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    Drugs Have Uses We Can’t Imagine. He’s Using A.I. to Find Them.

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    A little over a year ago, Joseph Coates was told there was only one thing left to decide. Did he want to die at home, or in the hospital?Coates, then 37 and living in Renton, Wash., was barely conscious. For months, he had been battling a rare blood disorder called POEMS syndrome, which had left him with numb hands and feet, an enlarged heart and failing kidneys. Every few days, doctors needed to drain liters of fluid from his abdomen. He became too sick to receive a stem cell transplant — one of the only treatments that could have put him into remission.“I gave up,” he said. “I just thought the end was inevitable.”But Coates’s girlfriend, Tara Theobald, wasn’t ready to quit. So she sent an email begging for help to a doctor in Philadelphia named David Fajgenbaum, whom the couple met a year earlier at a rare disease summit.By the next morning, Dr. Fajgenbaum had replied, suggesting an unconventional combination of chemotherapy, immunotherapy and steroids previously untested as a treatment for Coates’s disorder.Within a week, Coates was responding to treatment. In four months, he was healthy enough for a stem cell transplant. Today, he’s in remission.The lifesaving drug regimen wasn’t thought up by the doctor, or any person. It had been spit out by an artificial intelligence model.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      A Guy I Know Had a Liver Transplant. Now He’s Boozing Again.

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      The magazine’s Ethicist columnist on how to support someone with an addiction problem.My significant other has a friend who is a longtime alcoholic, while also being intelligent, entertaining and conniving. For example, he used to tell his wife he was going to the gym and then head to the bar; before returning home, he’d dampen his clothes in the bathroom to make it seem as if he’d gotten a good sweat on. He was off the radar for a bit, and then we learned he had a liver transplant. After that, he had an episode of hepatic encephalopathy, a brain disorder caused by liver dysfunction. It seems the doctors knew he was still drinking but gave him the new liver anyway and counseled abstinence. A few parties later, he was sneaking vodka, gin and whatever else was around. He lies to everyone and has made his guy friends vow not to tell his wife about his drinking. They’ve made a meager attempt to confront him, only to be assured that he just fell off the wagon and would be good. Just don’t tell the wife!I’m appalled that they’re going along with this. There are a couple of ethical issues here. First, who should decide whether someone is entitled to a transplant? Some hospital systems deny a liver transplant to patients who continue to drink alcohol, and other hospitals don’t. Second, do the friends have an obligation to tell this man’s wife that he’s still drinking? She could insist he leave the house and go to rehab, in which case he might have a chance of living long enough to see his children get married. Some additional context: A friend of mine died waiting for a liver transplant. I am also the child of a lifelong alcoholic. — Name WithheldFrom the Ethicist:There’s more than one morally defensible way of allocating donor organs. In the United States, as in Western Europe, the system emphasizes equity and basically gives priority to patients with the greatest need. An approach that focused instead on efficiency — on getting the maximum use out of donated livers, as measured by ‘‘quality-adjusted life years’’ — might give an edge to people who were younger and otherwise healthier and might work against low-income and minority populations.Organ allocation in the United States is governed by the Organ Procurement and Transplantation Network (O.P.T.N.), whose policies determine the order in which deceased-donor organs are offered; they do not, however, dictate medical practice. So it’s up to a medical center to decide whether or not transplant candidates with alcohol-related liver disease are to abstain from alcohol for some period — six months having long been a typical sobriety window. Some studies indicate that carefully selected patients who aren’t subject to a sobriety window can do just as well as those who are (though the data is hard to interpret because of the ‘‘carefully selected’’ part). And if your drinking has caused a severe case of acute hepatitis that doesn’t respond to medical treatment, you probably won’t survive a six-month waiting period. So the trend seems to be away from requiring an extended interval of abstinence.The point is that the current system for allocating this scarce resource is morally legitimate, whatever trade-offs it may entail; its architects are perfectly aware that many liver recipients will not succeed in refraining from heavy drinking afterward. The fact that this longtime alcoholic has returned to his old habits is distressing. It doesn’t mean that the system isn’t functioning the way it’s meant to.One thing that transplant centers may try to determine is whether patients with an alcohol problem have social networks that could help them stay sober. This brings us to your second question. This fellow’s friends weren’t looking after him when they agreed to uphold this boozy bro code and keep mum. He doesn’t want to die, but he’s drinking himself to death, which means that, at least in this key area, he lacks the capacity for rational decision-making. In a situation like that, it’s more important to attend to his interests than to respect his autonomy. If there’s a chance that his life can be extended by successful management of his alcoholism, and if discussing the problem with his wife will help, thoughtful friends would do just that.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Patient Dies Weeks After Kidney Transplant From Genetically Modified Pig

