A Thymus for Maggie

Medical and ethical debate over liberalized abortion laws has centered on the woman and the unborn child. A byproduct of legal abortions, however, can affect the vital interests of a third party: a desperately ill youngster who can be helped by a transplant from an aborted fetus. Such operations are still rare. But Dr. Arthur Ammann of the University of California's San Francisco Medical Center has performed two gland transplants that may encourage increasing use of fetal tissue.

Magdalena Vozaites, 5, is the daughter of a Greek immigrant family living in Daly City, Calif. The victim of a birth defect that prevented her from resisting infection, Maggie has had illness as her constant companion since infancy. During one 18-month period, she was hospitalized nine times with serious infections, including pneumonia. It was questionable whether she would survive childhood.

Vital Gland. Last summer, Maggie was referred to Ammann, a specialist in pediatric immunology. When she failed to respond to injections of a white blood cell extract as a means of arousing immunity, Ammann realized that the problem was in her thymus gland--a butterfly-shaped bit of tissue that lies just behind the breastbone. The gland has a key role in the development of the body's immune responses.Tn one previous case, Ammann knew--implantation of a thymus from a miscarried fetus stimulated this process in a child born without the gland.

Hopeful that a similar operation could help Maggie, Ammann took advantage of California's liberalized abortion law to search for an appropriate fetal thymus. The task proved difficult. For best results, Ammann needed a transplant from a healthy fetus 14 to 20 weeks old. These are rare because most California abortions are performed before the twelfth week of pregnancy. But in December, Ammann found a woman who was having a late abortion on psychiatric grounds and got permission to use the fetus' thymus.

Moral Question. Flown to San Francisco in an insulated container, the thymus was implanted during a three-hour procedure. That proved relatively easy. Many other transplants must be hooked up to the circulatory system in order to function properly; the thymus, requiring no connection, is merely placed in the abdominal cavity. Maggie's liver and spleen, which had become enlarged during her illnesses, have decreased in size. She is now at home, and her immunological system appears to be working normally.

Last month, Ammann tried the operation again on Matthew Octavio of Petaluma, four weeks old, who suffered from an immune defect that had killed six of his cousins. He was sent home, then returned to hospital with a possible respiratory infection, which the transplant might help him to overcome.

Despite its success, the operation is likely to come under fire from opponents of abortion who question the morality of using tissue from aborted fetuses. But Ammann sees no ethical problems in his operation. "We don't go around soliciting abortions," he says. "These are abortions that are already being done for other reasons." Dr. Samuel Kountz, a kidney specialist at the U.C. Medical Center, would like to try an even bolder operation--the transplant of a fetal kidney.

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