaker 1: disturb most people. So it changes your quality of life. 442 00:23:05,040 --> 00:23:08,320 Speaker 1: It changes your quality of life. And if you're not 443 00:23:08,400 --> 00:23:11,480 Speaker 1: having issues with your transplant, it may be easy to 444 00:23:11,520 --> 00:23:14,399 Speaker 1: think like, Okay, maybe it's all right if I skip 445 00:23:14,440 --> 00:23:16,880 Speaker 1: this for a day, or even just because it's difficult 446 00:23:16,880 --> 00:23:20,760 Speaker 1: to keep up this type of regiment, you may unintentionally 447 00:23:20,800 --> 00:23:22,720 Speaker 1: miss a day, right, you know, meantimes, I miss my 448 00:23:22,760 --> 00:23:25,720 Speaker 1: allergy medicine, even though I know how awful I'm gonna feel. 449 00:23:26,080 --> 00:23:27,960 Speaker 2: Yeah, it's not intentional, it's o. 450 00:23:27,960 --> 00:23:32,439 Speaker 1: Can you imagine missing one pill in your routine and 451 00:23:32,480 --> 00:23:35,280 Speaker 1: then having these things that you also can't see. We know, 452 00:23:36,000 --> 00:23:38,440 Speaker 1: just human behavior, we delay things we can't see. We 453 00:23:38,480 --> 00:23:40,800 Speaker 1: don't put as much importance on things that we can't see, 454 00:23:41,440 --> 00:23:43,080 Speaker 1: and so it may not feel like there's going to 455 00:23:43,119 --> 00:23:45,640 Speaker 1: be a media action, but that immune system is quick. 456 00:23:45,640 --> 00:23:48,080 Speaker 4: And we see there's a lot of studies that have 457 00:23:48,200 --> 00:23:52,280 Speaker 4: shown that actually sort of stopping taking the immuno suppression 458 00:23:52,840 --> 00:23:57,119 Speaker 4: really a leading cause of transplant failure, especially in younger people. 459 00:23:57,359 --> 00:24:00,400 Speaker 4: I think that's something to sort of consider, is that 460 00:24:00,640 --> 00:24:04,520 Speaker 4: a lot of the imminosuppressive drugs out there, they're quite powerful, 461 00:24:04,560 --> 00:24:08,080 Speaker 4: and they have a number of side effects that could 462 00:24:08,119 --> 00:24:11,760 Speaker 4: be seen as quite undesirable, you know, like excess weight 463 00:24:12,400 --> 00:24:15,520 Speaker 4: being gained and hair growth and things like that. 464 00:24:15,720 --> 00:24:19,360 Speaker 3: This whole process might seem like a lot and it is. 465 00:24:19,680 --> 00:24:23,119 Speaker 3: It used to take weeks to determine histo compatibility, but 466 00:24:23,160 --> 00:24:26,320 Speaker 3: doctor Lowe was telling us that their technology has improved 467 00:24:26,359 --> 00:24:28,960 Speaker 3: and what used to take weeks can now be done 468 00:24:28,960 --> 00:24:30,640 Speaker 3: in a matter of hours, and. 469 00:24:30,600 --> 00:24:34,320 Speaker 4: In those cases where it's a deceased donor, you've usually 470 00:24:34,600 --> 00:24:37,720 Speaker 4: got much less time because as soon as the organ 471 00:24:37,840 --> 00:24:41,119 Speaker 4: is retrieved from the donor and placed on ice, then 472 00:24:41,160 --> 00:24:43,600 Speaker 4: the clock is ticking. We have this thing called cold 473 00:24:43,640 --> 00:24:47,159 Speaker 4: ischemic time, which is used to describe the number of 474 00:24:47,160 --> 00:24:50,679 Speaker 4: hours that the organ is placed on ice before we 475 00:24:50,760 --> 00:24:54,639 Speaker 4: can implant into the recipient. So part of what we 476 00:24:54,720 --> 00:24:59,919 Speaker 4: do is to make these tests as rapid as we possibly. 