AN INHUMAN DILEMMA DEBATE OVER USE OF ANIMAL PARTS IN PEOPLE WEIGHS POTENTIAL BENEFITS WITH HEALTH UNCERTAINTIES, MORAL QUANDRIES.

Byline: Evan Henerson Staff Writer

ON A MEMORABLE early episode of Fox's now canceled ``Ally McBeal,'' the series' title character defended a surgeon accused of transplanting a pig liver into a woman without her permission. Upon regaining consciousness, Hanna Goldstein (played by Liz Torres) was outraged that Dr. Greg Butters (Jesse L. Martin) had to use ``a big fat hog'' to save her life.

Is such a scenario plausible? Absolutely not, says Dr. Robert Mendez, transplant surgeon at St. Vincent Medical Center.

``Nothing like that would ever be done without incredible informed consent,'' Mendez says. ``You would have about four attorneys with the patient's family if the patient was not conscious. No way would this be done on someone who was not able to give informed consent. That's TV stuff.''

However, the use of animal parts in humans is hardly science fiction. Given the need for organs and the shortage of donors, scientists are looking at every option to help bridge the gap - including stem cell research and artificial organs.

And, yes, animal organs. Pig organs in particular.

``I can't help feeling that if we can have a well-functioning pig heart, a natural heart, it would be better than a mechanical device,'' says Dr. David Cooper, associate professor of surgery at Harvard Medical School, and co-author of the book ``Xeno: the Promise of Transplanting Animal Organs Into Humans.'' ``And with kidneys, livers and so on, there is nothing on the horizon that will be a suitable artificial organ that you can implant.''

Cooper adds, ``If we had an unlimited donor supply, we might do four times as many transplants, but we're never going to solve the problem with humans. From very early on, I felt the only way was to go get an animal organ.''

Officials from People for the Ethical Treatment of Animals (PETA) counter that a stronger push to get human donations is a better solution.

``We have an ethical problem with all use of animals for experiments, and this is particularly objectionable,'' says Kathy Guillermo, a spokeswoman and writer for PETA. ``The science isn't great and the risk is high. We don't believe it's right to treat animals as living donors.''

Saved by xeno

The National Institutes of Health has a committee devoted to the study of xenotransplantation: the process of transplanting live, nonhuman animal cells, tissues or organs into human beings for medical purposes. The procedure is relatively common regarding the transfer of nonvital organs. Scientists have used xenografts from pigs to shore up rotator cuffs and replace defective heart valves.

Through the use of nonlive tissue, doctors don't have to worry about rejection or infection. Basically, the human body simply absorbs the pig tissue and your heart or shoulder is almost as good as new, doctors say.

After he broke 41 bones, including his rotator cuff, in a boating accident, Thomas Archibald said his shoulder could fall out of its socket when he was only sitting.

Dr. John Itamura, an orthopedic surgeon at USC University Hospital, repaired the rotator cuff using the first Restore Orthobiologic Soft Tissue implant - commonly known as the ``pig patch.''

The procedure, say Archibald and Itamura, won't be ideal for everybody who sustains a severe shoulder injury. Archibald elected to try the patch - which resembles a dried up potato chip - figuring it would give him the best chance for recovery.

``I asked Dr. Itamura if he would have it done and he said 'No, it's too painful and I don't need to do what you do,' '' said Archibald, 60, a former Sierra Madre resident who is president of Haztech Systems, Inc. in Mariposa, Calif. ``I'm a very active person.''

The successful transfer of animal hearts, livers and kidneys is still in the future. Doctors have used primate and pig organs to keep people alive for periods of up to 60 days. International researchers have reported success using pig islets cells to control symptoms of Parkinson's disease and diabetes.

And 18 years after Baby Fae survived three weeks with a transplanted baboon heart - eventually succumbing to a blood type incompatibility - scientists say the prospect of another groundbreaking xenograft is alive and exciting.

``All hospitals may eventually be doing them,'' says Mendez, who is on the NIH's advisory committee, which reports to the Secretary of the U.S. Department of Health and Human Services. ``I'm so impressed by the manner in which the problem is being addressed and how deliberate and how detailed everything is.''

``We have ethicists, philosophers, scientists, clinicians, religious leaders. The committee covers all spectrums,'' he adds. ``There's not going to be any rogue type of clinics or experimentation done in the United States. That's just not going to happen.''

There are, of course, a myriad of medical and ethical issues to overcome. The fact that certain species of primates are endangered has made their use less than ideal. Chimps and baboons also have longer gestation periods, so they can't be bred as quickly. And whatever the species, scientists risk transmitting an infection that the human body is not equipped to battle, meaning - as with human transplants - a lifetime of anti-rejection medication.

In 1992, a team of surgeons led by Dr. Thomas Starzl at the University of Pennsylvania performed a pair of baboon liver transplants. One patient survived for two months, another for 26 days. In both cases, the patients were suffering from terminal diseases that had severely harmed their immune systems. In all likelihood, researchers say, it was an infection, not the transplant itself that led to their deaths.

The pig has become the transplant animal of choice. Through genetic engineering, scientists have created pigs that are extremely close molecularly to human beings, thereby reducing the risk of transferring a harmful disease. Unlike nonhuman primates, pigs will never be in short supply. But the problem of preventing the human body from rejecting a nonhuman organ is still to be solved.

Animal rights activists are hardly pleased at the use of pigs for medical research, but scientists counter that pigs are not an endangered species and we already use them for food. As Mendez points out, if we use 4,000 pigs a week in California for food, why shouldn't we be using the animal as a possible means of curing diabetes?

Losing the race?

Animal organs have also been used as temporary ``jump'' organs, to keep severely ill patients alive long enough for a more suitable human organ to be found.

Scientists say anybody who has had a cellular xenotransplant will be monitored for life and should not reproduce. ``We don't know if these cells will be transferred to the next generation,'' says Mendez.

``That becomes another ethical issue,'' he continues. ``Religious leaders and others have asked the question, 'Are we changing the human race in a manner that God didn't intend? God didn't intend for us to be part human and part animal.' ''

Hollywood has already exploited the possibility of xenography in films like ``Spider-Man,'' ``The Fly'' and the recent comedy ``The Animal'' that had Rob Schneider taking on nonhuman characteristics after he had been ``fixed up'' with numerous animal parts. Adam, the character played by Christian Slater in the 1993 romance ``Untamed Heart,'' is told he had a baboon heart transplant at birth. Given that the character is well over the age of 21, that would make him a medical miracle.

Even with Hollywood's assistance - or hindrance, as the case may be - Cooper says the primary objection to xenotransplantation seems to be from animal rights organizations rather than from people worried about Frankensteinian species blends.

When faced with counterarguments, Cooper quotes Sir Peter Medawar, a Nobel prize winner and considered the father of transplantation immunology.

``He was talking about human transplantation,'' says Cooper. ``He said, 'You can discuss it as much as you like. The crunch is that people will accept it because they'd rather be alive than dead.' If (xenotransplantation) works, if we can show that it's really life-saving, people will accept it.''

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SOURCE: National Institutes of Health; International Xenotransplantation Assocation.