It is an exciting time to be a transplant surgeon because of the technical advances occurring that will help address a major limitation for transplant: a shortage of donated organs.
In the United States, there are approximately 105,000 people on the transplant waiting list. Over time, these technological advances will reduce the number of patients who die while waiting for organs and even may allow us to expand the group of patients who are eligible for organ transplants.
The future of transplants
One technological advance that I am most excited about is a technique called machine perfusion, which better protects and preserves donated organs outside the body while awaiting a transplant. Currently, donated organs are placed in a special preservation solution inside a cooler, leaving a small window of time to perform a transplant.
Research is demonstrating that utilizing machines to pump preservation fluids or blood through the organs while they are outside the body can preserve the organ for a longer time and improve the function of the organ to make transplant safer.
There are a few approaches that have been taken. For decades, kidney transplant recipients have benefited from this type of technology where the kidney is removed and a machine pumps preservation fluid through the kidney to help preserve the kidney for transplant. However, newer technology is now pumping blood through other types of donated organs at a normal body temperature. Using this approach, you can see the organs begin to function again — for example, lungs absorbing oxygen, a liver clearing toxins and making bile or even see a heartbeat returning. Along with expanding the window of time to transplant an organ, this technology will enable us to use organs that otherwise would not have been safe to transplant by testing the function outside of the body before transplant or improving the function of the organ.
The most exciting area of transplant right now is the use of genetically engineered pig organs for transplant. This is in the very early stages of research, but there are a few examples of successful transplants using genetically engineered pig hearts and kidneys with transplant into humans. This is not routinely available at this time but has the potential to have a huge impact in our field.
How UVa Health can help
Here at UVa Health, we are also working to expand the groups of patients that can benefit from transplant. We have just performed our first living donor liver transplant for a patient who had colon cancer that had spread to the liver and could not be treated successfully in any other way.
Another area we are working on improving at UVa Health is the medications patients take to protect their bodies from rejecting donated kidneys. The medications typically used have serious side effects, such as injuring kidneys and causing diabetes.
We are expanding the use of a medication called belatacept that does not have these same side effects and continues to have the same protection of kidneys and long-term function. This allows us to use donor kidneys that we may not have been able to use in the past, enabling more patients to receive transplants.
At UVa Health, we have a world-class team developing technologies that are innovative and will advance the field of transplant care. But at the same time, we are always focused on providing holistic, state-of-the-art care for the patients who need our help right now.
For more information on transplants at UVa Health, visit uvahealth.com/services/transplant.