It’s easy to grasp the medical miracle of the organ transplant, where a kidney or heart is passed from one person to another to restore the life of the recipient. Stem cell transplants are a little more abstract in concept, with the life-saving exchange happening via blood donation and infusion rather than the drama of dual surgeries. But the effects upon patients who receive a stem cell transplant are no less transformative, providing them with a new future free from leukemia, myeloma and other bone marrow cancers and the health issues and unpleasant treatments those conditions entail.

As such, it made sense to organize an opportunity for stem cell transplant patients to share that experience with each other, just as recipients of other types of transplants have their own events. The 2nd annual Celebration of Life - a reunion of patients, donors, family members and medical staff - was held this past weekend at the University of Chicago Medical Center, drawing more than 200 people to hear and share stories of the procedure’s success. Held in the atrium of the Duchossois Center for Advanced Medicine, a beautiful spring day appropriately bathed the attendees in sunlight as they talked about the new beginning offered by the treatment.

While patients and their families mingled at the event, we pulled some aside to hear the stories of life before and after stem cell transplant. In the video below, you can view several of those stories, from patients who had their transplant in recent months to patients who received a stem cell transplant more than 15 years ago. We also heard from Koen van Besien, director of the stem cell transplant program at the Medical Center, about why he is “humbled” to see so many patients living healthy lives after the procedure.

A common thread throughout the event was the ever-widening window for people to be eligible for stem cell transplant. By coincidence, van Besien and Lucy Godley have a commentary in this week’s issue of the Journal of the American Medical Association, describing the advances that have allowed doctors to treat more patients with stem cell transplant. For people who are unable to receive autologous transplants from their own blood, the search for compatible donors has been a major obstacle for the procedure. But as the JAMA commentary describes, innovation in the immunological testing of potential donors, preservation of umbilical cord blood, and drugs that enable the use of partially-matched donors are giving more and more patients access to the treatment. As Andrew Artz says in the video below, the hope is that the procedure will become so widely available that future reunions will need to take place in Soldier Field.

For more on stem cell transplants, see our Dr. FAQ videos with Dr. Godley posted last week.

There are probably few medical topics more plagued by online misinformation than stem cell transplants. Part of this confusion is down to people mixing up embryonic stem cells, which have yet to be adapted to clinical use, with hematopoietic stem cells, which have been used in transplants for over four decades. Hematopoietic stem cells are found in bone marrow and circulating blood and are less versatile than their embryonic counterparts, as they are only capable of turning into blood cells. But for patients with blood disorders and cancers such as leukemia or multiple myeloma, a transplant of stem cells from a healthy, compatible donor can be a life-saving procedure.

This weekend, dozens of stem cell transplant patients and their families will come to the University of Chicago Medical Center for a reunion event to celebrate the impact the procedure made on their lives. Many will also reconnect with the physicians and nurses who helped them through their transplant experience, which involves strong chemotherapy and very careful (and sometimes lengthy) screening for compatible donors. Lucy Godley, assistant professor of medicine, is one of the Medical Center’s stem cell transplant experts, serving in both the clinic and the laboratory to help patients and push forward the frontiers of the procedure. We sat down to talk about the basics of stem cell transplants: what diseases it is used for, what the experience is like for donors and patients, and how research is expanding the number of patients eligible for the treatment.

Enjoy the videos, and tune in next week for interviews and footage from the stem cell patients’ reunion.

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fMRI on Trial

Last year, one of the most-followed trials in the Chicago area was the first-degree murder case against Brian Dugan, who was accused of murdering a 10-year-old Naperville girl in 1983. The Dugan trial was interesting for many reasons, most notably for coming at the end of a 26-year process during which two other men were falsely convicted and sentenced to death for the crime. But it wasn’t until I read this week’s issue of Nature that I realized the scientific precedent set during the trial, one that signaled a new intersection of science and law that could be very important in coming decades.

During the sentencing portion of the trial, after Dugan had been convicted of the murder, testimony for both the defense and prosecution was provided by neuroscientists. This occurrence in and of itself is not unusual, as scientific evidence is more and more frequently used to argue whether a criminal suffers from mental illness that contributed to the crime. But as reporter Virginia Hughes summarizes nicely, this courtroom science debate was different, as it hinged upon new evidence for mental illness: an fMRI brain scan.

Through his defense team, Dugan had been volunteered for a study conducted by Kent Kiehl from the University of New Mexico on the brains of psychopaths, people who lack a sense of moral behavior. According to Hughes’ article, Kiehl has conducted fMRI scans - which create a live movie of brain activity - on more than 1,000 criminals over 16 years, including many that used a mobile scanner located at a prison in New Mexico. Dugan, already in police custody for two other murders, was scanned by Kiehl at Northwestern Memorial Hospital during his trial and interviewed by Kiehl for a diagnosis of psychopathy.