477 00:25:00,560 --> 00:25:03,240 Speaker 1: Both of those points, doctor Lomay, are really important. That 478 00:25:03,320 --> 00:25:07,120 Speaker 1: timeframe for determining compatibility and the ability to leverage more 479 00:25:07,400 --> 00:25:10,560 Speaker 1: deceased donors, those are both really important because the demand 480 00:25:10,560 --> 00:25:13,560 Speaker 1: for organ transplants is still very high. 481 00:25:13,480 --> 00:25:17,639 Speaker 3: Right According to orgondonor dot gov, over one hundred thousand 482 00:25:17,720 --> 00:25:21,280 Speaker 3: people are currently on the National Transplant Waiting List, and. 483 00:25:21,240 --> 00:25:24,440 Speaker 1: The bulk of these folks are waiting for kidney transplants. Currently, 484 00:25:24,440 --> 00:25:27,400 Speaker 1: there are ninety thousand candidates on the kidney transplant list. 485 00:25:27,640 --> 00:25:30,479 Speaker 3: And the statistic that really got me is that every 486 00:25:30,600 --> 00:25:34,320 Speaker 3: day in the US, seventeen people die waiting for an 487 00:25:34,440 --> 00:25:35,280 Speaker 3: organ transplant. 488 00:25:35,400 --> 00:25:36,919 Speaker 1: And so when you consider all of this, you know, 489 00:25:37,040 --> 00:25:40,640 Speaker 1: we talked earlier in the dissection about compatibility and how 490 00:25:40,680 --> 00:25:42,680 Speaker 1: that can be one of the biggest obstacles to getting 491 00:25:42,680 --> 00:25:46,080 Speaker 1: a transplant. But we both wanted to know if that 492 00:25:46,280 --> 00:25:48,320 Speaker 1: was the major cause of the long waiting list that 493 00:25:48,320 --> 00:25:50,600 Speaker 1: we're seeing, or if there's like some other issue that 494 00:25:50,640 --> 00:25:53,320 Speaker 1: we've seen in other places, like you know, specific types 495 00:25:53,320 --> 00:25:55,120 Speaker 1: of demand for different organs. 496 00:25:55,280 --> 00:25:58,040 Speaker 4: I think supplying demand is a good way to put it. 497 00:25:58,160 --> 00:26:01,320 Speaker 4: You know, the number of people waiting on list, generally speaking, 498 00:26:01,400 --> 00:26:06,520 Speaker 4: they outnumber the number of available organs. And then there 499 00:26:06,520 --> 00:26:09,840 Speaker 4: are the reasons that we've talked about why some patients 500 00:26:10,040 --> 00:26:12,600 Speaker 4: may wait longer than others. So the patients with a 501 00:26:12,600 --> 00:26:16,359 Speaker 4: lot of antibodies, they're going to struggle to get a 502 00:26:16,520 --> 00:26:21,560 Speaker 4: donor from the waiting list, so they're waiting for deceased donors. 503 00:26:21,760 --> 00:26:24,639 Speaker 4: So I think that's important to talk about as well, 504 00:26:24,720 --> 00:26:29,879 Speaker 4: that in some organs, like kidney, a large proportion of 505 00:26:29,920 --> 00:26:32,840 Speaker 4: the transplantation is taken from live donors. 506 00:26:33,520 --> 00:26:37,119 Speaker 5: So quite often it could be family members, a brother, a. 507 00:26:37,000 --> 00:26:40,960 Speaker 4: Sister, mother, father, child, the people on the transplant weight list, 508 00:26:41,040 --> 00:26:44,040 Speaker 4: you know, maybe they don't have a potential live donor. 509 00:26:44,600 --> 00:26:48,159 Speaker 3: These challenges of supply not meeting the demand mean that 510 00:26:48,359 --> 00:26:51,560 Speaker 3: scientists and doctors have to think a little more creatively 511 00:26:51,760 --> 00:26:55,320 Speaker 3: about different ways to get patients transplanted successfully. 