In Martine Rothblatt's mind, the organ farm of the future looks something like this:
There's reason to take her seriously—the Sirius satellite radio founder turned pharmaceutical magnate turned transhumanist has been successful in most everything she's done, and now she's focused on growing 100,000 lungs, hearts, and other transplantable organs per year.
Rothblatt has invested heavily in a fairly new technique called ex vivo lung perfusion, in which the lungs of a brain dead person are kept alive outside the body by pumping a warm, blood-like liquid through them. EVLP has been successful in saving lungs that have been without blood or oxygen for over an hour, which was once thought impossible. EVLP is the technology that's available and in use today—it was approved by the FDA last year and has been used in more than 1,000 procedures so far. But EVLP still requires you to find a brain dead human with a functioning set of lungs. Why not grow some at a farm?
"When you need to build 100,000 lungs, you need to build a pathogen-free place," Rothblatt said Tuesday at a DARPA biotechnology conference in New York City, as she unveiled the image you see above. "How man made dogs, how biotech made medicine, we'll make organs."
"I'm using technology to create an unlimited supply of transplantable organs, and I'm doing it now, with no delay," she added.
"Weird does not mean unethical"
At her proposed organ farm, Rothblatt's company, United Therapeutics, plans to grow human organs in genetically modified pigs. Animal-to-human transplantation, called xenotransplantation, isn't a new idea—the heart valves of pigs are regularly transplanted into humans all the time. Transplanting entire pig organs into humans has been something of a pipe dream for a while, which is why Rothblatt is trying a new approach.
"Organs from porcine donors fit nicely in terms of size and function, but they do not fit nicely in how the molecules mesh together," she said. "The idea began to percolate—maybe the way an artist of a sculpture chisels off rock, maybe we can chisel off enough genes to make a human-compatible genome."
"There will be pigs whose lungs are 99 percent pig genome, with a little bit of human genome"
Far from seeming utterly futuristic, Rothblatt's presentation seemed like one of the more plausible ideas presented at a conference where DARPA scientists casually discussed editing human genomes after we're born, creating artificial life, and melding humans with artificial intelligence. Whether she can actually pull it off is anyone's guess, but, regardless, work has already started.
Rothblatt figured that "chiseling off" anywhere from eight to 15 genes will make it possible to transplant a pig organ into a human one without the need for immunosuppressants, and she said the company has "sequenced the pig genome to a far greater level of granularity than any database in the world."
But it's not just sequencing. The company and its partners at the National Institutes of Health have edited out four of the necessary genes so far, and have transplanted the heart of one of those pigs into several baboons, one of which lived for two years after surgery.
"There will be pigs whose lungs are 99 percent pig genome, with a little bit of human genome to make them tolerable to humans," she said.
Rothblatt says it'll be possible to attempt a pig-to-human transplantation in an end-stage lung disease patient by 2020. After that, she plans on starting the organ factory you see above, where genetically-modified pigs will be allowed to breed with each other to push production into overdrive.
"We want to make herds of homozygotic pigs with modified genes of interest in order to save many tens of thousands of lives," she said.
This all may sound a bit overly optimistic, and there certainly are very significant hurdles to get over. Can these genetically modified pigs survive with organs that are made to be transplanted into humans, for instance? It's hard to say at the moment, but xenotransplantation is just the near-term goal for Rothblatt, who said she wants to eventually take pig hearts, strip them of everything that makes them porcine, and replace them with human cells, creating something that makes the organ have the "scaffold of a pig's lungs, but all the cells will be human."
She thinks that eventually, we will 3D print replacement organs that use the recipient's own genetic material. You will receive an organ that is, genetically, identical to the one you were born with. She knows it's a hard sell for traditionalists, and that, at least in the near term, people may think that growing human organs in pigs is perhaps a bridge too far for science.
"Weird does not mean unethical. There's a 45-degree line on a graph—as long as the utility exceeds the yuckiness, social acceptance wins," she said. "Taking organs from dead people and putting them in living people once seemed weird, it's not weird anymore. It would be stupid to abjure nature's greatest invention since chemistry."