Dr. Robert Montgomery talks about performing one of the first transplants of a genetically modified pig kidney into a living patient and the future of medicine.
Alice ParkIt’s singular enough to be one of the most pioneering transplant surgeons in the world. But Dr. Robert Montgomery’s journey in medicine is even more remarkable since he is a transplant patient himself.
As professor of surgery and director of the NYU Langone Transplant Institute, Montgomery performed one of the first transplants of a genetically modified pig kidney into a living patient in 2024. Using carefully tailored pig parts instead of human ones could revolutionize the field of organ transplantation, potentially helping to resolve the chronic shortage of organs available for patients who need them. Montgomery’s pursuit of better options for transplant patients is both personal and professional. His father died at 52, when Montgomery was 16. Back then, doctors couldn’t tell the family that his father had a genetic form of heart failure, which also affected Montgomery’s uncle and which he and his two brothers also inherited. “I remember this scene very distinctly,” he says. “My father was unable to leave the hospital at that point, and it was probably the first time I really heard about transplantation—my mother was pleading with the cardiologist if there was anything else they could offer. He said, ‘Well, there’s a heart transplant, but your husband is too old. And they don’t work anyway.’”“I think that was a seed that was sort of planted in my adolescent brain, and I wondered, ‘Why don’t they work?’” he says.After initially wanting to be a veterinarian, his father’s early death drew Montgomery toward medicine and transplantation. It was a field still struggling to overcome the basic challenges of not only finding enough organs for people who needed them, but improving the odds that once these scarce organs were transplanted, people would live long and healthy lives. It was a seemingly impossible task, since the human immune system is designed to reject anything it doesn’t recognize as its own. But Montgomery saw an opportunity to help innovate solutions to help people like his father. “My mind doesn’t go to the routine or the day-to-day,” he says. “I immediately went to the bigger questions: how can I make things better?” After becoming a surgeon, he divided his time between the operating room and studying ways to both increase the availability of donor organs and better control the immune system to improve the success of transplants. By this time, one of Montgomery’s brothers had developed the same heart condition that their father had and needed a heart transplant. He finally received a donor heart, but Montgomery remembers the agony of waiting months while his brother deteriorated. One strategy Montgomery pioneered became known as “domino” or “chain” transplants, in which incompatible donors of patients needing transplants agree to donate organs to other, matching patients so that their intended recipient would receive a compatible organ from someone they didn't know to prevent the organs from being rejected. Montgomery also explored new ways to expand the pool of living donors for organs like the kidney and liver. One such population that had never been considered before, he proposed, was people with hepatitis C infections . Hepatitis C prevented them from donating, since they could pass on their virus and make an already risky transplant procedure even more dangerous for the recipient. Montgomery initiated a trial using new antiviral drugs after transplants with these organs and found that in more than 95% of cases, the medications controlled the infection.But like his father and brothers, Montgomery began to experience symptoms of heart failure. He had gone into cardiac arrest seven times, revived each time with an implantable defibrillator he received when he was 29. He, too, needed a heart transplant, and he decided to put his theory to the test in the most personal way: by becoming one of the first people in the world to receive a heart from a donor with hepatitis C. It worked. Transplant centers now accept organs from people with hepatitis C.Seven years later, Montgomery is still forging new paths in transplant surgery, perfecting the transplants of pig kidneys that have been genetically modified to be more compatible with the human immune system. These xenotransplants, as animal-to-human organ transplants are called, are an important part of addressing the organ shortage and represent a much-needed way to replace diseased organs, he says. “I’m someone who wakes up every day thinking, ‘This has to go faster.’ But the speed at which this field has evolved is, to me, stunning.” For transplant candidates—like Montgomery— and those who love them, the clock is always ticking. “I have three kids who have inherited this disease. Someday, there is going to need to be something for them. And it’s got to be better than it was for my father—and even better than it’s been for me.” Eventually, such animal organs could even contribute to helping people live healthier and longer lives, he says. “Most people, when they die, they die from organ failure. And it’s usually just one organ. In terms of longevity and thinking about, I think the single most powerful thing is going to be having another source of organs.” The really exciting potential, Montgomery says, is the idea that “we can just replace or switch out a damaged or failing organ and rejuvenate a person. In most kinds of diseases, switching an organ out by giving somebody a new organ will give them a new lease on life and many added years.” Just as it did for him. This article is part of TIME for Change, a new series spotlighting extraordinary leaders who are working to solve urgent health problems—one bold idea at a time.
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