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He said new technologies such as thoracic-abdominal normothermic regional perfusion (NRP), which allows organs to continue to be perfused at room temperature inside the donor, can help extend the time that organs are available for transplant, and forming regional transplant teams to harvest organs locally can improve efficiency and reduce costs.
Current Issues in Organ Transplantation
Kong highlighted the inefficiencies of the current organ transplant system, describing it as outdated and rushed. Once a donor and recipient are matched, a transplant center dispatches a team, sometimes on a chartered plane, to the donor's hospital. The process is expensive and carries the risk that the organ will be deemed unusable after evaluation, leading to a huge loss of time and resources.
Historically, organs have been preserved by cooling them to near freezing temperatures, typically 0-4 degrees Celsius, a method that dates back to the beginnings of organ transplantation. While this method, which involves placing organs on ice in a cooler, is simple and effective for short periods of time, it is not suitable for long periods of time or for transport over long distances. More advanced preservation methods use sophisticated pump systems that maintain a blood-based perfusion solution, improving temperature control and aiming to reduce the organ's ischemia time (the time an organ is deprived of blood flow, nutrients, and oxygen).
“We're trying to get better at preservation. Some of it is very sophisticated pump systems that pass preservatives or blood-based perfusion through the organ to improve preservation. Some are cold, some are warm, some just raise the temperature. So it's very easy to put something on ice, but getting it to maybe the right temperature, which is a little bit higher than ice temperature, is a little bit more complicated,” Conn said.
Various organs can survive longer outside the body while waiting for a transplant
Kong noted that different organs have different lengths of time they can survive outside the body without the nutrients their cells need to survive, with the heart being particularly sensitive and having a very short window of opportunity for transport.—Within 4 to 5 hours
But once a kidney is damaged, it can be left outside the body for much longer, anywhere from 24 to 36 hours, and that time can be even longer depending on what platform is being used to preserve the kidney, he said.
“These time frames are so important because they directly relate to the function of the transplanted organ when it's actually in the recipient's body. Cryopreserving a transplant, whether it's for a short or long period of time, is probably associated with being the least tolerable,” Conn explained.
Introduction of normothermic regional perfusion for heart transplantation
Kon is pioneering the use of NRP, a method to significantly improve organ preservation and recovery outcomes. NRP perfuses donor organs with warm, oxygenated blood after circulatory death, reducing ischemic injury and increasing organ survival. This method not only improves organ quality, but also increases the number of organs that can be transplanted from a single donor.
Kong is CEO and co-founder. On-demand procurementis an organ retrieval and logistics company that uses NRP. Kong wanted to rethink how the current organ transplant system works to make it more efficient and cost-effective, while also improving patient outcomes by providing more viable organs.
He said the study provides answers to several key questions in current methods of harvesting and preserving organs during transport.
“NRP in the United States is primarily a subset of the heart. Heart Donation After Circulatory Death (DCD)“This is a category of donor that has never been available historically in the United States because it's kind of a black box of what happened. Was there an injury? Is the heart functioning? The NRP allows us to better assess that,” Conn explained.
Historically, average organ transplant yields from DCD have been between 1 and 1.4 organs per donor, but with NRP, it is now empirically possible to transplant three or more organs, he said.
How NRP perfuses blood into donor organs
The transplant recovery team waits for the patient to die before going into the operating room to prepare the body, Kong said. They then perfuse the organs being transplanted, which could include the heart, lungs, liver, kidneys and pancreas. This restores nutrients and blood flow and reduces some of the damage that can occur if they are suddenly shipped on ice, Kong explained.
The NRP process typically uses a total bypass modified circuit with a reservoir, allowing for full decompression of the venous system and maintaining optimal perfusion pressure. This is preferred over extracorporeal membrane oxygenation (ECMO) due to its ability to maintain low venous pressure and create pulsatile blood flow, which Cong said is believed to be more beneficial for organ health.
The process also allows for in-vivo assessment of the heart: “You can actually look at the heart and see how well it contracts, what kind of pressure it can create. By looking at the echo images while you do this, you can actually assess the heart in a very clever way that wouldn't be practical or possible otherwise,” he said.
Competition for organs could affect professionalism
Another big benefit of the NRP, says Kong, is that it transitions the donor operating room to a more collaborative, professional environment. Traditionally, multiple transplant teams might work simultaneously, resulting in a chaotic, competitive atmosphere. But with the NRP, a single, highly skilled team manages the perfusion process, allowing them to spend more time on the organ. This improves outcomes for all organs involved, not just the heart, Kong says.
“A lack of cooperation can lead to unpleasant situations and certainly negative outcomes for any organ as we literally race to make the most of it and preserve it as much as possible,” Kong explained. He said this can also lead to a lack of professionalism and increased stress.
Another ongoing concern is that the people sent to actually assess and remove the organs are often the least experienced members of the surgical team.
“So now they're being told to compete with other people for organs, which is the most stressful situation, so you can imagine that that will exacerbate the conflict even more,” Kong explained.
To overcome this experience gap, Kong sought to create a regional or local, on-demand marketplace for vetted, highly skilled surgeons who could better evaluate these organs in a collaborative and professional manner. He said that creating such local experts would increase their volume of experience and allow them to evaluate and harvest organs much more quickly than teams that only perform a few evaluations each year.
The Future of NRP in DCD Organ Donation
Conn envisions a future where NRP becomes the standard of care for all DCD organ donations in the U.S. He stresses the importance of having a local, highly specialized team managing the NRP process, rather than hospitals trying to perform these steps sporadically. This approach ensures consistency, reliability, and cost-effectiveness, ultimately leading to better patient outcomes and more efficient use of resources, he says.
