A Promising Boost

In the U.S., some 800,000 patients are living with kidney failure, yet only 25,000 ever receive a donated organ.

In spite of astonishing medical and scientific breakthroughs, most donor kidneys—along with other transplant organs—still are packed in ice and shipped in coolers. Once outside the body, the organ begins to deteriorate immediately due to lack of blood supply.

“We can’t change the severe shortage of organs available for transplants, but we do believe it is possible to dramatically improve the condition of the donor kidneys that are available so the organs arrive as healthy as possible, giving the recipients the best chance for a successful transplant,” says Dr. Hanna Wollocko, an adjunct clinical associate professor of internal medicine at TouroCOM in Middletown and president and CEO of the medical research firm OXYVITA, Inc.

Wollocko and her research colleagues have created a way to perfuse the donor organ with a continuous blood substitute supply, by adding a hemoglobin-based oxygen carrier (HBOC), which replaces the oxygen-carrying capacity of the body’s hemoglobin and, therefore, blood. “Ex-situ machine perfusion is an exciting and promising technology,” she says.

The basic idea is to connect sterile tubing to the ex-vivo organ’s artery and vein in the prepared perfusion system. The tubing is then connected to a peristaltic pump, which circulates the solution with a hemoglobin-based oxygen carrier into the organ. “We’ve tried it successfully on rabbit kidneys, and it has proven very promising,” Wollocko says. “Now, we will try it on a pig kidney. In science, it is repetition and patience, patience and repetition and finally, with hard work and a little luck, success!”

Here’s where a collaborator from Touro, Dr. Nilank Shah, an associate physiology professor, and her students come in. One group prepares the perfusion system, using a plastic container connected by tubing with a peristaltic pump and a bioreactor containing the perfusion solution with the HBOC. Another group prepares the perfusion solution. The ultrasound group works on application of the technique for the assessment of the organ’s tissue conditions and guided biopsies of the organ during the process. The histopathology group conducts biopsies and the final assessment of the tissue deterioration after the experiment. The 3D printer group prepares the removable “bed” for the organ to place it in the perfusion container and gives access to it for the biopsies and ultrasound analysis during the 24-hour experiment. Those biopsies and ultrasounds, taken every couple of hours, indicate organ deterioration.

“Let’s say the best match of a kidney in New York is to a transplant patient in California,” she says. “But it takes, say, six hours, to get the organ from here to there. In that time, there could be serious deterioration of that donor organ. If this works as we expect it to, that organ will arrive healthy and viable for transplant, potentially as good as if the donor was in the next room over. This has real-life implications for transplant patients.”