Artificial Organs in the New Gilded Age

Having the bank take possession of your house is terrible. But what if it happens to your liver?

Photo by Joe Raedle/Getty Images

Cutting-edge bioscience researchers too often seem to imagine that the new technologies they develop exist somewhere beyond society, in some zone beyond politics. It’s unfortunate that the fruit of their lab work often outstrips their capacity to explain, or even open a conversation about, the fruit’s societal significance. What we usually get instead is innocuous-sounding boosting. Promises about the problems that the strictly beneficent application of new technology will bring in the near future abound. Without being sensational, the typical scenario tossed up by these researchers is idyllic.

This pattern certainly holds for last week’s announcement of the latest development in organ fabrication and transplantation. Using a technique based on induced pluripotent stem cells (derived from adult human skin and reprogrammed, they can differentiate into various cell types, like natural stem cells), researchers based in Yokohama created functional, vascularized human “liver buds” in vitro. About 4 millimeters wide, these minilivers were then transplanted into mice that had been made to suffer from chemically induced liver failure. As the published report’s abstract puts it, the pluripotent stem cell liver buds “rescued the drug-induced lethal liver failure model.” In addition to being good news for the guinea pig mice, this development is genuinely amazing. Technically, it’s a giant step. The liver buds secreted like a natural human organ, splooshing out the same chemical stew as your liver—if it’s working properly—is doing right now. The buds even linked up with the mice’s vascular system and continued growing. And maybe as important as its scientific success, the induced pluripotent stem cell technique also defuses the ethical critique of natural pluripotent stem cell experimentation because it does not call for destruction of embryos.

But these coups shouldn’t shield experts’ blue-sky predictions from scrutiny. The notion of “off-shelf livers” brings to mind a visit to Target, a casual stroll down the artificial organ isle. But the hope that in a near future this technique will make it “possible to generate virtually any failing body organ” seems criminally naïve.

There’s little evidence to warrant blue skies and fairytales. Statusization is the watchword in our New Gilded Age. Given our embrace of ever finer gradations of class, it’s likelier that the wealthy will have access to freshly minted organs, while the organ-comprised poor will have dreams of, hope for, aspirations toward, and other sundry substitutes for genuinely rehabbed bodily systems. But scientists (and their institutions’ PR teams) can do better than the fairytale-ish tendency to depict events that have not happened and very likely won’t happen. Instead, they—and we—should learn from science fiction’s proclivity for scenarios that have not happened but actually could happen.

In his 1968 novel A Gift From Earth, Larry Niven shows us a future world in which artificially grown human organs are used to destabilize a liberty-poor society that’s come to rely upon the harvesting of organs from criminals. The transplants are more about punishment and life-extension than beneficent therapy. By simply linking criminality and organ transplantation, Niven’s nearly 50-year old parable is light-years ahead of last week’s liver bud announcement. In the world of Repo Men, the 2010 movie from Miguel Sapochnik, a corporation monopolizes sales of mechanical organ replacements, not the lab-grown type. The tech is different, but the punch line is relevant and cuts to the quick: The replacements are so expensive that most customers purchase them on a payment plan, and when customers fall behind in their installments—as many do—the corporation reclaims the products. “Can’t pay for your car? Bank takes it back. Can’t pay for your house? Bank takes it back. Can’t pay for your liver? Well, that’s where I come in,” the central repo man character, Remy, tells us.

These science fiction parables ring truer than the researchers’ fairytales. And those parables point to questions that we should probably answer before the technology ripens: What happens when organ engineering and transplantation techniques emerge in societies defined by stark class-, race-, and gender-based striations. More and more, our society at large resembles nothing so much as the arrangement of classes defining the experience of contemporary air travel. Will you be able to afford an economy class liver? Perhaps a business class model? Will organ markets reproduce the qualitative differences we’ve come to accept with commercial air classifications? Should organ performance track organ price? Or will costs differentials turn mainly on trademarks and branding (the new Fendi liver, fresh for fall 2027!). If you’re underwater on your liver mortgage, it’s safe to assume you’ll be hard-pressed to walk away. Perhaps what the fairy tales lack in realism they make up for through placation.