512 00:26:55,600 --> 00:26:59,120 Speaker 4: So when I talked before about a lot of patients 513 00:26:59,119 --> 00:27:03,320 Speaker 4: on the list have a lot of antibodies and disproportionately 514 00:27:03,520 --> 00:27:07,680 Speaker 4: high numbers of female patients that you have to get 515 00:27:07,800 --> 00:27:10,800 Speaker 4: a little bit creative and how are you going to 516 00:27:10,880 --> 00:27:14,960 Speaker 4: get patients like this to have a transplant? And there 517 00:27:14,960 --> 00:27:17,040 Speaker 4: are things you can do that I think they're really 518 00:27:17,119 --> 00:27:17,680 Speaker 4: quite clever. 519 00:27:18,040 --> 00:27:19,840 Speaker 5: One is pared donation. 520 00:27:20,359 --> 00:27:23,480 Speaker 4: So you know, you might have a patient and they 521 00:27:23,600 --> 00:27:28,040 Speaker 4: might have a lot of antibodies and their wife or 522 00:27:28,080 --> 00:27:31,280 Speaker 4: sister or brother is willing to donate, but because of 523 00:27:31,280 --> 00:27:35,520 Speaker 4: the antibodies, they're not compatible. So what often happens is 524 00:27:35,800 --> 00:27:40,920 Speaker 4: they will enter into a paired donation scheme. So what 525 00:27:40,960 --> 00:27:44,159 Speaker 4: they'll say is that, Okay, my brother can't give an 526 00:27:44,280 --> 00:27:46,800 Speaker 4: organ to me, but we're going to go into this 527 00:27:47,160 --> 00:27:50,919 Speaker 4: pool of people of patients and donors, and we're going 528 00:27:50,960 --> 00:27:53,560 Speaker 4: to find out maybe there's a patient in there that 529 00:27:54,200 --> 00:27:57,320 Speaker 4: he is compatible with, and maybe there's a donor in 530 00:27:57,359 --> 00:27:59,600 Speaker 4: there that the patient is compatible with. 531 00:28:00,520 --> 00:28:02,560 Speaker 5: In its simplest form, they. 532 00:28:02,480 --> 00:28:05,840 Speaker 4: Literally just swap donors and then everybody gets what they 533 00:28:05,880 --> 00:28:08,919 Speaker 4: need and if the patient is willing to accept a risk, 534 00:28:09,440 --> 00:28:12,560 Speaker 4: you can do some more high risk transplants where you 535 00:28:13,320 --> 00:28:16,719 Speaker 4: have a donor and they've got antibodies against them, but 536 00:28:16,800 --> 00:28:20,440 Speaker 4: you use that donor anyway, and what you can do 537 00:28:20,560 --> 00:28:24,480 Speaker 4: is you can do what's called desensitization therapy. So we 538 00:28:24,520 --> 00:28:29,120 Speaker 4: will treat the patients and remove their antibodies. So usually 539 00:28:29,200 --> 00:28:33,919 Speaker 4: we'll do it by plasmaphoresis, so we'll essentially hook them 540 00:28:34,000 --> 00:28:38,320 Speaker 4: up to a machine and remove components of the blood 541 00:28:38,680 --> 00:28:42,520 Speaker 4: and get the antibodies down to a level where we think, okay, 542 00:28:43,080 --> 00:28:47,800 Speaker 4: we're not going to have a hyperacute rejection. The immunosuppression 543 00:28:47,960 --> 00:28:50,640 Speaker 4: is going to be enough to stop that happening. 544 00:28:50,880 --> 00:28:53,640 Speaker 1: But once again it's really important to note that for 545 00:28:53,840 --> 00:28:58,600 Speaker 1: procedure like plasma poresis, they are removing all the antibodies, which, 546 00:28:58,640 --> 00:29:01,600 Speaker 1: as we know from Lab forty seven, means a much 547 00:29:01,720 --> 00:29:02,920 Speaker 1: much weaker immune system. 