Top surgeon predicts organ donation from pigs could advance to become superior option

A senior US transplant surgeon leading a landmark clinical trial of pig kidney transplants in living patients has said such organs could eventually outperform those from human donors.

Dr Robert Montgomery, who heads the trial at NYU Langone’s Transplant Institute, is overseeing a study in which six patients are initially expected to receive gene-edited pig kidneys, according to an article by The Guardian.

The organs have been modified at 10 genetic sites to reduce the risk of rejection by the human immune system. The technique of using non-human organs, known as xenotransplantation, is designed to address the chronic shortage of donor organs. If the US Food and Drug Administration (FDA) approves the early results, the trial could be expanded to include 44 additional transplants. One procedure has already been carried out, with another planned for January.

Participants in the study are patients who are either ineligible for a human kidney transplant or are on waiting lists but face a high likelihood of dying or remaining without a transplant within five years.

“The truth is that there’s just never going to be enough human organs,” Montgomery told the Guardian.

“I think everybody really knows that we have a terrible problem in terms of rationing organs because there’s such a scarcity of supply. But unless you’ve walked in the shoes of somebody who’s waiting for a transplant, you don’t really fully understand how unlikely it is that you’re going to receive a transplant in time,” he said.

Montgomery has spent much of his career developing ways to increase the availability of human organs. He helped pioneer domino-paired kidney transplants, in which incompatible donor-recipient pairs are linked into chains that allow multiple transplants to take place.

He has also led efforts to use organs from donors with hepatitis C, treating recipients with medication to clear the infection. In a highly personal decision, Montgomery even accepted a hepatitis C–positive heart for his own transplant after suffering repeated cardiac arrests caused by an inherited condition.

Despite these advances, he believes incremental improvements are no longer enough.

“Having spent a career trying to increase incrementally the number of human organs available, I realised that we just weren’t making that much progress, not in a meaningful way,” he said. “And any progress we made was kind of deleted by the ever-expanding number of people who are waiting for transplants.”

While xenotransplantation has been discussed for decades, Montgomery said recent breakthroughs—particularly the ability to genetically edit pigs—have transformed the field.

“There were all these kind of jokes about xenotransplantation, like it’s just around the corner and it’s an awfully long corner,” he said. “But suddenly we’re in it.”

In 2021, Montgomery performed the world’s first transplant of a gene-edited pig kidney into a human. Although the recipient was brain-dead, he said the procedure demonstrated that the organ was not immediately rejected and provided vital safety data that paved the way for trials in living patients.

Looking ahead, Montgomery suggested pig organs could one day surpass human ones in transplant medicine.

“They could be superior at some point because we can constantly modify them to make them better, where you can’t do that with a human organ,” he said.

By Nazrin Sadigova