Innovations in donation and transplantation

Jeroen de Jonge is a transplant surgeon at Erasmus MC and chairman of the National Advisory Committee for Donation and Transplantation Innovation (LADTI). He talks about the latest developments and opportunities for the future.

More usable organs through perfusion

Jeroen de Jonge: 'One of the most rapid developments in my field concerns machine perfusion. With machine perfusion, organs are kept in optimal condition in a device after donation, before the transplant takes place. About 5 years ago, this was still pioneering work. Now, it is already being applied routinely in Dutch transplant centers.'

'Machine perfusion allows us to monitor the function of an organ, which means organs from Extended Criteria Donors (ECD donors) can be used more often. These are organs that were previously considered unsuitable, such as a liver from someone in their 90s. Sometimes organs perform better on the machine than expected, and we can still transplant them.'

Future: treating organs during perfusion

The next step in this process is treating and improving organs during perfusion. 'In the future, we might be able to administer anti-aging medication or treat an infection in lungs with high doses of antibiotics while in the machine.'

Artificial intelligence

Machine perfusion generates enormous amounts of medical data, which offers opportunities for artificial intelligence (AI). De Jonge: 'It is difficult to recognize patterns in that data, and that is exactly what AI is good at. In the future, AI can advise on variables such as temperature, resistance, and organ function, further optimizing machine perfusion.'

AI also offers broader possibilities. 'We are already collecting a lot of data on donors, recipients, transport times, oxygen levels, and immunological factors. AI can combine that data and indicate areas for improvement. But to realize this, good cooperation between specialties, such as immunology and transplant surgery, and hospitals is essential. In addition, we must make agreements about where the data is stored, how privacy is guaranteed, and who takes on the coordination. The Dutch Transplant Foundation can also play a role in this.'

Cultured tissue and xenotransplantation

There are also important developments in the field of tissue engineering and xenotransplantation. 'Growing complete organs from stem cells turns out to be very difficult. I mainly see applications in hybrid organs, such as a hybrid artificial heart in which human tissue reduces rejection reactions and thrombosis.'

'In addition, hopeful results have been achieved abroad with xenotransplantation. I never expected that I would experience a pig heart being successfully transplanted into a living patient during my career. That shows how fast developments can sometimes go.'

New challenges

Partly thanks to these innovations, the number of people dying on the Dutch waiting list has decreased for the first time in years. Nevertheless, the increase in organ transplants brings new challenges, such as greater operating room capacity and technical facilities for machine perfusion.

'In the past, 2 transplants in a weekend were special; now we sometimes do 3 in a weekend. To meet the increased demand for facilities and provisions, specialized organ improvement clinics might emerge in the future, specifically set up for donation and transplantation processes.'

Organ donation remains crucial

Nevertheless, De Jonge warns against too much optimism. ‘Technological developments must not make us forget that organ donation remains essential. The danger is that people think: “The problem is solved,” and no longer think about the necessity of donation. We must continue to inform people and actively involve them in the discussion about organ donation.’