548 00:29:03,120 --> 00:29:05,280 Speaker 4: That's one of the downsides is you're going to remove 549 00:29:05,400 --> 00:29:08,080 Speaker 4: antibodies that kind of the patient needs. 550 00:29:08,400 --> 00:29:10,200 Speaker 5: There's antibodies that protect you. 551 00:29:10,200 --> 00:29:14,400 Speaker 4: Against bacteria, virus, whatever it might be, so you kind 552 00:29:14,400 --> 00:29:16,960 Speaker 4: of run the risk of leaving your patient a little 553 00:29:17,000 --> 00:29:19,760 Speaker 4: bit extra vulnerable and then you're going to give them 554 00:29:19,800 --> 00:29:23,120 Speaker 4: amino suppression as well, so you can be double vulnerable. 555 00:29:23,280 --> 00:29:25,040 Speaker 3: This is such a great point, and this is part 556 00:29:25,080 --> 00:29:28,200 Speaker 3: of why it's so important that those patients who've received 557 00:29:28,320 --> 00:29:32,720 Speaker 3: transplants have regular monitoring. For example, doctors may want to 558 00:29:32,760 --> 00:29:36,080 Speaker 3: periodically screen patients to make sure that they aren't developing 559 00:29:36,160 --> 00:29:40,240 Speaker 3: anybodies that might reject the transplanted organ, whether it's regular 560 00:29:40,280 --> 00:29:43,440 Speaker 3: clinic visits or new technology that allows patients to take 561 00:29:43,480 --> 00:29:47,200 Speaker 3: these samples at home. Being a transplant recipient is really 562 00:29:47,440 --> 00:29:51,120 Speaker 3: a lifelong commitment, and in order to make this lifelong. 563 00:29:50,720 --> 00:29:52,880 Speaker 2: Commitment more bearable. 564 00:29:52,920 --> 00:29:56,600 Speaker 3: There's a lot of technological advances that scientists are trying 565 00:29:56,640 --> 00:30:00,280 Speaker 3: to pour into so that it makes that commitment of 566 00:30:00,320 --> 00:30:03,000 Speaker 3: a burden. So we ask doctor Low about some of 567 00:30:03,040 --> 00:30:05,600 Speaker 3: the advances in transplant technology. 568 00:30:05,840 --> 00:30:08,960 Speaker 4: There's been great advances over the last few years as 569 00:30:09,000 --> 00:30:13,000 Speaker 4: we've gone from sort of the cells right through to 570 00:30:13,280 --> 00:30:18,560 Speaker 4: various PCR techniques and now we're onto next generation sequencing 571 00:30:18,600 --> 00:30:22,400 Speaker 4: and that gives you that deep level of understanding of 572 00:30:22,440 --> 00:30:25,840 Speaker 4: the tissues so that we can have more information we 573 00:30:25,920 --> 00:30:29,080 Speaker 4: can match to a higher and higher level. And this 574 00:30:29,240 --> 00:30:33,200 Speaker 4: is amazing, and now we're trying to say, Okay, we 575 00:30:33,280 --> 00:30:35,920 Speaker 4: can do it. But a lot of the time, some 576 00:30:35,960 --> 00:30:38,920 Speaker 4: of these workflows take two or three days, so it's 577 00:30:38,960 --> 00:30:40,840 Speaker 4: how can we speed it up? What can we do 578 00:30:40,880 --> 00:30:42,840 Speaker 4: to speed it up? And I think that's some of 579 00:30:42,840 --> 00:30:47,120 Speaker 4: the really exciting stuff that's going on right now. 580 00:30:46,560 --> 00:30:48,960 Speaker 5: Is that you know, there's lots of. 581 00:30:48,960 --> 00:30:53,400 Speaker 4: Us working on getting that deep level of resolution as 582 00:30:53,480 --> 00:30:54,520 Speaker 4: quickly as possible. 