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Preparing for an Organ Shortage

Self-driving cars will save lives lost to car accidents, but will decimate available donor organs. How will Boston’s biotechnology be a part of the solution?

As companies begin testing self-driving cars in major cities – Boston startup nuTonomy began earlier this year – we need to prepare for more than relaxing commutes and extra downtime. Safer driving conditions will also translate into an unexpected consequence – an exacerbation of our existing organ shortage.

According to the United Network for Organ Sharing, more than 118,000 people are currently awaiting an organ transplant, and approximately 22 people a day will die before they can receive the life saving donation they need.  

For all those currently waiting, just over 33,000 transplants were performed last year. 20 percent of those donations were procured from fatal car crashes. Considering that the U.S. Department of Transportation attributes 94 percent of car crashes to driver error, it is easy to see how self-driving cars will decimate our donor organ supply. In fact, the EnoCenter for Transportation in D.C. estimates that if 90 percent of cars on the road were autonomous, 4.2 million crashes would be prevented, and 21,700 lives would be saved.

While the U.S. Department of Human and Health Services has found that 95 percent of U.S. adults support organ donation, only 48 percent are currently registered as donors. This disparity is especially alarming considering that only 3 in 1000 people die in a way that allows for organ donation.

Switching to an opt-out system could help alleviate this shortage. In an “opt-out” system, all eligible adults are organ donors unless they choose otherwise. Studies have shown that in countries already utilizing this system, they see 25 to 30 percent more organ donations than opt-in countries, like the US.

Dr. Harald Ott

Yet considering the divergence between people awaiting donation and the number of transplantations occurring each year, it is clear that we need a radical solution. According to Dr. Harald Ott, director of the Ott Lab for Organ Engineering and Regeneration at Mass General Hospital, this need will only continue to grow as our ability to extend life improves.

As Ott sees it, “medicine is evolving to a point where we manage to survive and solve problems better and better. So, a few things happen. One, life expectancy luckily increases, but also many more patients survive an injury like a heart attack or kidney injury – so you end up with patients that survive acute events but then end up with damage that cannot be regenerated, and end up with lack of function.”

Ott continued, “If you just look at numbers in the country, 500,000 patients are on hemodialysis, and we do less than 20,000 kidney transplantations per year. In the end, you can see that there is a stark contrast between the need for organ replacement and how we can meet this need with donor organs.”

Outside of the inability of donor organs to satisfy this medical need, Ott also sees a need to provide better treatment options to patients awaiting organ transplantation.  “I think that there’s a growing clinical need to develop solutions for patients in end-organ failure. The quality of life is poor in end-organ failure, and your long term survival in the currently available replacement therapies, beside organ transplantation is not perfect,” says Ott. “So, it seems like the next logical step in medicine would be to come up with a way to make personalized replacement parts for patients.”

While personalized, lab-generated “replacement parts” are not yet an option, Ott’s research is supplying critical building blocks.

“Well what we’ve done so far, trying to make functional tissue based on the extracellular matrix and stem cells, has gotten to the point where we can implant organ grants into large animals, and they function for a short period of time,” explains Ott of his work. “I think that has really shown me that there is true potential in this technology, and together with the advances in stem cells and developmental biology, we’ll eventually be able to make tissues or organs for transplantation.”

While organ regeneration for complex organs is in the distant future, Boston biotechnology startup Biostage is making significant strides towards creating what they term “hollow organs.”

Saverio LaFrancesca

Saverio La Francesca, Executive Vice President and Chief Medical Officer of Biostage, says the company’s focus is “on what we define as ‘hollow organs;’ esophagus or airways, trachea and bronchus.”

Says La Francesca, “our product is actually comprised of two portions. One is the scaffold, which is synthetic material made in a specific way so that it can be sort of a home for the mesenchymal stem cells. These cells are taken from the patient – we get the cells from a small biopsy of fat, enough to isolate a specific fraction of mesenchymal cells. And these cells have great properties; basically all the growth factors and signaling cues that tell our cells in our own body to start regenerating. ”

La Francesca continued, “when we implant our scaffold with the cells, we really are able to tell the body, ‘start growing new tissues.’ So this new tissue becomes a real biological response to our implant, and our implant is actually removed only 3 weeks after we implant.”

According to La Francesca, being able to remove the implant is truly revolutionary; “when people think about implants and tissue engineering – they think about something that stays there, and it then becomes part of the new regenerated tissue. Which is, truth be told, is in the current paradigm. But we have found something different.”

Biostage’s products aim to improve quality of life for patients being treated for esophageal, tracheal, or lung cancer that has localized in the bronchus. Current treatment options for these diseases offer reduced quality of life, complications, and poor long-term survival rates.

Current treatment options for esophageal cancer patients, following resection of malignant tissues, involve repurposing a patient’s stomach and gastrointestinal tissues to replace the resected esophagus section. These surgeries are lengthy and have low 5-year survival rates.

Says La Francesca, “the quality of life of the patient with esophageal cancer, after the operation, is highly affected by the operation itself. It will be impossible to go back to normal eating habits. It will be hard to go back to sleep[ing] lying down – you’re going to have to sleep in a recliner.”

Says La Francesca, “I think it’s pretty obvious we ought to be able to deliver a better alternative.”

Following testing in animals, Biostage is preparing for their first clinical trials later this year. Says La Francesca, “The final study is going to be a small one. The trial is going to focus on two areas – one is the esophageal cancer … were also going to focus on esophageal atresia. At the beginning, we want to address esophageal cancer and treatment for the babies born without an esophagus.”

Sarah Schroeder

Sarah Schroeder

    Sarah Schroeder is a Masters of Public Health candidate at the University of Texas School of Public Health in Austin, TX. She is studying health promotion and behavioral sciences, with a concentration in health disparities. Sarah recently completed her practicum with the Texas Tribune, where she helped curate and develop stories for an online health newsletter. She is interested in using journalism and storytelling to highlight important health issues and empower readers to create a healthier world for themselves and others. As an editorial intern with MedTech Boston, she looks forward to learning more about medical technology, while further developing her skills as a health journalist.When not reading, writing, and learning about all things health-related, Sarah enjoys cooking, practicing yoga, and sewing garments.

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