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> The hospital said it had “no indication that it was the result of his recent transplant.” Sorry, the burden of proof goes backwards. When you are doing somet

> The hospital said it had “no indication that it was the result of his recent transplant.” Sorry, the burden of proof goes backwards. When you are doing something this novel and the patient dies so soon afterwards, the null hypothesis is that it had something to do with the transplant and you have to show evidence that it was not due to the transplant.

pocketarc 2y ago
It is entirely possible that the hospital knows what happened and why the person died, and are just not sharing it (maybe to respect the family's privacy, for example). Having said that, I do think you're right, the cause of death should absolutely be shared, otherwise it looks quite dodgy. If he was indeed discharged with "one of the cleanest bills of health I’ve had in a long time", then how could he die so shortly after, and why would there not be more discussion around the specifics?
- everforward 2y ago
  It’s grim, but he had renal failure requiring an operation in 2018 and then back into renal failure causing congestive heart failure in 2023. It’s very possible for him to have the cleanest bill of health he’s had in 6 months or a couple of years, while still dying. I suspect that unwinding whether his death is related to the transplant or not is non-trivial. He had a few issues that would likely kill him soon. Figuring out which one did, and whether it was caused by the transplant, may be difficult.
jorlow 2y ago
On the other hand, you have to be pretty sick to qualify for such extremely experimental procedures. And transplants are pretty intensive operations even when someone is otherwise healthy (and getting human organs). It doesn't seem farfetched for unrelated complications to indeed be the cause of death.
Someone 2y ago
If alternative treatment with decent prognosis exists (in this case Hemodialysis is such an option), to get past the ethics committee, first operations like these typically have to be done on patients on their death bed. That doesn’t make it likely the patients survive a long time. For example, here’s what Wikipedia says this of the first receiver of a heart transplant (https://en.wikipedia.org/wiki/Louis_Washkansky https://en.wikipedia.org/wiki/Louis_Washkansky): “As a result of heart attacks in 1965, approximately only one third of his heart was still functioning. In late October, he went into a diabetic coma, but regained consciousness. Once, when he was swollen with fluid and in considerable pain, his wife Ann asked him in a whisper how he was doing. He managed a smile and whispered, "I'm on top of the world." He was also suffering from kidney and liver failure.” And that’s a case where no good alternative treatment existed, at a time when ethics committees weren’t as stringent as they are today, if they existed at all.
bsder 2y ago
Someone who has end stage kidney disease practically by definition has a shitload of other problems--any of which can kill the patient. This is similar to AIDS. AIDS almost never kills directly. Some other disease like cancer or pneumonia does the actual killing.
rediguanayum 2y ago
While article doesn't say the cause of death, the patient did suffer from congestive heart failure, as a prior condition. Further congestive heart failure can cause all sorts of complications, meaning that the patient was pretty sick at baseline. According to the article, patient had an earlier human kidney transplant in 2018 that failed in 2023 leading to the congestive heart failure, and thus made patient a candidate for the xeno-kidney transplant. Patient was a pioneer- rest in peace.
andrelaszlo 2y ago
This is why there are concepts like relative survival. Maybe new procedures are evaluated using similar methods? https://en.m.wikipedia.org/wiki/Relative_survival https://en.m.wikipedia.org/wiki/Relative_survival
hombre_fatal 2y ago
Not when the intervention is done on someone already about to die.
torstenvl 2y ago
No. When a very ill patient with several terminal comorbidities dies, the null hypothesis is that he died from one of those conditions. Your prior is to be skeptical of new medical interventions, and that's fine, but it is your responsibility to distinguish between your biases and the most likely a priori cause.
choilive 2y ago
The patient had a host of other conditions that put their mortality risk already extraordinarily high, which is likely why this experiment treatment got approved in the first place. Kidney function might now be fine but it could have just have easily been one of the other comorbidities that did them in. I am sure they are doing more research on this.

pocketarc 2y ago

It is entirely possible that the hospital knows what happened and why the person died, and are just not sharing it (maybe to respect the family's privacy, for example). Having said that, I do think you're right, the cause of death should absolutely be shared, otherwise it looks quite dodgy. If he was indeed discharged with "one of the cleanest bills of health I’ve had in a long time", then how could he die so shortly after, and why would there not be more discussion around the specifics?

everforward 2y ago
It’s grim, but he had renal failure requiring an operation in 2018 and then back into renal failure causing congestive heart failure in 2023. It’s very possible for him to have the cleanest bill of health he’s had in 6 months or a couple of years, while still dying. I suspect that unwinding whether his death is related to the transplant or not is non-trivial. He had a few issues that would likely kill him soon. Figuring out which one did, and whether it was caused by the transplant, may be difficult.

jorlow 2y ago

On the other hand, you have to be pretty sick to qualify for such extremely experimental procedures. And transplants are pretty intensive operations even when someone is otherwise healthy (and getting human organs). It doesn't seem farfetched for unrelated complications to indeed be the cause of death.

Someone 2y ago

If alternative treatment with decent prognosis exists (in this case Hemodialysis is such an option), to get past the ethics committee, first operations like these typically have to be done on patients on their death bed. That doesn’t make it likely the patients survive a long time. For example, here’s what Wikipedia says this of the first receiver of a heart transplant (https://en.wikipedia.org/wiki/Louis_Washkansky https://en.wikipedia.org/wiki/Louis_Washkansky): “As a result of heart attacks in 1965, approximately only one third of his heart was still functioning. In late October, he went into a diabetic coma, but regained consciousness. Once, when he was swollen with fluid and in considerable pain, his wife Ann asked him in a whisper how he was doing. He managed a smile and whispered, "I'm on top of the world." He was also suffering from kidney and liver failure.” And that’s a case where no good alternative treatment existed, at a time when ethics committees weren’t as stringent as they are today, if they existed at all.

bsder 2y ago

Someone who has end stage kidney disease practically by definition has a shitload of other problems--any of which can kill the patient. This is similar to AIDS. AIDS almost never kills directly. Some other disease like cancer or pneumonia does the actual killing.

rediguanayum 2y ago

While article doesn't say the cause of death, the patient did suffer from congestive heart failure, as a prior condition. Further congestive heart failure can cause all sorts of complications, meaning that the patient was pretty sick at baseline. According to the article, patient had an earlier human kidney transplant in 2018 that failed in 2023 leading to the congestive heart failure, and thus made patient a candidate for the xeno-kidney transplant. Patient was a pioneer- rest in peace.

andrelaszlo 2y ago

This is why there are concepts like relative survival. Maybe new procedures are evaluated using similar methods? https://en.m.wikipedia.org/wiki/Relative_survival https://en.m.wikipedia.org/wiki/Relative_survival

hombre_fatal 2y ago

Not when the intervention is done on someone already about to die.

torstenvl 2y ago

No. When a very ill patient with several terminal comorbidities dies, the null hypothesis is that he died from one of those conditions. Your prior is to be skeptical of new medical interventions, and that's fine, but it is your responsibility to distinguish between your biases and the most likely a priori cause.

choilive 2y ago

The patient had a host of other conditions that put their mortality risk already extraordinarily high, which is likely why this experiment treatment got approved in the first place. Kidney function might now be fine but it could have just have easily been one of the other comorbidities that did them in. I am sure they are doing more research on this.