Future of organ and tissue transplantation

The loss or damage of a tissue or organ is a common, costly, and tragic occurrence. The treatment of organ failure has improved thanks to developments in mechanical artificial organs. Organ transplantation, and developments in molecular immunology, tissue engineering, and stem cell biology promise even better therapeutic modalities in the future. Improved immune tolerance of transplanted tissues, a better understanding of cellular differentiation and tissue growth, and advancements in biomaterials may make it possible to create implantable tissue and organs.

Tissue loss or organ failure account for a significant portion of the nation's health-care costs, and nearly 8 million surgical procedures are conducted in the United States each year to treat these conditions. 1 Current treatment of organ failure or tissue loss involves transplantation or surgical reconstruction or mechanical devices such as kidney dialyzers. These medicines have transformed medical practice, yet they have drawbacks. The donor scarcity is limiting transplantation—more than 70 000 patients are currently waiting for organ transplantation, but only 11 000 donors (cadaveric and live) are available each year. 2 Every year, organ shortages worsen, and many people die while waiting for transplants.

Tens of thousands of patients currently await organ transplantation, but any significant expansion of the donor pool is unlikely. Previous efforts to increase the number of available organs have included expansion of acceptable donor criteria and development of living related liver and lung transplantation procedures. However, the risks incurred by healthy donors will likely limit living related donations to a small number of specialized situations.

However, the UK national strategy for organ transplantation (‘Taking organ transplantation to 2020: a UK strategy’) states that advances in stem cell treatment are unlikely to have a significant impact on organ donation over the next decade. Therefore, improving currently available therapies and the discovery of novel immunosuppressive regimes remains at the forefront of transplant medicine research.

Improving compatibility testing between donor and recipient could also reduce the risk of transplant rejection and increase the longevity of the transplant. The better matched the donor and the recipient are, the more tolerant the recipient’s immune system will be to the transplanted organ or tissue. Additionally, a greater understanding of the disparity between the donor and recipient will better inform treatment strategies after transplantation and help avoid repeated episodes of acute rejection.

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