583 00:30:54,640 --> 00:30:57,320 Speaker 5: So it's kind of a race, you know, where everyone's 584 00:30:57,360 --> 00:30:57,960 Speaker 5: working on it. 585 00:30:58,080 --> 00:31:01,080 Speaker 1: So tt we consider it like that that we saw 586 00:31:01,120 --> 00:31:07,520 Speaker 1: about the pig heart transplant. The recipient recently passed away. Yeah, 587 00:31:07,600 --> 00:31:09,560 Speaker 1: I saw that, But they're also. 588 00:31:09,320 --> 00:31:10,880 Speaker 2: Saying they don't know what the cause is. 589 00:31:11,040 --> 00:31:12,400 Speaker 1: And one thing that we do know is when you 590 00:31:12,480 --> 00:31:14,440 Speaker 1: have those types of transplants that you're taking a lot 591 00:31:14,480 --> 00:31:16,800 Speaker 1: of them, you know, suppressant, so it could be anything. Right, 592 00:31:17,080 --> 00:31:20,080 Speaker 1: This was really groundbreaking technology, but it was kind of 593 00:31:20,080 --> 00:31:20,920 Speaker 1: a one off. 594 00:31:20,800 --> 00:31:23,400 Speaker 3: Right, Yeah, I think it's a really great start when 595 00:31:23,400 --> 00:31:27,520 Speaker 3: we're thinking about the future of organ transplant And so 596 00:31:27,600 --> 00:31:30,480 Speaker 3: we asked doctor Low what does he feel as possible 597 00:31:30,520 --> 00:31:33,719 Speaker 3: in the coming years. Is this the future of transplant technology? 598 00:31:34,080 --> 00:31:34,320 Speaker 5: Yeah? 599 00:31:34,360 --> 00:31:37,760 Speaker 4: I mean I don't know if I'll be anything like accurate. 600 00:31:37,840 --> 00:31:40,080 Speaker 4: I guess we could meet in ten years or something 601 00:31:40,400 --> 00:31:44,920 Speaker 4: and see. But xeno transplantation, so using an organ from 602 00:31:44,920 --> 00:31:48,360 Speaker 4: another species is it's been around for quite a long time. 603 00:31:48,600 --> 00:31:52,040 Speaker 4: There's been a number of high profile cases that have 604 00:31:52,160 --> 00:31:55,280 Speaker 4: come up recently, and that's got us really interested. And 605 00:31:55,400 --> 00:31:57,840 Speaker 4: what I've seen from some of these organs that have 606 00:31:57,920 --> 00:32:01,480 Speaker 4: been used is that they've knocked out genes that express 607 00:32:01,560 --> 00:32:05,160 Speaker 4: proteins that are thought to be important in the immune response, 608 00:32:05,240 --> 00:32:09,760 Speaker 4: and they've engineered those genes out to presumably and hopefully 609 00:32:09,840 --> 00:32:14,080 Speaker 4: make things safer. And they've engineered in certain human genes. 610 00:32:14,680 --> 00:32:18,200 Speaker 4: So let's try and make that pig kidney or heart 611 00:32:18,680 --> 00:32:23,040 Speaker 4: more closely resemble the recipient. So it's science fiction, but 612 00:32:23,200 --> 00:32:26,760 Speaker 4: it's coming, it's here, and it's you know, it's really crazy. 613 00:32:26,840 --> 00:32:30,680 Speaker 5: So I'll be really interested to see how these transplants 614 00:32:31,280 --> 00:32:32,480 Speaker 5: go longer term. 615 00:32:32,520 --> 00:32:34,600 Speaker 4: I think there's a lot we need to learn about 616 00:32:34,840 --> 00:32:39,720 Speaker 4: how that immune response to that pig organ differs from 617 00:32:39,720 --> 00:32:43,120 Speaker 4: a human and what challenges we might have. I know 618 00:32:43,200 --> 00:32:48,160 Speaker 4: that in these cases, these recipients are extremely heavily immunosuppressed, 619 00:32:48,440 --> 00:32:50,720 Speaker 4: so it's not easy. I think there's a long way 620 00:32:50,760 --> 00:32:52,680 Speaker 4: to go and there's going to need to be a 621 00:32:52,720 --> 00:32:54,800 Speaker 4: lot of large human trials. 