Future of organ transplantation

A few days back, I came to know about my cousin in his 40s who is planning to get his kidney transplanted. He had an acute kidney failure because of his lifestyle and was waiting for a kidney from a donor. I was disappointed by seeing his pain and the inconvenience caused to him by dialysis. This is not just one story, we have millions waiting across the globe for organ transplantation.

Humans have around 10 different organs in our body that can be transplanted. These include kidneys, heart, liver, pancreas, intestines, lungs, bones, bone marrow, skin, and corneas. As per the Donate Life Foundation, 80% of the global organ demand constitute the kidneys with an average wait time of over 3 years. In 2016, for the first time, the organ transplants performed in the United States alone crossed 30,000. But, as we speak approximately four times of that number still awaits lifesaving organ transplants. Furthermore, around 22 people die every day waiting for an organ. From an Indian perspective, 5 lakh people across the India die each year due to non-availability of organs. One out five need a liver, but only one in hundred receive it. Two out of five need a kidney, but only one in twenty receive it.

Even though 8-10 brain dead potential donors are available in Intensive Care Units of any major city hospitals around the globe, the taboo of the donation still constrain the effectiveness of donation. Can the new stream of tissue engineering change the fate of modern demographics?

Yes. The fundamental change of making synthetic organs is going to allow the ageing population of the world to work until a later age before taking their pensions – an imminent concern both in developing and developed countries. The stunning fact is that the majority of the organ transplants are happening over 40 years of age.

To give an economic perspective, today almost one in ten are over 60 years old. By 2050, one in five will be over 60. On the other hand, when we consider the state support for the non-working age population, in 1950, there were 7.2 people aged 20–64 for every person of 65 or over in the OECD countries. But by 2010 this support ratio fell to 4.1 and is projected to reach just 2.1 by 2050. This demographic shift will put undue pressure on the working age population. To avoid this scenario, the option left for the government is to reduce the support to older demographics. This will force the old age population to remain fit and healthy and thus remain productive up to an age over 80. This leaves the septuagenarians and octogenarians to maintain a healthy lifestyle and if required replace the damaged or non-functional organs with fresh ones which would be available both from donors or through tissue engineering. Since we have seen a macro perspective of donations, let us see how tissue engineering is going to solve this problem?

Right after identifying the pluripotency (ability to develop to different organs) of stem cells after cloning Dolly, bio-engineering has gone to a different level of creativity. A few days back, Organovo world’s first publicly traded 3D bio-printing company, announced the medical success of the bio-printed liver and kidney with promising results. Like the complex, multi-cellular tissues found within a person, these human tissues are created through cell division; they mature and integrate into the tissue, forming connections with surrounding cells and contributing functionality throughout their lifespan. As individual cells within the tissue age, they eventually undergo cellular senescence and death—much as they would in a living tissue inside the body. This is the ultimate approach to the shortage of donor organs – manufacture and transplantation of bio-artificial organs. The latest trend is the chimaera – a mixture of cells from more than one species growing together as a single animal – resulting in human organs being produced in other animals. By perfecting the art of growing such chimeric replacement livers, kidneys and pancreases inside the animal hosts, the organ shortage may end. It may so happen that we may be ordering a homo-porcine kidney on Amazon soon by end of this decade.