Technology in Organ Procurement: A Transformation

The Critical Need for Organ Donation in the U.S.

Annually, over 100,000 individuals across the United States are on the waiting list for a life-saving organ donation. Tragically, more than twelve individuals succumb to death each day while awaiting a suitable organ. This stark reality underscores both the urgency and the hopeful dedication inherent in the field of organ procurement.

The Network of Organ Procurement Organizations

Over the last few decades, a private system of 57 organ procurement organizations (OPOs) has developed. These organizations maintain a broad affiliation with UNOS, the United Network for Organ Sharing.

UNOS, a nonprofit organization, is contracted by the federal government to facilitate the matching of donated organs with individuals in need of transplants.

A Surprisingly Tech-Driven Field

The organ donation and transplantation process, while deeply rooted in medicine, shares characteristics with the fast-paced world of technology startups.

The network and its associated organizations have consistently worked to enhance the efficiency and dependability of organ transplantation, evolving from initial experimental systems to a more sophisticated and contemporary technological infrastructure.

Exploring Current and Future Initiatives

Recent efforts have focused on refining logistical operations and strengthening planning infrastructure. Simultaneously, more ambitious, forward-thinking projects are being investigated.

These include areas like xenotransplantation, the use of drone-delivery systems, and platforms designed to assess organ viability.

To gain insight into these advancements, interviews were conducted with personnel from both UNOS and two separate OPOs. The goal was to identify what innovations are currently being implemented and what possibilities remain on the horizon.

The Early Days of Organ Transplantation Coordination

Joel Newman, a senior communications strategist at UNOS with nearly three decades of service, highlights that transplantation has consistently demanded real-time collaboration and communication among numerous individuals, often those unfamiliar with one another. Remarkably, considering the critical nature of organ transplantation, many of these initial arrangements were surprisingly lacking in formal structure.

Indeed, during the formative years, the process of matching donors to recipients was largely managed through a simple voicemail inbox.

Howard Nathan, the current president of Gift of Life – and the longest-serving president of any Organ Procurement Organization (OPO), having assumed the role in 1984 – credits Don Denny with establishing much of the collaborative infrastructure as organ transplantation gained viability in the 1980s.

Denny, who relocated to Pittsburgh in 1977, devised a patient status system ranging from one to four, where one signified the most pressing need for an organ (the scale is now reversed). Nathan recounts that Denny would daily record a message on his voicemail, which would then be listened to by those involved. Following this, “a review of the donor in the ICU, with family consent, would be conducted to determine a match, prompting a phone call if one existed.” Denny is credited with coordinating 2,700 transplants over a period of 4.5 years, relying solely on recorded voicemails and telephone communication.

UNOS was established in 1977 and formally incorporated in 1984. By 1986, it had transitioned to more computerized systems for organ matching, utilizing then-modern communication technology: faxes.

Rick Hasz, currently vice president of clinical services at Gift of Life and slated to succeed Nathan as president in 2022, notes that this technology wasn’t always dependable. “Early on, we used thermal paper faxes,” he explains. “If allocation wasn’t swift, the thermal paper would fade, resulting in lost lists.”

Naturally, UNOS has continually updated its technology to meet the evolving needs of organ donors, donor hospitals, organ recipients, and transplantation centers. The organization now utilizes a web-based application and a dedicated mobile app.

Amy Putnam, director of IT customer advocacy at UNOS, emphasizes that a significant advancement came with the introduction of a mobile app designed to minimize errors. “In 2012, we implemented TransNet… a mobile application available on both iOS and Android, enabling OPOs to electronically package and label organs.” She adds, “Given the time – often three in the morning – legibility of handwriting can be an issue, leading to data entry mistakes, and TransNet proved invaluable in addressing this.”

However, the true benefit of developing this system lay in the ability to collaborate with all OPO affiliates and refine procedures based on user feedback.

Revolutionizing Organ Procurement: A Technology-Driven Approach

Effective communication and coordination are paramount in the process of organ transplantation. Organ donation events are often unexpected and can occur in diverse locations. Organ Procurement Organizations (OPOs) face the critical challenge of transporting organs from the donor hospital to the recipient patient within a limited timeframe.

Determining the most suitable recipient from a waiting list, with potentially numerous transplant centers vying for a single organ, demands rapid decision-making. UNOS’s current technological infrastructure is heavily focused on streamlining this complex process in real time.