622 00:32:58,120 --> 00:32:59,480 Speaker 2: Immunology is everywhere. 623 00:32:59,600 --> 00:33:03,600 Speaker 3: Yeah, I don't know much about immunology, but I feel 624 00:33:03,600 --> 00:33:06,600 Speaker 3: a lot smarter after all of this, and I feel 625 00:33:06,640 --> 00:33:10,800 Speaker 3: like the future looks bright for organ transplant science. 626 00:33:11,160 --> 00:33:14,360 Speaker 1: I think it's really exciting, Like you said, it's bright, 627 00:33:14,520 --> 00:33:17,960 Speaker 1: But I also am cautious. I think a lot of 628 00:33:17,960 --> 00:33:20,920 Speaker 1: times we have the technology moving and it's divorced of 629 00:33:21,040 --> 00:33:23,920 Speaker 1: this social context, And so I'm like, what does it 630 00:33:24,000 --> 00:33:27,120 Speaker 1: mean for transplant technology? You know, as we start thinking 631 00:33:27,160 --> 00:33:30,640 Speaker 1: about this new tech and until it's readily available for everybody, 632 00:33:30,720 --> 00:33:33,240 Speaker 1: how are people going to decide who gets what? It 633 00:33:33,280 --> 00:33:36,760 Speaker 1: feels like this technology and the implementation of it is 634 00:33:37,000 --> 00:33:40,680 Speaker 1: ripe for abuse, you know, or more of the same 635 00:33:40,760 --> 00:33:43,040 Speaker 1: where we see people with the most money get these things. 636 00:33:43,080 --> 00:33:45,240 Speaker 1: And so I'm like, how can we do this better 637 00:33:45,280 --> 00:33:47,400 Speaker 1: than we've done some of the other systems of healthcare? 638 00:33:47,520 --> 00:33:49,120 Speaker 2: Yeah, but I feel excited about it. 639 00:33:49,160 --> 00:33:51,280 Speaker 1: Like you said, what was it the ear on the 640 00:33:51,320 --> 00:33:54,920 Speaker 1: back of the mouse, it's time to update the textbook photos. 641 00:33:55,040 --> 00:34:06,080 Speaker 1: That's right, it's the genetically altered pig heart. Now, what's 642 00:34:06,120 --> 00:34:06,680 Speaker 1: your one thing? 643 00:34:06,760 --> 00:34:08,359 Speaker 2: Tt my one thing this week? 644 00:34:08,440 --> 00:34:10,520 Speaker 3: Is a Dope Labs live show that is happening on 645 00:34:10,600 --> 00:34:14,319 Speaker 3: April fourteenth at the Boston Museum of Science. We did 646 00:34:14,320 --> 00:34:17,960 Speaker 3: a live show in Minnesota and so many people were like, oh, man. 647 00:34:17,960 --> 00:34:19,440 Speaker 2: I wish I'd known, I would have come out to 648 00:34:19,440 --> 00:34:22,560 Speaker 2: see you. So now you know. Tickets are free ninety nine. 649 00:34:22,840 --> 00:34:25,600 Speaker 3: You can come April fourteenth at the Boston Museum of 650 00:34:25,600 --> 00:34:28,200 Speaker 3: Science at seven pm. There'll be a link in the 651 00:34:28,239 --> 00:34:30,760 Speaker 3: show notes so that you can reserve your ticket. 652 00:34:31,160 --> 00:34:33,960 Speaker 1: My one thing this week is this citizen science project. 