Making unsuitable donor organs suitable
Ageing and lifestyle changes lead to population alterations and are increasingly affecting social and health-related issues. These changes do have an impact on organ transplantation where patients of all ages need high-quality organs to be transplanted successfully. Organs retrieved from elderly, obese or unhealthy lifestyle donors and those donated after cardiac arrest do not recover from injury inherent to surgery as completely as young organs. Therefore, there is great reluctance to accept organs of marginal donors because of fear of non-function in the recipient. At present, the availability of donor organs is desperately insufficient to meet the need, and new strategies are needed to solve the donor organ shortage. For some, living organ donation may be a successful alternative but finding a relative to donate might not always be an option as for lung and heart donation. Most patients will remain dependent on deceased organ donation, facing a 20% mortality rate on the transplant waiting list. Alternative options like dialysis, and pulmonary or cardiac support may be offered albeit with increased risk on morbidity and early death. Obviously, the current situation necessitates the development of new strategies. In this Flagship, we envision technological innovation to build a long-term machine perfusion platform to not only sustain but also recover donor organ viability out-of-the-body. Damaged donor organs will be made suitable for transplantation. The Erasmus MC is needed to deliver fundamental insights in cellular and tissue repair, targets for pharmacotherapy and stem cell knowledge for regenerative medicine approaches to preserve, repair and regenerate organs for transplantation. A breakthrough technological innovation from TU Delft is needed to integrate machine components, optimize regulatory feedback systems, and miniaturize the system, while EUR expertise is needed to compare the outcome of these developments with alternatives in terms of costs, (heath‐related) benefits, patient/societal preferences, and ethical aspects.
Jan N.M. IJzermans
- Esther W. de Bekker-Grob