Understanding Ischemic Time and Organ Viability

Newman detailed the time-sensitive nature of organ transplantation. Kidneys can generally be transplanted within 24 hours, with shorter durations being preferable. Livers and pancreases ideally require less than eight hours for transport.

Hearts and lungs have the most stringent time constraints, needing to be transplanted within four to six hours after blood supply is lost. This period, known as the ischemic time, defines the organ’s viability.

From Package Tracking to Real-Time Organ Location

For several years, UNOS has been developing increasingly sophisticated tracking systems to monitor organ locations. Julie Kemink, chief clinical officer at LifeSource, an OPO, likened the initial tracking capabilities to standard package delivery services.

While shipment confirmation was available, precise location information remained elusive. However, recent infrastructure updates from UNOS are now providing real-time location data for every organ.

The "Uber" Model for Organ Tracking

Kemink explained that the new system functions similarly to the ride-sharing app Uber, allowing for constant monitoring of an organ’s physical location. This represents a significant advancement in logistical control.

Challenges in Implementing Universal Location Standards

Implementing GPS coordination for each organ presented considerable logistical hurdles. Donor hospitals, OPOs, and transplant centers operate as distinct entities, making the establishment of a universal location standard a complex undertaking.

Ensuring the availability of appropriate equipment and trackers across the entire country, given the unpredictable nature of organ donation events, also posed a significant challenge.

Real-Time Updates for Transplant Surgeons

Improved logistics information now enables transplant surgeons to receive real-time updates regarding organ arrival times. If an organ’s transport plane arrives ahead of schedule, medical teams can prepare the recipient patient sooner.

Conversely, if traffic delays impact the organ’s arrival, transplant centers can adjust pre-operative procedures accordingly.

Developing an "Expedia for Organs"

Leveraging the increased data availability, UNOS is exploring the development of a “travel app,” described by Putnam as a potential “Expedia for organs.” This application would allow OPOs and transplant hospitals to input donor and recipient center information.

The app would then present travel options, including flight schedules and estimated driving times. A pilot phase is underway, with the potential for full organ ticketing within the app experience in the future.

Shifting from Regional Boundaries to Distance-Based Allocation

UNOS is also revising its approach to defining distance for organ allocation. For decades, a regional boundary system was utilized, prioritizing recipients within the same state or neighboring regions.

This system, while simple, was susceptible to exploitation by affluent individuals. The case of Steve Jobs receiving a transplant in Tennessee despite being a non-resident highlighted this issue.

The Impact of "Multiple Listing" and Private Charters

Jobs utilized a practice known as “multiple listing,” registering on numerous regional organ donor waiting lists. Those with financial resources could secure a match nationwide and charter private planes to expedite organ transport, effectively shortening their wait time.

A New Distance Algorithm and Geographic Disparities

UNOS now employs a distance algorithm based on actual radius, rather than arbitrary regional boundaries. However, geographic disparities persist. Kemink noted that organs from Minnesota can be allocated nationally.

Conversely, obtaining a heart from a distant location, such as New York, is often impractical for transplant centers in California.

Streamlining Integration and Data Sharing

UNOS has prioritized platform integration to simplify the process for medical professionals. Putnam emphasized the need to reduce the burden of multiple usernames, passwords, and disparate systems.

Recent upgrades have focused on providing a unified and streamlined experience.

Enhanced Data Upload and Imaging Capabilities

The integration efforts included expanding options for uploading patient data and imaging files. Doctors can now “upload and actually see the coronary angiography to see that [a heart] is the right match for a recipient,” Kemink stated.

This capability accelerates decision-making and improves the overall viability of organ transplants.

Revolutionizing Organ Procurement: A Technology-Driven Approach

With the increasing prevalence of organ transplantation – evidenced by the 39,000 procedures performed in the United States as per official records – substantial datasets are now accessible.

These datasets enable refined optimization of the organ allocation strategy, ultimately leading to a greater number of successful transplants.

Leveraging Predictive Analytics for Improved Outcomes

Currently, a project is underway to integrate predictive analytics into the organ offer process.

This initiative focuses on assessing the likelihood of survival following the acceptance of a specific organ.