But when defense lawyers attempted to introduce the results of the scan and interview into court as a “mitigating factor” that could save him from the death penalty, prosecutors objected. Hughes writes that DuPage County State’s Attorney Joseph Birkett argued in court that the scans would prejudice the jury due to “bright colors and statistical parameters…chosen by the researchers.” A hearing held outside the jury’s presence led the judge in the trial to rule that the results of Dugan’s scan could be discussed, but not shown in the trial. After some more legal oddness unrelated to the brain scans, Dugan was eventually sentenced to death in November 2009.

Though somewhat irrelevant to the details of the case, the role that fMRI scans played in Dugan’s sentencing could open the floodgates of a phenomenon speculated about for quite some time: the use of brain imaging in courtrooms. Hughes’ article does a great job of rounding up scientist opinions about this use - both against and, perhaps surprisingly, for - so I won’t recapitulate those here. But the central argument against brain scan “diagnosis” of mental illness is worth remembering for all brain scan studies - most such research uses average pools of data from multiple subjects that can’t always be applied on an individual basis. As Hughes reports Jonathan Brodie, a psychiatrist from New York University, said in the trial, “If you look at professional basketball players, most of them are tall…but not everyone over six foot six is a basketball player.”

There’s a nice overview of this article and some other research into brain imaging of mental illness by Vaughan Bell at Mind Hacks.

Elsewhere…

In another crossover of science and law enforcement, a PNAS study suggested that the thriving worlds of bacteria present on everyone’s skin (gross but true) could be employed as a forensic tool. Specifically, the authors proposed that by testing the bacteria present on a computer mouse or keyboard, they could identify people who had recently used those devices - a useful police tool for determining who hacked into a system or deleted incriminating data. And as Ars Technica and Wired report, it worked, putting the old-fashioned fingerprint duster on notice.

Science-writing kerfuffle! I normally think that the science writers at UK newspaper The Guardian are some of the best around (and their sportswriters are the best), but boy is this article wrongheaded. I just wrote about epigenetics on the blog recently, and will do so again many times in the future, but nowhere will I ever claim that it proves Darwin wrong, because that’s just, well, wrong. Jerry Coyne, Carl Zimmer, and another Guardian reporter have already torn it to shreds, it’s worth reading like a car accident is worth gaping at.

Should people be allowed to donate their organs to strangers in exchange for money? A recent survey from the University of Pennsylvania said that payment for organ donation would increase supply without drawing disproportionately from the poor, but the University of Chicago’s Lainie Ross criticized their conclusions.

I’ve come down with a severe case of baseball fever this week, earlier than ever before. Could climate change be to blame? Regardless, I thought I’d put that condition to good use with a couple pieces of science news from the sports world.

The Touchy-Feely Strategy

To tide me over through the long, slow crawl of spring training, I’ll be paying extra attention to college basketball as March Madness gets into full swing. As I start to ponder my bracket, I might do some scouting of how the top-ranked teams perform in an unusual statistical category: high-fives. That’s based on an unusual paper, reported recently in the New York Times, that correlated “tactile communication” with better performance in NBA teams analyzed during the 2008-09 season. The vocabulary of such communication includes the following, according to the paper: “fist bumps, high fives, chest bumps, leaping shoulder bumps, head slaps, head grabs, low fives, high tens, full hugs, half hugs, and team huddles.” What, no Christian side hugs?

The authors, from the University of California, Berkeley, wanted to test their hypothesis that touch is an important way by which humans build “trust, cooperation, and group functioning” (The paper has not yet been published, but is available from lead author Michael Kraus’ website). The background section mentions that primates spend as much as a fifth of their time grooming each other, and that several psychology experiments have found that brief touches increase trust and bonding between two people. That benefit, they reasoned, would be especially useful in team sports, where working together presumably increases chances of success (don’t tell Allen Iverson).

Testing this hypothesis involved “scoring” a number of basketball games from early in the 08-09 season for the above list of hands-on celebrations, as well as less overt “expressions of cooperation and trust,” such as talking, gesturing, passing the ball and helping on defense. The researchers then correlated those touch scores to individual players’ and teams’ performances over the rest of the season, and found a positive correlation for both. In other words, the touchier a player was, the better season they had; the touchier a team was as a whole, the more successful they were over the course of a season.