653 00:34:34,440 --> 00:34:36,279 Speaker 1: I don't know if you remember the earthquake back in 654 00:34:36,360 --> 00:34:39,600 Speaker 1: Haiti and what we consider seismology and how do we 655 00:34:39,680 --> 00:34:43,399 Speaker 1: track all of these events. There's a system called Raspberry Shake, 656 00:34:43,480 --> 00:34:46,080 Speaker 1: which are these small computers that allow you to track 657 00:34:46,239 --> 00:34:49,880 Speaker 1: seismic activity at a smaller level. So there's a network 658 00:34:49,960 --> 00:34:53,759 Speaker 1: of all these little computers giving us a worldview, and 659 00:34:53,880 --> 00:34:57,440 Speaker 1: just regular citizens, you know, not institutions are tracking this 660 00:34:57,560 --> 00:35:01,359 Speaker 1: information and sending it to this hub is raspberry shake 661 00:35:01,480 --> 00:35:03,880 Speaker 1: dot org, and you can see all the different stations 662 00:35:04,280 --> 00:35:08,160 Speaker 1: and track the most recent events, even really small events, 663 00:35:08,480 --> 00:35:11,399 Speaker 1: at station view dot raspberry shake dot org. 664 00:35:11,560 --> 00:35:23,799 Speaker 2: It's kind of cool. That's it for Lab fifty six. 665 00:35:24,080 --> 00:35:26,799 Speaker 1: Call us at two zero two five six seven seven 666 00:35:26,920 --> 00:35:29,520 Speaker 1: zero two eight and tell us what you thought, or 667 00:35:29,719 --> 00:35:31,239 Speaker 1: you can give us an idea for a lab you 668 00:35:31,280 --> 00:35:34,360 Speaker 1: think we should do. Either way, we love hearing from you. 669 00:35:34,440 --> 00:35:37,880 Speaker 1: That's two zero two five six seven seven zero two eight. 670 00:35:37,880 --> 00:35:40,239 Speaker 3: And don't forget there's so much more for you to 671 00:35:40,239 --> 00:35:42,479 Speaker 3: dig into on our website. There will be a cheat 672 00:35:42,520 --> 00:35:45,560 Speaker 3: cheet there for today's lab and additional links and resources 673 00:35:45,560 --> 00:35:47,640 Speaker 3: in the show notes. Plus, you can sign up for 674 00:35:47,719 --> 00:35:50,360 Speaker 3: our newsletter, so check it out at Dope Last podcast 675 00:35:50,480 --> 00:35:54,879 Speaker 3: dot com special thanks to today's guest expert, doctor Dave Low. 676 00:35:55,320 --> 00:35:58,040 Speaker 1: You can find more information about Davelow's work with organ 677 00:35:58,080 --> 00:36:01,279 Speaker 1: transplantation on LinkedIn at one Lambda Incorporated. 678 00:36:01,680 --> 00:36:04,160 Speaker 3: You can find us on Twitter and Instagram at Dope 679 00:36:04,239 --> 00:36:05,520 Speaker 3: Labs Podcast. 680 00:36:05,360 --> 00:36:08,320 Speaker 2: And TT's on Twitter and Instagram at d R Underscore 681 00:36:08,400 --> 00:36:12,360 Speaker 2: t Sho, and you can find Zakia at z said So. 682 00:36:13,320 --> 00:36:16,480 Speaker 3: Dope Labs is a Spotify original production from Mega owned 683 00:36:16,480 --> 00:36:17,080 Speaker 3: Media Group. 684 00:36:17,160 --> 00:36:20,080 Speaker 1: Our producers are Jenny Radlett Mast and Lydia Smith of 685 00:36:20,160 --> 00:36:21,360 Speaker 1: WaveRunner Studios. 686 00:36:21,680 --> 00:36:25,000 Speaker 3: Editing in sound design by Rob Smerciak. 687 00:36:24,560 --> 00:36:26,200 Speaker 2: Mixing by Hannes Brown. 688 00:36:26,440 --> 00:36:30,320 Speaker 3: Original music composed and produced by Taka Yasuzawa and Alex 689 00:36:30,400 --> 00:36:36,120 Speaker 3: Sugier from Spotify, Executive producer Corinne Gilliard and creative producer 690 00:36:36,320 --> 00:36:43,360 Speaker 3: Miguel Contreras. Special thanks to Shirley Ramos, Jess Borrison, Jasmine Afifikamu, Elolia, 691 00:36:43,760 --> 00:36:47,759 Speaker 3: tillkrat Key, and Brian Marquis. Executive producers from Mega Own 692 00:36:47,800 --> 00:36:57,040 Speaker 3: Media Group are US T T Show, Dia and Zakiah Wattley.