New focus, more funding for improving transplant process, organ viability

A number of organizations, including the White House, have united to improve the process for organ transplants in hopes of reducing the time recipients must wait for the life-saving opportunity they so desperately need.  At the White House Organ Summit, the administration announced what steps these organizations will take to improve the donor process, which includes a $160 million program led by the Department of Defense to develop cell repair and replacement techniques.

Registration: Is opt-in the best strategy?

Although 95 percent of the American population supports organ donation, only half are registered as organ donors. This is one thing the united organizations hope to change. Over 120,000 hopeful recipients are on the waiting list, with nearly 100,000 of those needing kidneys. The wait is deadly, taking 22 lives per day.

The registration process, as it stands, leaves something to be desired. Donors must opt in at their Department of Motor Vehicles (DMV). In other countries, opt-out policies result in much higher registration levels. Although some have expressed concern about presuming consent, the high support rate indicates that most would not object to such a change. Social media companies have committed to a campaign to encourage people to declare themselves donors online instead of through the DMV.

Maintaining viability

One way to increase the successful use of donated organs is coming up with ways to preserve viability during transport. Toting an organ in a cooler packed with ice, as seen on television shows, is not the best strategy. A device that monitors the organ while maintaining its temperature and infusing it with oxygenated blood can help the organ to start functioning almost as soon as it is transplanted.

Cooling the organ slows its natural processes down, but the approach of keeping it warm allows it to continue functioning. Trials established the safety of the technique for hearts and lungs, but it had not been proven for the liver–yet a successful transplant indicates that it will work. Many potential donor hearts are unusable because putting them on ice would cause too much damage. A study is currently underway to determine if warm transport will alleviate this issue.

The device, developed by TransMedics, is a plastic box that can be manipulated as needed. It can attach to a cart or be removed to fit into a transport vehicle. Warmed blood and nutrients are pumped through while sensors monitor functions. Various conditions can be altered on a control screen. The device is awaiting FDA approval for commercial use, but it is already being used in the other parts of the world. Even if this option is successful, however, the device may be prohibitively expensive for payers.

In  the meantime, other efforts to improve the entire process are underway. Over 30 transplant centers have agreed to share data about kidney transplants, while Johns Hopkins University and the National Institute of Allergy and Infectious Disease are working together to expand HIV-positive donor options. The FDA and the American Society of Nephrology will work together to create alternatives to kidney dialysis. The government is also improving the online platform for matching, labeling, and tracking organs in order to reduce the burden on hospitals and speed up the process.

Creating an organ

Another approach to the organ shortage is developing new organs altogether. The Pentagon is creating the Advanced Tissue Biofabrication Manufacturing Innovation Institute to develop a process for generating new human cells and tissues. The National Cell Manufacturing Consortium and others are collaborating to best decide how to develop this technology. The idea of tissue engineering is not a new one, and the National Institutes of Health (NIH) has been involved in research to create tissues and expand human application. The new institute will hopefully build on these efforts and result in many more lives saved.