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Six weeks ago, the surgical team responsible for the first successful living-donor transplant were reunited at the University of Chicago Medical Center with Teri and Alyssa Smith, the mother and daughter who were donor and recipient in that historic surgery 20 years ago. But the conference was held on October 16, jumping the gun slightly, as the actual anniversary of the living-donor transplant was November 27, 1989. November 27, 2009 fell on the day after Thanksgiving, making the fuzzy date of the conference understandable, and also providing a valid excuse for why your ScienceLife editors completely missed our own plans to mark the occasion.

But it’s not too late to share with you the videos we shot at the conference with Alyssa Smith, now 21, her mother Teri, and Christopher Broelsch, lead surgeon of the team that conducted the 12-hour surgery 20 years ago. The delay also allowed time for a touching letter to arrive at the Medical Center communications office, written to Alyssa and her family by a chemistry teacher who assisted on experiments in the 1970’s that helped pave the way for living-donor transplants. That letter was in response to Katie Scarlett Brandt’s excellent cover story for Medicine on the Midway this month retelling the story of that first surgery in 1989.

First, the videos. Here’s Teri and Alyssa talking about what they remember (or don’t remember) about the surgery 20 years ago, and the strange feeling of attending a conference where you’re the star patient:

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Alyssa Smith, now 21, was the first U.S. recipient of a living-donor liver transplant in 1989.

Today’s conference celebrating the 20th anniversary of the first pediatric living-donor liver transplant in the United States was many things: a history lesson, a technical discussion of surgical techniques, a reunion of dispersed colleagues, a media event. But most impressively, it was the rare medical conference that paid direct tribute to the reason everyone was there - the patients. Capping nearly 8 hours of presentations were brief remarks by Teri and Alyssa Smith, the mother-daughter/donor-recipient pair at the heart of that first procedure back in November 1989.

In their speeches, both Teri and Alyssa listed off things that they do that most of us would likely take for granted: dancing ballet, playing bass clarinet, going off to college, comparing clothes over a video chat. But in the context of hearing about a procedure that seems implausible even today, much less in 1989, these everyday activities were like a series of priceless gifts, given to the Smith family by medical science and the talent and care of the surgeons, pediatricians, nurses and medical ethicists 20 years ago.

Many of those personnel had made it to Chicago for today’s conference, and many of the speakers spoke lovingly of Dr. Christoph Broelsch, the lead surgeon on that first living-donor liver transplant. Broelsch was the other featured speaker of the day, but he found little to talk about after all the preceding talks had outlined the history of the procedure and how it has since spread around the world and been used to extend the lives of thousands of patients. Instead, Broelsch took the time to thank the surgical teams, here and at the two medical centers he subsequently worked at in Germany, and to talk movingly about a failed case in the early days of liver transplantation, and how difficult such failures were to face.

Also moving was Giuliano Testa, director of liver transplantation at the University of Chicago Medical Center who spoke about the importance of protecting the donors in these types of procedures. The pressure of potentially holding the key to saving a loved one’s life often puts the donor in a situation where they may not be able to make an honest decision, Testa said, reinforcing the need for independent donor advocates provided by the hospital. When all agree that donating an organ is the right decision, medically and ethically, for the donor, they should be emphatically saluted, Testa said.

“It is only through the courage of this mother [Teri Smith], and all mothers, brothers, sisters, and fathers that have gone under our knife, that not only have we saved lives, but become better doctors,” Testa said.

I took several videos of Alyssa and Teri Smith, Christoph Broelsch, and medical ethicist Mark Siegler (who was intricately involved in the 1989 case), that I will post on this site in the future. If you want to read a more detailed account of this event, my live-blog commentary remains below.

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Dr. Michael Millis with Melvin and Raquel Allen (photo by John Easton)

(See Parts One and Two here)

One week after the living-donor liver transplant surgery that saw a portion of Catherine Ortiz’s liver transferred to 11-month-old Raquel Allen, Ortiz’s family visited Allen’s family at Comer Children’s Hospital. Raquel, a day removed from the pediatric intensive care unit, looked as good as new standing on her father’s lap and munching goldfish crackers as TV cameras rolled. She also got her first chance to meet Ortiz’s 1-year-old son, Phoenix, who has already been penciled in as Raquel’s prom date 16 years from now, according to Raquel’s mother Coral Grinage.

Here’s the final video in our three-part series, where surgeon Michael Millis talks about Raquel’s long-term prognosis, Ortiz talks about her recovery from liver-donor surgery and Melvin Allen talks about what’s in store for Raquel’s birthday this Saturday.