Furthermore, analysis is being conducted to determine the probability and timeframe for receiving a comparable or superior organ should an offer be declined, as Putnam explained.

UNOS is presently conducting a pilot program to gather feedback from its stakeholders regarding these modifications.

A key priority is ensuring complete transparency and clarity in the algorithm’s functionality, given the profound sensitivity surrounding organ donation.

Automating Decision-Making with Offer Filters

Introduced last year, “offer filters” are being piloted within the network.

These filters empower transplant centers to automate more of their decision-making processes concerning potential organ matches.

Putnam stated that historical kidney acceptance data was analyzed to identify offers consistently rejected by transplant centers.

Refining Screening Criteria for Efficiency

While centers have historically employed screening criteria, this new feature allows for more granular filtering.

As Newman of UNOS clarified, centers can now specify conditions under which they would not accept an organ.

For example, a center might decline a donor over 70 years of age, particularly if transportation would exceed six hours.

UNOS anticipates a nationwide implementation of this feature later in the current year.

The Evolving Landscape of Organ Donation

The organ procurement process is undeniably crucial, and recent improvements are largely attributable to advancements in information technology and its effective implementation. A key area of interest for entrepreneurs and investors centers on the potential of innovative, ambitious concepts to significantly increase organ availability for patients awaiting transplants.

Initial trials have already been conducted exploring the use of drones for organ delivery. According to Nathan from Gift of Life, a single case utilizing drone technology has been completed, with another group in Maryland currently conducting experiments. However, he expresses reservations regarding the practicality of this approach, citing the considerable distances organs may need to travel – potentially hundreds of miles – and the risk of organ damage during transport. Maintaining organ integrity is paramount; “You don’t want to put the organ at risk,” he emphasized.

Several technologies, including cryogenics and warm profusion, are being developed to extend ischemic time – or even eliminate it altogether. This would provide organ procurement organizations with increased flexibility in matching organs to the patients with the greatest need. Multiple devices and systems are currently undergoing evaluation through FDA trials, with anticipated implementation within the next decade.

Optimizing Organ Distribution

Kemink of LifeSource highlighted blood-type compatibility and recipient age as factors that could be improved through enhanced organ viability technologies. “AB blood type is the most uncommon blood type, so there aren’t that many patients who are waiting for that blood type,” she explained. At times, a suitable recipient may not be immediately available, and cryogenics could preserve the organ until a matching patient is identified. Similarly, organ size must align with the recipient’s physical characteristics. “You can’t take a heart from a 12-year-old and put it in a 70-year-old,” she stated, as size discrepancies would preclude successful transplantation. “We could preserve it until the person that needs it is there … that would be another tremendous advancement.”

Progress has also been made in procuring organs from patients experiencing circulatory death (DCDs), or donations following circulatory death. Nathan noted that, “There are 2.8 million people who die every year in this country, [and] only about 20,000 of those people are medically suitable to be an organ donor.” This limited pool of eligible donors contributes significantly to the lengthy wait times for organ transplants.

Hasz pointed out that advancements in DCD organ procurement have increased the probability of obtaining viable organs. “Up until the last couple of years, nothing really changed: It was quite limited to liver and kidneys,” he said. However, “in the past few years, the opportunity of helping more people with heart and lung transplants” has emerged, resulting in the utilization of “200 hearts.” These new technologies are projected to potentially expand the donor pool for DCD hearts by 30%.

Exploring Future Possibilities

Xenotransplantation, the transplantation of organs from animals to humans, represents another avenue of research. While experiments in this field have been ongoing for decades, progress has been incremental. Hasz indicated that “10-15 years is always what you hear about xenotransplantation.” Nevertheless, he acknowledges that recent technological breakthroughs, such as CRISPR gene editing, have accelerated progress in this area, potentially paving the way for animal organs to address the shortage of human organs.

Despite these advancements and emerging technologies, the fundamental challenge in the United States remains consistent: securing donor consent. “The biggest thing that we need is more people to say yes to donations,” Kemink emphasized. “Nobody gets a transplant unless people say yes to donation.” Currently, approximately half of Americans are registered organ donors, and increasing this number requires not technological solutions, but rather a renewed emphasis on the life-saving potential of organ donation and the profound impact individuals can have on others.

Updated September 22, 2021: Minor grammatical adjustments were implemented for enhanced clarity.