MEANS OF OVERCOMING THE HOMOGRAFT REACTION
The pathway that has led from the demonstration of the immunological nature of the homograft reaction and its universality to the development of relatively effective but by no means completely satisfactory means of overcoming it for therapeutic purposes is an interesting one that can only be touched upon very briefly. The year 1950 ushered in a new era in transplantation immunobiology in which the discovery of various means of weakening or abrogating a host’s response to a homograft—such as sublethal whole body X-irradiation, or treatment with certain adrenal cortico-steroid hormones, notably cortisone—began to influence the direction of the mainstream of research and engender confidence that a workable clinical solution might not be too far off. By the end of the decade, powerful immuno-suppressive drugs, such as 6-mercaptopurine, had been shown to be capable of holding in abeyance the reactivity of dogs to renal homografts, and soon afterward this principle was successfully extended to man.
Is my resistance to the draft based on an ingrained abstract distaste for tyranny in all forms or rather on the mere desire to keep my body intact? Could it be both, maybe? Do I need an idealistic rationalization at all? Don’t I have an inalienable right to go through my life wearing my own native-born kidneys?
The law was put through by an administration of old men. You can be sure that all laws affecting the welfare of the young are the work of doddering moribund ancients afflicted with angina pectoris, atherosclerosis, prolapses of the infundibulum, fulminating ventricles, and dilated viaducts. The problem was this: not enough healthy young people were dying of highway accidents, successful suicide attempts, diving-board miscalculations, electrocutions, and football injuries; therefore there was a shortage of transplantable organs. An effort to restore the death penalty for the sake of creating a steady supply of state-controlled cadavers lost out in the courts. Volunteer programs of organ donation weren’t working out too well, since most of the volunteers were criminals who signed up in order to gain early release from prison: a lung reduced your sentence by five years, a kidney got you three years off, and so on. The exodus of convicts from the jails under this clause wasn’t so popular among suburban voters. Meanwhile there was an urgent and mounting need for organs; a lot of important seniors might in fact die if something didn’t get done fast. So a coalition of senators from all four parties rammed the organ-draft measure through the upper chamber in the face of a filibuster threat from a few youth-oriented members. It had a much easier time in the House of Representatives, since nobody in the House ever pays much attention to the text of a bill up for a vote, and word had been circulated on this one that if it passed, everybody over sixty-five who had any political pull at all could count on living twenty or thirty extra years, which to a Representative means a crack at ten to fifteen extra terms of office. Naturally there have been court challenges, but what’s the use? The average age of the eleven Justices of the Supreme Court is seventy-eight. They’re human and mortal. They need our flesh. If they throw out the organ draft now, they’re signing their own death warrants.
For a year and a half I was the chairman of the anti-draft campaign on our campus. We were the sixth or seventh local chapter of the League for Bodily Sanctity to be organized in this country, and we were real activists. Mainly we would march up and down in front of the draft board offices carrying signs proclaiming things like:
KIDNEY POWER
And:
A MAN’S BODY IS HIS CASTLE
And:
THE POWER TO CONSCRIPT ORGANS IS THE POWER TO DESTROY LIVES
We never went in for the rough stuff, though, like bombing organ-transplant centers or hijacking refrigeration trucks. Peaceful agitation, that was our motto. When a couple of our members tried to swing us to a more violent policy, I delivered an extemporaneous two-hour speech arguing for moderation. Naturally I was drafted the moment I became eligible.
“I can understand your hostility to the draft,” my college advisor said. “It’s certainly normal to feel queasy about surrendering important organs of your body. But you ought to consider the countervailing advantages. Once you’ve given an organ you get a 6-A classification, Preferred Recipient, and you remain forever on the 6-A roster. Surely you realize that this means that if you ever need a transplant yourself, you’ll automatically be eligible for one, even if your other personal and professional qualifications don’t lift you to the optimum level. Suppose your career plans don’t work out and you become a manual laborer, for instance. Ordinarily you wouldn’t rate even a first look if you developed heart disease, but your Preferred Recipient status would save you. You’d get a new lease on life, my boy.”
I pointed out the fallacy inherent in this. Which is that as the number of draftees increases, it will come to encompass a majority or even a totality of the population, and eventually everybody will have 6-A Preferred Recipient status by virtue of having donated, and the term Preferred Recipient will cease to have any meaning. A shortage of transplantable organs would eventually develop as each past donor stakes his claim to a transplant when his health fails, and in time they’d have to arrange the Preferred Recipients by order of personal and professional achievement anyway, for the sake of arriving at some kind of priorities within the 6-A class, and we’d be right back where we are now.
Fig. 7. The course of a patient who received antilymphocyte globulin (ALG) before and for the first four months after renal homotransplantation. The donor was an older brother. There was no early rejection. Prednisone therapy was started forty days postoperatively. Note the insidious onset of late rejection after cessation of globulin therapy. This was treated by a moderate increase in the maintenance doses of steroids. This delayed complication occurred in only two of the first twenty recipients of intrafamilial homografts who were treated with ALG. It has been seen with about the same low frequency in subsequent cases. (By permission of Surg. Gynec. Obstet. 126 (1968): p. 1023.)
So I went down to Transplant House today, right on schedule, to take my physical. A couple of my friends thought I was making a tactical mistake by reporting at all; if you’re going to resist, they said, resist at every point along the line. Make them drag you in for the physical. In purely idealistic (and ideological) terms I suppose they’re right. But there’s no need yet for me to start kicking up a fuss. Wait till they actually say, We need your kidney, young man. Then I can resist, if resistance is the course I ultimately choose. (Why am I wavering? Am I afraid of the damage to my career plans that resisting might do? Am I not entirely convinced of the injustice of the entire organ-draft system? I don’t know. I’m not even sure that I am wavering. Reporting for your physical isn’t really a sellout to the system.) I went, anyway. They tapped this and X-rayed that and peered into the other thing. Yawn, please. Bend over, please. Cough, please. Hold out your left arm, please. They marched me in front of a battery of diagnostat machines and I stood there hoping for the red light to flash—tilt, get out of here!—but I was, as expected, in perfect physical shape, and I qualified for call. Afterward I met Kate and we walked in the park and held hands and watched the glories of the sunset and discussed what I’ll do, when and if the call comes. If? Wishful thinking, boy!