The increase in waiting lists for organ transplants, and in the number of people who die while waiting for a transplant, provide stark evidence of the National Health Service's inability to cope adequately with the growing problem of premature end-stage organ failure. (1)  The number of donated human organs is insufficient to meet demand and the option of using transgenic pig organs is being pursued.

The impetus to develop this methodology will grow following the publication on 20th August of the report, which showed that transmission of porcine endogenous retrovirus (PERV) had not occurred in 160 people who had been treated with living pig tissue. (2) While this does not mean there is no risk of viral transmission, it will be perceived as reassuring and will encourage progress towards clinical trials of transplantation of whole pig organs.  In perhaps five to 15 years, transplantation of pig organs could be taking place routinely and might even provide the major contribution to transplantation programmes, providing the rejection problem can be overcome, and providing there is no transmission of viruses which are dangerous to human beings.

The leading cause of premature organ failure is diabetes and, over the next 15 years, the number of people with diabetes in this country is likely to increase from some 1.5 million to around 3 million, on the basis of world-wide forecasts. (3) The demand for kidneys and other organs will therefore grow.  Consequently, we will need more transplant facilities, more surgeons and other staff, more organs and more money.  Pig organs cannot be expected to survive as long as transplanted human organs and will need to be replaced more often, adding to overall costs. 

Over the next 15 years, there will also be an increase in the prevalence of cancer, cardiovascular disease, strokes and dementia.  More facilities, staff, and money will be required to meet these needs.  It will not be possible for the National Health Service, as presently funded, to meet all of these conflicting demands.  Resources will have to be rationed.  In the absence of additional funding, waiting lists  for transpant surgery can be expected to increase.

This rather unhopeful scenario is, of course, not the only possible future.  It would be possible over the next 15 years to reduce the prevalence of diabetes and therefore of end-stage organ failure.  It would also be possbile, with early effect, to reduce the waiting list for organ transplants, notably kidneys, by increasing the number of donated human organs.  This could be achieved firstly, if the percentage of kidneys gifted by living donors were to rise from the present UK level of 10%, to nearer that of Norway, where 45% of all the transplanted kidneys are given by healthy volunteer donors. (4)  Secondly, we could improve the uptake of organs from people who wish to gift them after their deaths - at present less than 70% of these gifted organs are used. (5)

The measures required to reduce the prevalence of diabetes are remarkably simple.  As a nation, we take very little exercise and more than 50% of British people are too fat.  In addition, the British diet is dominated by sugary drinks and processed foods which contain excessive quantities of refined sugar, saturated fat and salt.  These two factors are well known to be jointly responsible for most of the increase in the prevalence of diabetes, but there are barriers to making the change to a leaner, fitter nation, whose diet actually prevents diabetes.  These barriers are commerical, political and social in nature.

Any reduction in future demand for organ transplants would adversely affect the financial prospects of companies involved in xenotransplantation development.  Any change towards a health-promoting national diet would adversely affect the profits of the food and drink processing industries.  The provision of more cycle lanes, recreational and sporting facilities would require major capital investment.  Government policy on health is dominated by commercial providers whose interests are best served by the increasing investment of resources in treatment of sick people, rather than by investment in prevention.  People who live in cold, damp houses, who are unemployed, who do not know if they will have enough money to buy food in the coming days, are not in a position to change their diet or choose a healthier lifestyle.  These same people are those most vulnerable to premature organ failure.

Prevention of diabetes is the key to the intermediate and long term solution of the problem of end-stage organ failure.  But it is more than this.  The measures which prevent diabetes are, together with the avoidance of cigarette smoking,also measures which prevent cancer, cardio-vascular disease, strokes, and dementia.  The Government knows this, the commercial interests involved in health care provision know this, but the people do not.

The health of much of the adult population of the United Kingdom is already compromised.  The future health of our children need not be compromised if we all, that is the Government, the food industry, and the people themselves, cooperate in the piloting, resourcing the introduction of measures to prevent diabetes.  The first steps towards this goal would be to tell the nation the truth about the stark options to be faced; to facilitate public discussion and debate on the issues involved; and to provide for full representation of the people in the decisions to be made.

We can either prevent diabetes and so provide a healthy future for the nation, or we can, by default, permit diabetes to increase and so provide a future dominated by the commercial exploitation of premature organ failure.

(1) Kmietowicz, Z: "More doctors and donors needed for transplantion in the UK" BMJ 1999  318: 350
(2) Paradis, K et al. "Search for cross-species transmission of porcine endogenous retrovirus in patients treated with living pig tissue" SCIENCE 1999; 285: 1236-9
(3) Mandrup-Poulson, T "Diabetes"  BMJ 1998 316: 1221-5
(4) Nicholoson, MI and Bradley, JA: "Renal transplantation from living donors" BMJ 1999; 318: 350
(5) Turner, S: "Interest falls in the human organ bank." BMA News Review", October 1997
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Press release August 27, 1999