In Partnership with CSL Behring

In recent decades, huge strides have occurred in every aspect of transplant, from surgical techniques to immunosuppressive drugs. However, as demand for organs rises, organ supply has not increased to match this demand. This problem has fueled an innovation explosion in many fields like policy, bioengineering, and computer science; extraordinary scientific ideas are under way for addressing issues from the waitlist to all the way through improving post-transplant kidney function. Three notable approaches include: increasing the donor kidney supply, decreasing demand for organs, and increasing donated kidney duration.

In part 2 of this innovation series, we will focus on decreasing demand:

Creating new organs and increasing organ supply sounds like something out of science fiction (see part 1 of this series to learn more). However, a very real alternative, or complement to increasing supply, is to decrease the number of people with chronic diseases like end stage renal disease (ESRD) that require transplantation. While organ supply innovations continue, it is necessary to address issues like rising demand for organs, the disparity between organs needed and organs available, and the quality of life of those awaiting transplants. Focusing on slowing disease progression and increasing access to programs for early prevention or treatment are crucial.

The key to decreasing demand is preventing kidney failure. Diabetes and hypertension are two common diseases that account for more than 70% of cases that end in ESRD and require transplant. Thus, early education and lifestyle change in patients with diabetes and patients with hypertension can dramatically reduce long term complications, and delay onset of renal failure[1].

Medications for kidney failure are also a major area of advancement, hoping to reduce the loss of kidney function and slow the progression of disease. Initiatives like KidneyX, an innovation accelerator, and the 2019 Advancing Kidney Care Health Executive Order, which helps accelerate the development of therapies, are pushing for better drugs and therapies for people with kidney disease[2]. As kidney disease is better understood, and new diagnostic technologies, biomarkers, and signaling pathways are discovered, therapeutic development may be a promising avenue to reduce kidney demand and improve quality of life.

Finally, many people awaiting a kidney transplant need dialysis. While dialysis is a lifesaving, it can have major effects on one’s quality of life, finances, environment, and overall wellbeing[3]. For example, conventional dialysis machines are heavy, requiring people to be stationary, and generally require multiple sessions per week at a clinic. One innovative approach to dialysis is “wearable artificial kidneys”, which is a smaller, more portable device.[4]

[1] Stephan A. Organ shortage: can we decrease the demand?. Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation. 2017 Feb 1;15(Suppl 1):6-9.

[2] Watnick S. The kidney accelerator: Innovation wanted, nephrologists needed. Clinical Journal of the American Society of Nephrology. 2018 Nov 7;13(11):1750-2.

[3] Himmelfarb J, Vanholder R, Mehrotra R, Tonelli M. The current and future landscape of dialysis. Nature Reviews Nephrology. 2020 Oct;16(10):573-85.

[4] Himmelfarb J, Ratner B. Wearable artificial kidney: problems, progress and prospects. Nature Reviews Nephrology. 2020 Oct;16(10):558-9.