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New technologies used for transplanting vital organs

September 21, 2019

New technologies used for transplanting vital organs

Organ Replacement A Mixed Bag of New Technologies
The best approach to organ replacement depends on the organ system involved and may change over time. In heart failure, for example, xenotransplantation initially seemed like the best solution, but Platt says that progress in implantable mechanical assist devices and cellular therapy to augment myocardial function now makes these approaches more practical. Using stem cells from the affected patient confers the advantage of avoiding the immune response to donor cells, but carries the theoretical disadvantage of limited proliferative potential. On the other hand, the more complex structure and function of the kidney and the lung limit potential progress in implantable devices or cellular therapy as a replacement for these organs. Cellular therapy is more effective when the structure of the failing organ is relatively simple, and when the disease is localized rather than diffuse.

New techniques introduced
If researchers are successful, these same calculations and questions will look a lot different in the future. Several new techniques could extend the time an organ stays viable outside the body, which could help give doctors more time to find recipients and decrease the number of organs that are underutilized. One technique, called normothermic perfusion, keeps an organ continually awash in a solution similar to the one that would be found in the body at room temperature. Though the idea behind the technique has been around since transplants were first possible, researchers have greatly improved upon it to even repair organs before they are implanted. Keshavjee designed the technique initially for lungs a special machine keeps lungs doused in a solution to keep them damp, as well as a reverse version of a ventilator so the lungs are effectively breathing outside the body. So far, the technique has kept lungs viable for 20 hours outside the body, more than triple the typical time of six hours. That extra time also allows doctors to treat the organs to reduce the risk of rejection or transmission of infectious disease to the recipient.
Artificial organs are grown in the lab
There are other, far more distant techniques that may someday close the gap between the supply of transplantable organs and their demand. Scientists are working to develop a technique of xenotransplantation or growing organs in other animals that could be viable in humans. One of the major hurdles continues to be immunological the organs grown in pigs, the most promising candidates so far, have cells that cause the human immune system to reject the transplanted organ. Other researchers are creating artificial organs that can be grown in the lab. Most organs are made from several different cells that have to work in concert, and growing them to the right size and function to be implanted is still a challenge. Those avenues won’t be available shortly, though researchers have started making progress in developing them. So how close are we to having enough organs to meet the demand of recipients? Klassen suspects the gap between supply and demand will be there for the foreseeable future that is until we can start expanding the pool of possible organs beyond those in humans.

However, there are many more than that waiting on the transplant list about 120,000 people total. Sometimes they wait for years; an average of about. Researchers, doctors and policymakers are exploring new strategies to increase the supply of organs needed to meet the demand. Part of the reason for the shortfall is that not all donated organs can be used. One factor is the standard method of transport and storage. There is a short window of time to get the organ to the recipient in time. Another problem is mismatching donors to recipients. In response, there is a movement afoot to find tech solutions to combat the crisis. Unlike algorithms used by places like Facebook or Netflix, which incorporate machine learning or artificial intelligence, UNOS’ algorithm compares complex and multifaceted medical and logistical factors, such as the patient’s blood type and antigens, and logistical factors such as distance and medical urgency, to match donors to recipients.

The equation gets more complex when donors are offered organs that may come with a higher risk of infectious disease or poorer function, such as those that come from older donors or donors with risky behaviours, like drug use. Patients have to agree to accept one of these organs, and though they might be reluctant to accept an organ labelled “high risk,” studies show that most of these organs function just fine, and patients who accept them fare much better than those who keep waiting. If researchers are successful, these same calculations and questions will look a lot different in the future. Several new techniques could extend the time an organ stays viable outside the body, which could help give doctors more time to find recipients and decrease the number of organs that are underutilized. One technique, called normothermic perfusion, keeps an organ continually awash in a solution similar to the one that would be found in the body at room temperature. Though the idea behind the technique has been around since transplants were first possible, researchers have greatly improved upon it to even repair organs before they are implanted.

Policy changes from agencies that regulate hospitals and transplantation centres could also help get donated organs to where they’re most needed. Changes to the hospital reimbursement system, for example, could encourage more centres to accept high-risk organs, Schold suggests. Education campaigns on the benefits of accepting high-risk organs (or changing that terminology to something less ominous, like “increased risk”) and changing the way organ transplant centres are compensated, regulated and evaluated could have a big impact, Schold says.
Artificial organs are grown in the lab
There are other, far more distant techniques that may someday close the gap between the supply of transplantable organs and their demand. Scientists are working to develop a technique of xenotransplantation or growing organs in other animals that could be viable in humans. One of the major hurdles continues to be immunological the organs grown in pigs, the most promising candidates so far, have cells that cause the human immune system to reject the transplanted organ. Other researchers are creating artificial organs that can be grown in the lab. Most organs are made from several different cells that have to work in concert, and growing them to the right size and function to be implanted is still a challenge. Those avenues won’t be available shortly, though researchers have started making progress in developing them. So how close are we to having enough organs to meet the demand of recipients? Klassen suspects the gap between supply and demand will be there for the foreseeable future that is until we can start expanding the pool of possible organs beyond those in humans.

How then can we replace structurally complex organs? One potential solution is organogenesis, the growing of an organ from primitive cells or stem cells. Tissue engineering could assist organogenesis by providing a substrate to protect a small organoid and allow it to grow. The most obvious drawback of this approach is that the internal environment of a sick person is not likely to be conducive to in vivo organ regeneration or growth. Even if organogenesis is possible, it could take months or even years, Platt says, necessitating other therapies in the interim. Technologies for organ replacement can be complementary rather than competing. Alternatives to organ replacement therapy and the accompanying need for immunosuppression include prevention of disease in the first place, mechanical devices that replace lost function, and induction of repair or regeneration of the affected organ. Ultimately, future alternatives could include the generation of a new organ. Disease prevention is a noncompeting technology, which should reduce the need for organ replacement. Screening of blood products may prevent liver failure caused by hepatitis C, and tight glycemic control has lowered the risk of diabetic nephropathy.
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