What’s the one medical condition most likely to kill you? If you follow statistics, you’d probably say heart disease. About one in four deaths in the US is due to the condition. Each year, more than a million Americans have a heart attack. Though heart disease tops most “causes of death” lists, far more Americans die due to the transplant organ shortage.
We rightly fear heart attacks. Unless there’s someone near you able to administer CPR, you probably wouldn’t survive an acute myocardial infarction long enough for an EMT to arrive.
But we can prevent most cardiac arrest deaths with heart transplants.
The problems with transplants
One problem is that the waiting list for donor hearts is huge. More than 25 million people in the US are diagnosed with heart disease, but only about one tenth of one percent get transplants. That means a half million Americans who could be saved by heart transplants die from cardiac arrest each year.
The same kind of shortage exists for livers, kidney, lungs, and other organs. An estimated 900,000 deaths per year could be prevented or delayed by organ or engineered tissue transplants. This represents about 35% of all US deaths, making lack of transplant tissues America’s leading cause of death.
The standard response to this statistic is to call for more donors. But that is not the solution. Far more organs are donated than used. Even if someone has checked the organ donor box on the back of their driver’s license, their organs are almost never extracted. But why?
The need for organ banking
Even using the best preservation technologies, organs deteriorate within hours after removal. First, tests are run to verify that organs are immune compatible with potential recipients. In addition, the donor’s family must usually give consent for the extraction. This takes more time.
Even if the immune compatibility tests are done, the logistical problems and costs of transport are immense and involve dozens of medical professionals. If you’re part of a minority population with a rare immune profile, the odds are that you’re out of luck.
Total costs for organ transplantation can run to a million dollars or more. Few people can afford an organ transplant or even an insurance policy that provides full coverage.
Our healthcare system is already stumbling under the increase in costs associated with the aging demographic. No serious analyst thinks that spending another trillion on transplantation is feasible.
I’m not telling you that you shouldn’t become an organ donor. What I’m saying is that there may already be enough organs donated to save the lives of all those who need them. We just need to figure out a cost-efficient way to do it.
The only way to do that is to develop biotechnologies that allow organ banking. In theory, this could be done by freezing and then restoring organs when they’re needed. Then, immune-matched organs could be supplied to patients at a reasonable cost exactly when they are needed.
The Antarctic eelpout and other natural solutions
Fortunately, nature has shown us the way. Several types of fish that are native to polar waters produce antifreeze proteins (AFPs). AFPs protect cell structures and prevent harmful ice formation. Fish, like the longhorn sculpin and the Antarctic eelpout, can endure subzero temperatures. Similar molecules could be used to preserve organs indefinitely.
Extraction of AFPs from these fish is not a solution. A ton of these relatively rare fish produce only a few grams of antifreeze protein. That means the species would be extinct if we had to rely on natural sources. Happily, we live in an era of accelerating biotechnological progress.
In December 2014, the US Department of Defense launched a program for developing “Organ Cryobanking for Transplants.” This was the first high-profile and well-funded effort to encourage the research needed to make organ banking for transplants a reality. The effort was applauded by other scientists and organizations searching for viable organ banking.
In 2015, the first Organ Banking Summit took place at Stanford University, NASA Research Park, and Lawrence Berkeley National Labs. The proceedings were published in the journal Cryobiology. (I’m irritated that the paper is not publicly available as tax monies were involved in its production.)
Regardless, I think the biggest impact of the emerging consensus on the need for cryobanking is that private biotechs working on the problem now have increased credibility. While the Department of Defense research grants are useful, it will take private investment to make cryobanking a reality. The involvement of major governmental and research organizations will help attract the attention of institutional investors.
Based on my discussions with scientists working on this problem, I’m impressed by extremely rapid progress in this emergent biotechnology. That progress will benefit investors as well as the millions of patients in the world who need transplants annually.