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  • Writer's picturePre-Collegiate Global Health Review

Tackling the Organ Shortage Crisis

By Phay Shi Hui Claire, Raffles Institution, Singapore



Organ transplants play a vital role in enhancing the well-being and extending the lifespans of numerous patients. However, due to the current shortage of available organ donors, a pressing organ shortage crisis has emerged, depriving many of life-saving treatments. To combat the growing crisis, techniques such as xenotransplantation and normothermic perfusion have been implemented. Additionally, as the crisis is a mutli-faceted problem, exploring elements such as education, robust infrastructure and innovation to achieve more breakthroughs becomes crucial towards tackling the crisis, to provide better global access to organ transplants globally, and allow more patients to benefit from organ transplants.  


 

Organ transplants are pivotal life-saving treatments for many, with each donor having the potential to save 8 lives and enhance the lives of 74 more. However, there is a growing organ shortage crisis, with alarming statistics showing 7 people die each day from lack of an organ transplant, further underscored by a staggering waitlist of 108,000 patients awaiting an organ transplant (Health Resources and Services Administration, n.d.).   

 

Highlighting the crisis is crucial, given the countless benefits organ transplants offer patients. These benefits encompass an extended life expectancy in patients, leading to enhanced quality of life, and improved chances of survival in medical treatments. For example, renal transplantation increases patient survival over dialysis (Grinyo, 2013). Organ transplants also provide life-saving treatments for individuals with irreversible liver, heart, or lung diseases. Statistics show 1 in every 7 Americans suffer from kidney disease, and kidney and liver diseases claim over 96,000 lives each year (American Transplant Society, 2023). 

  

To tackle the issue, the next step would be to examine the factors contributing to the crisis. Firstly, organ transplants can be unaffordable in low-income countries. In Africa, chronic kidney disease (CKD) is 3 to 4 times more common than in developed countries, yet only 21% of citizens with CKD are on renal transplant therapy (Naicker, 2017). There is a need to increase the availability of organ transplants, but the daunting costs associated with such procedures, evident in Figure 1, pose a financial barrier to many. This is further compounded by an average yearly income of $6,530 USD (Statista, n.d.). Furthermore, 50% of citizens do not have access to basic healthcare, depriving a significant portion of individuals of essential treatments. This has led to a rise in individuals suffering from end-stage renal disease (Tessema, 2022).


Figure 1. Average amount billed for transplants in the US (Milliman, n.d.).


Secondly, there is a limited pool of organ donors. Cultural and religious beliefs regarding the body and organ transplants are some key factors attributing to the dwindling organ donor numbers. A lack of awareness in regards to organ donation also persists, as studies indicate that knowledge significantly influences an individual's willingness to become a donor ((Muthiah et al., 2021). 

 

Despite these challenges, new techniques are being implemented to alleviate the crisis. Xenotransplantation, for example, is the transfer of organs, tissues, and cells from animals and is performed by selectively breeding of anatomical and physiological characteristics of domestic animals that could be partly adapted to match the human body (Hammer, 2004). Xenotransplants could be used for many purposes, such as for burns and kidney failure (U.S. Food and Drug Administration, 2021). Nevertheless, xenotransplantation faces ethical and immunological challenges, and is still being developed (Cascalho et al., 2008).


Figure 2. Example of a normothermic perfusion machine (OrganOx, n.d.).


Normothermic perfusion is another example. Normothermic perfusion recreates the physiological environment by maintaining a normal temperature and providing the essential substrates for cellular metabolism, oxygen, and nutrition. The growing transplant waitlists and declining supply of cadaveric donor organs have led to the transplantation of increasingly marginal organs, giving rise to problems of preservation and ischemia-reperfusion injury. Normothermic perfusion remedies this issue and also keeps the organ metabolically active, making it possible to measure function. This allows doctors to predict post-transplant outcomes before subjecting the patient to surgery (Reddy et al., 2009). However, challenges arise due to the complexity and financial cost of the technology, as well as ethical considerations regarding clinical trials. Furthermore, the procedure can only be commercialized if it can be proven that it allows for successful organ transplants, making clinical trials high-risked.   

  

Yet, the multi-dimensional nature of the crisis necessitates a more comprehensive approach. Education’s role needs to be improved, as it remains paramount to enabling patients to understand the importance and relevance of organ donation and dispelling the stigma associated with the subject. Integrating the organ shortage crisis into the curriculums of primary and secondary schools could enhance students’ understanding, as demonstrated by the Netherlands, which rolled out an interactive education programme to educate high school students on organ donation, which resulted in a 33% increase in registration to be an organ donor (Steenaart et al., 2020).  

 

Innovation and collaboration efforts remain crucial to developing new medical advancements and possible improvements for pre-existing procedures, as well as potential solutions to the factors contributing to the crisis. Initiatives like the U.S. government-sponsored organ donation and transplantation collaboratives, have been successful in significantly increasing organ donation over several years (Wynn et al., 2011).  

  

Infrastructure enhancements to better support the organ transplant system are also equally crucial. The COVID-19 pandemic had created numerous challenges for the organ transplant system, such as suspensions of organ donation programmes and travel restrictions that restricted the transport of organs. These  severely impacted the system. Concerns regarding donor and patient safety were also raised. These factors contributed to an astonishing 16% decrease in organ transplant activity (Nimmo et al., 2022). As such, more infrastructure could be implemented to better support the organ transplant system and process, allowing more patients to benefit from it.  

  

In conclusion, the complexity of the organ shortage crisis mandates a comprehensive review of the current treatment options and what could be improved upon. Allocating more resources towards collaborative efforts between stakeholders and ground-breaking research techniques, are imperative steps to take to pave the way for better equitable global access to organ transplants and enable more individuals to reap the life-saving benefits from this medical advancement. 


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