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      Richard Slayman received the historic procedure in March. The hospital said it had “no indication” his death was related to the transplant.Richard “Rick” Slayman, who made history at age 62 as the first person to receive a kidney from a genetically modified pig, has died about two months after the procedure.Massachusetts General Hospital, where Mr. Slayman had the operation, said in a statement on Saturday that its transplant team was “deeply saddened” at his death. The hospital said it had “no indication that it was the result of his recent transplant.”Mr. Slayman, who was Black, had end-stage kidney disease, a condition that affects more than 800,000 people in the United States, according to the federal government, with disproportionately higher rates among Black people.Surgeons performing the world’s first kidney transplant from a genetically modified pig into a living human in March.Michelle Rose/Massachusetts General Hospital, via Agence France-Presse — Getty ImagesThere are far too few kidneys available for donation. Nearly 90,000 people are on the national waiting list for a kidney.Mr. Slayman, a supervisor for the state transportation department from Weymouth, Mass., had received a human kidney in 2018. When it began to fail in 2023 and he developed congestive heart failure, his doctors suggested he try one from a modified pig.“I saw it not only as a way to help me, but a way to provide hope for the thousands of people who need a transplant to survive,” he said in a hospital news release in March.His surgery, which lasted four hours, was a medical milestone. For decades, proponents of so-called xenotransplantation have proposed replacing ailing human organs with those from animals. The main problem with the approach is the human immune system, which rejects animal tissue as foreign, often leading to serious complications.Recent advances in genetic engineering have allowed researchers to tweak the genes of the animal organs to make them more compatible with their recipients.The pig kidney that was transplanted into Mr. Slayman was engineered by eGenesis, a biotech company based in Cambridge, Mass. Scientists there removed three genes and added seven others to improve compatibility. The company also inactivated retroviruses that pigs carry and could be harmful to humans.“Mr. Slayman was a true pioneer,” eGenesis said in a statement on social media on Saturday. “His courage has helped to forge a path forward for current and future patients suffering from kidney failure.”Mr. Slayman was discharged from the hospital two weeks after his surgery, with “one of the cleanest bills of health I’ve had in a long time,” he said at the time.In a statement published by the hospital, Mr. Slayman’s family said he was kind, quick-witted and “fiercely dedicated to his family, friends and co-workers.” They said they had taken great comfort in knowing that his case had inspired so many people.“Millions of people worldwide have come to know Rick’s story,” they said in the statement. “We felt — and still feel — comforted by the optimism he provided patients desperately waiting for a transplant.” More

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      Share Your Story About the Organ Transplant System

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      We want to hear from doctors, nurses, technicians, patients and others with experience in the system. Tell us your experiences below.The New York Times is interested in the organ transplant system.Do you have a tip about irregularities in the system? If so, we need your help.If you are a doctor, nurse, technician or anybody else working on organ transplants, we’d love to hear from you. We are also eager to talk to from medical residents working in those transplant programs. And of course, we also want to hear from patients and their families.Share your story about the organ transplant systemWe will not publish any part of your submission without contacting you first. We may use your contact information to follow up with you. More