Raquel Allen is prepared for surgery August 25th

(See parts One and Three)

One week ago today, I spent the day in two operating rooms of Comer Children’s Hospital at the University of Chicago Medical Center filming a living-donor liver transplant surgery. In one room, the patient was 27-year-old Catherine Ortiz, who had agreed to donate about a quarter of her liver to a co-worker’s young daughter. That patient, 11-month-old Raquel Allen, was brought into an adjacent operating room after doctors confirmed that Ortiz’s liver would be suitable for transplant.

After four hours of surgery, a portion of Ortiz’s liver had been removed and placed on ice as Raquel’s defective liver (she suffers from the congenital disorder biliary atresia) was removed by a second surgical team next door. After a short trip between operating rooms, surgeons placed the liver fragment in Raquel’s abdomen, then very carefully sewed blood vessels and bile ducts together to fully connect the new organ with the infant’s circulatory and digestive systems. At 4:30 p.m., Raquel’s incision was closed, and her new liver began its work - a medical achievement impossible until 20 years ago, now accomplished in less than 8 hours.

Below is a video that takes you inside those operating rooms for a glimpse at this amazing procedure. Since it is surgery, there is some blood and graphic footage, so if you are bothered by that sort of thing, take heed.

Catherine Ortiz is recovering at home after her discharge from the hospital last Thursday, two days after the procedure. Raquel Allen was moved from the pediatric intensive care unit yesterday, and will remain in the hospital for at least another week, including her birthday this Saturday. We’ll check back in with Raquel and her parents for a video to be posted later this week.

The transplant was also featured in the Chicago Sun-Times today. Part 1 of our video series, containing interviews with Raquel’s parents and Catherine, can be found here.

Raquel Allen and her parents before the surgery

(See parts Two and Three)

Twenty years ago this November, the first living-donor liver transplant was performed at the University of Chicago Hospital, transferring a portion of the organ from Teresa Smith to her 9-month-old daughter, Alyssa. In October, the team of surgeons (led by Dr. Christopher Broelsch), pediatricians and ethicists who collaborated on that historic procedure will reunite for a conference, alongside Teresa and Alyssa Smith - now 20 years old and healthy.

Surgeons continue to perform living-donor liver transplants today, and though the procedure has become practically routine for some transplant surgeons, it remains an amazing feat of medicine that seems almost improbable: a piece of one person’s organ granting new life to another. This week, one such gift played out at the University of Chicago Medical Center, as 11-month-old Raquel Allen, diagnosed with biliary atresia (a congenital disease where the liver does not properly secrete bile), received a portion of a donor’s liver. Remarkably, donor Catherine Ortiz is not related to Raquel, but is a co-worker with Raquel’s mother at a Chicago pharmacy.

Raquel’s parents, Catherine and the surgeons were gracious enough to allow us to observe the procedure as it unfolded over 8 hours last week, and for the next few days we’ll be posting a video documentary of the event in three installments. Here’s the first, which contains interviews with Raquel’s parents, Melvin Allen and Coral Grinage, and Catherine Ortiz. Tomorrow, we’ll post footage from the surgeries, and later this week we’ll check in with Raquel and her family as she recovers in Comer Children’s Hospital.

You’d rather not live without any organ, but some are easier than others to replace with technology. Kidney fails? Get dialysis. Diabetes saps your pancreas? Take insulin. Heart gives out suddenly? Try a left ventricular assist device.

Credit: HepaLife

But the liver poses a special problem. Its biochemistry is so complex that no one understands all the functions it serves, or the details of how it works. We do know it’s essential for blood clotting and for removing a wide range of toxins from the bloodstream. Acute liver failure can lead to death within 48 hours. Yet even the liver’s well-defined functions are difficult to mimic completely. Then there are the thousands of proteins the liver produces, many of which have poorly understood roles in the body.

All of that makes it hard for artificial livers to do much more than help patients survive a few more hours while they wait for a donor organ. Even the term “artificial liver” is a bit misleading, because most of the devices rely on liver cells of some kind. Duplicating their function from scratch is just too difficult. (Imagine if heart assist devices had to use actual heart muscle cells.)

As this Forbes piece observes, several companies have gone out of business trying to make artificial livers. One of the rare success stories that the story cites is a University of Chicago patient, Amy Petrovic, who nine years ago survived on a synthetic liver for a few days - long enough for her condition to improve so she could survive a liver transplant operation. 

Attempts to make reliable devices keep coming - one company this week announced plans for a new Phase III trial of an artificial liver system, and a separate trial started last month. But stories like Petrovic’s also underscore the immensity of this challenge, and the limits of medical knowledge. Many hurdles in medicine are purely technological in nature. In this case, researchers don’t know exactly where the technological intervention should start, because they don’t fully grasp the underlying biology.