Top 21 Vital Organs. You’ll never guess #18!

Modern medicine has gotten really good at replacing organs. That, or modern medicine just lops off organs because they’re not vital. Here’s a ranking of the pieces of the human body ranked from least to most valuable, judged by how often/easily modern medicine excises or artificially imitates them.

1. Gallbladder – We take it out out so frequently and patients care so little they forget that they don’t have it anymore. Who needs an on-demand bile bag anyway?
2. Spleen – Removing it is therapeutic for conditions like sickle cell and hereditary spherocytosis. If your spleen gets nicked somehow (i.e. stabbed or shot), it’s out with the spleen!
3. Breasts – Cow milk and baby formula are complete substitutes. Prophylactic mastectomies are gaining in popularity thanks to some celebrity outreach. Some people prefer fake ones anyway.
4. Thyroid – Got too little thyroid hormone? Take synthroid! Too much thyroid hormone? Take the gland out, then take synthroid! Thyroid too big, too bumpy, too cancerous? Take it out!
5. Female reproductive organs – The human species wouldn’t fare well if we performed too many TAH/BSOs (total abdominal hysterectomy, bilateral salpingo-oophorectomy) but women individually are okay without them. Regardless, after around 50 years they kind of stop working and start causing problems.
6. Male reproductive organs – orchiectomies to excise the testicles are well tolerated; they just don’t happen often. Penectomies are quite rare, but all that’s really needed is a redirection of urine. In remote history, the removal of these was used in, uhh, less voluntary contexts.
7. Colon – A dedicated poop bag is unnecessary. When total colectomies are performed, surgeons can make a J pouch (a folded segment of small bowel with a hole at the end) and plug it into the rectum. If the rectum/anus/sphincter is compromised, just use a bag hanging off the abdominal wall. Yay, colostomies!
8. Limbs – #amputate
9. Kidneys – Complex, but doable. Dialysis, i.e. kidney replacement therapy, is strikingly common considering how expensive it is. Either direct central venous access, an artificially created arteriovenous fistula, a giant filtration system that requires active monitoring, and 3-4 hours 3 times weekly for the rest of your life. But America decided dialysis was a government-mandated right, so now we’re really good at doing it. Thanks, diabetes.
10. Urinary bladder – it’s nice not be be constantly be dribbling urine out, but your endogenous pee bag can be supplanted by redirecting urine to an exogenous pee bag.
11. Stomach – Now that our food is so clean, our bodies’ acidic cauldron loses much of its utility. Just cut it out, connect the esophagus to the duodenum, eat smaller meals, and you’re good.
12. Esophagus – See stomach. Just cut it out, hang the stomach to the back of the throat, and try not to regurgitate too much. Related: if the mouth/upper GI tract is compromised, just put in a feeding tube downstream, i.e. “drop a PEG.”
13. Pancreas – Digestive pancreatic enzyme pills to take with food are readily available and completely replace pancreatic exocrine function. Type 1 diabetics can get by with insulin injections and fingersticks, which replaces the key endocrine function. It’s when the pancreas goes haywire that you’re in for a bad day…
14. Adrenal glands – These underappreciated pair of pyramids make steroids and other hormones. With some monitoring, they can be replaced with exogenous hormones.
15. Small bowel – When you lose your intestines, you can’t absorb nutrition anymore, which would have been a problem in years past. Medicine’s got it figured out though! IV nutrition, or “TPN,” total parenteral nutrition. Easy.
16. Immune system – Okay, now here is where it starts getting tricky.
    We do deliberately carpet bomb bone marrow to obliterate the immune system in the setting of cancers, but we have to do it reaallllly carefully, and then transplant in someone else’s immune system. To bridge that gap, chemo patients need strict isolation in order not to get infected and die. Even just handicapping the immune system, like by AIDS, goes quite poorly quite quickly. Antibiotics help though.
17. Lungs – Despite the simplicity of the lungs’ core physiological function (a large semi-permeable surface interfacing with oxygen), its value comes in its minute-to-minute urgency. Like, if your lungs stop working, everything starts dying real fast. You can get by with extracorporeal membrane oxygenation (ECMO), which is used for premature newborns, but ECMO machines are cumbersome.
18. Liver – This surprised me, but we haven’t quite figured out this one yet — just ask cirrhotics. True, we can get by with fractions of livers, but we have no definitive artificial liver replacement. Lose your liver and you’ll imminently get poisoned to death, bleed to death, clot to death, or something else horrible to death.
19. Skin – Like the immune system, but way more painful.There are artificial skin grafts to help skin regrow, and plastic surgeons can move skin around, but you need skin. If you don’t have skin almost everywhere on your body, you’ll need to stay in a sterile chamber constantly loaded with antibiotics and fluids and extra protein to build that skin or else you’ll get infected and die. Also, not having skin hurts like hell; serious burn patients are often sedated heavily.
20. Heart – Like the lungs, the heart is physiologically straightforward. Cardiopulmonary bypass (the heart-lung machine used in open-heart surgery) can actually sustain the body completely; it’s just that said body is usually anesthetized as the chest is ripped open. Still, there exist implantable artificial ventricles that use roller pumps to constantly circulate blood, which can completely replace the native heart’s pair of crazy dual-valve compression chambers. People have lived and walked around with them for extended times. It’s just that — technically speaking — they’re dead.
    The heart only gets this high score because no electrical activity in heart = dead. Hmm, does that mean we should reevaluate the definition of what it means for a human to be alive?
21. Brain – Okay, this is what makes us human. For now, the brain is quite literally irreplaceable.
    But wait, there are sections of brains more vital than others, and technically speaking really the brainstem actually counts. We can lobotomize all of the cortex, the cerebellum (lol the cerebellum), and as long as you preserve a brainstem reflex, you’re still technically alive. Hmm, does that mean we should reevaluate the definition of what it means for a human to be dead?
    With all the above tools — a tracheostomy and ventilator, a PEG or TPN, dialysis, various catheters and ostomies, various hormones, shitloads of antibiotics, external manual labor to preserve skin and run the show — modern medicine can keep a person technically alive in the face of great adversity. Organs can be failing left, right, and center, and with ICU support a “body” can keep on chugging along. It’s wild.

PS. I omitted sensory organs because I didn’t know how to deal with them. Vasculature, lymphatics, muscles, and bones are too widespread to discuss in this context.
PPS. Thymus – lmao, what’s a thymus?!