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babes and baboons jesica santillan and experimental pediatric transplant research in america lesley a. sharp Organ transplantation within the American context is regularly proclaimed as a miraculous medical procedure, and indeed for many patients with life-threatening illness it can o√er a remarkable extension of life. Bearing the potential to save, and thus enhance or extend individual lives, the transplant miracle nevertheless depends on radical surgical interventions. In anticipation of organ replacement, anesthetized patients must enter the operating theater, where their natal hearts and lungs, for instance, are removed, their vital functions temporarily bridged by complex apparati until their surgeons can implant newly acquired parts. When transplantation is viewed in this manner, it does in fact seem miraculous that annually, tens of thousands of patients survive such procedures, their lives prolonged by days, months, and even decades as a result of full organ replacement. These facts are even more astounding when we consider that many of these patients are children.∞ Our willingness to accept organ transplantation as an increasingly routine procedure stems from a cultural imperative that biomedical expertise must include the ability to repair breakdowns in fragile human bodies. Therefore, medicine bears the promise of extending human lives, or, as it is commonly phrased within the transplant arena itself, granting ‘‘second lives’’ or ‘‘rebirths ’’ to organ recipients. When patients su√ering from organ failure are adults, surgical outcomes are assumed to bear additional promises associated with longevity: these include greater mobility and, in turn, enhanced economic productivity. An altogether di√erent set of concerns emerge, however, when the patients in need are children. Within our society, we readily perceive a life cut short as no life at all. Thus, children, as innocents, are frequently identified as candidates for some of the most radical forms of medical intervention known. This pairing of social expectations and medical responses springs 300 lesley a. sharp from shared understandings that we, as parents and extended kin, as community members, and as physicians, must do all that is possible to save children from the throes of death. Such is true even when children must endure great su√ering in order to survive. Our actions are based on our desire that they experience adulthood and lead long and healthy lives. Middleclass values shape more specific social expectations and concerns, too: we hope that they complete advanced levels of schooling; find fulfillment in lucrative forms of work; encounter suitable partners and fall in love; survive long enough to bear witness to their own children’s accomplishments; and outlive their elders, too. Once defined as a maverick and thus dangerous clinical dream only fifty years ago, organ transplantation has rapidly transformed into a routinized medical practice. This transformation, however, would not have been possible were it not for ongoing experimental research involving both human and animal subjects. This progression, from renegade desire to medical success story, has depended overwhelmingly on an extraordinarily complex array of biotechnological interventions. The respirator, for instance, insures the viability of precious organs even when housed in the body of a brain-dead donor, the machine’s pulsing action driving a steady flow of oxygenated blood and stimulating the heart’s pulse. Anesthesia, in turn, stabilizes this ‘‘dead’’ body during surgery, dampening reactions that could threaten the ‘‘life’’ of vital organs. Furthermore, pharmaceutical cocktails composed of immunosuppressants , steroids, blood thinners, gastrointestinal medications, and vitamin supplements enable a transplanted graft to escape the assault of full-scale rejection once it has been placed in an organ recipient’s body. Such procedures , now commonplace, nevertheless rest on a history of trial and error and, thus, failure and success. In more explicit terms, this means that a host of patients died while furthering the cause of transplantation. The ability to sustain human life—whether that of a child or a seasoned elder—bears a heavy price: the success of all medical procedures, no matter how routine they may now seem, rests on earlier forms of experimentation. This experimental imperative pervades every area of medicine. Each time the novice practitioner attempts a procedure for the first time, the patient is, inevitably in some sense, an experimental subject. And with each innovation —be it a new medication, an emergent medical device, or even a slight innovation on an established surgical technique—individual patients again serve as medical guinea pigs. Often the most heroic acts are those known to involve the greatest risks: when attempting a new lifesaving procedure, the practitioner knows that it may...

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