March 5, 2024

New preservation technologies: an ethical solution to the organ shortage?

Many Western nations face dire shortages of vital organs for transplant. Some doctors have proposed controversial changes to increase the number of organs available.

One such proposal – defended by American bioethicists Franklin Miller and Robert Truog – is that we abandon the dead donor rule for vital organ procurement. If transplant surgeons are able to harvest organs before death, then they will have an increased likelihood of procuring viable, non-damaged organs. Many organs are “lost” as a result of doctors having to wait too long before being allowed to procure them.

Yet perhaps we won’t need to opt for such an ethically contentious solution to the organ shortage. A research team led by biomedical engineers from the University of Oxford have discovered a way of preserving harvested livers that is far more effective than current cold-storage techniques. This new technique may eventually allow us to double the number of liver organ transplants available, some experts say.

Here’s an excerpt from a Nature article on their ground-breaking findings:

The metra device works by supplying the liver with oxygenated blood, anti-clotting drugs and assorted nutrients, all while keeping the organ at a steady 37°C. Because immune cells are removed from the device’s blood supply to avoid inflammation, “the liver is allowed to recover in a very benign environment”, says Peter Friend, a transplant surgeon at the University of Oxford, UK, and co-founder of the device’s manufacturer, OrganOx.

  The trial involved 220 patients across Western Europe whose livers had failed because of hepatitis, cirrhosis, cancer or other causes. Each participant was randomly allocated a donor liver that was either hooked up to the metra machine, or stored on ice — which slows down cellular metabolism to mitigate damage, but makes the organ prone to injury when blood supply returns to the tissue.

  Recipients of livers kept on the device showed a 50% average decrease in levels of an enzyme associated with organ damage, compared with recipients of livers preserved on ice. The rate of early allograft dysfunction — a serious and potentially deadly complication of transplantation — occurred in only 10% of machine-stored liver recipients, versus 30% of those allocated ice-stored ones. (The one-year trial was too short and small to detect any difference in long-term patient survival.)

New preservation technologies: an ethical solution to the organ shortage?
Xavier Symons
Creative commons
dead donor rule
organ donation
organ procurement
organ transplantation