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Organ transplantation has been around for decades as a way to cure the diseases that come from end stage organ failure. It was the successful transplantation of the kidney that led scientists to transplant other organs such as the liver, lungs, pancreas and heart. Even after more than 60 years, the kidney is still the most commonly transplanted organ. The first human kidney transplant was performed in 1954 in Boston, MA using identical twins as both donor and recipient. The kidney lasted a total of 8 years. With the discovery of cyclosporine, the first immunosuppressive drug to help prevent rejection in organ recipients, the technique of transplantation provided a hopeful future for people who were suffering from end stage organ failure. (Hakim, N. & Papalois, V., 2003)
“Organ transplantation can, with certainty, be considered one of the greatest achievements in the history of medicine. Long term results of people being able to live many years with a donated organ are rather good and the impact on the quality of life is tremendous. Kidney transplantation by far is considered the gold standard for renal replacement therapy” (Orlando, Soker, Stratta & Atala, 2014). “According to the US Renal Data System, someone that is between the ages of 40 and 44 can live an additional eight years from when they first went on dialysis. If this person were to receive a kidney transplant, the number of years of life increases significantly which are 85%, 70% and 44% after 5, 10 and 20 years respectively” (Organ Procurement and Transplantation Network, 2012).
Despite the fact that organ transplantation is considered a cure, this country is experiencing two major issues: the organ shortage crisis and life-long immunosuppressive therapy in recipients that harmful in the long term outlook of overall health. In Figure 1, the data shows just how much of a crisis this country is in regarding a shortage of organs. “According to the graph, in 1991 there were 23,198 people waiting for life saving organs. In 2013, that number grew to over 120,000 people while the amount of donors went from 6953 in 1991 to only 14,257 in 2013 and the number of transplants went from 15,756 in 1991 to only 28,954 in 2013. This is a huge gap and a harmful one. In the present day of 2016, an estimated 21 people die every day waiting for a life-saving organ and 13 people are added to this same list every day “(Sign Up to be an Organ Donor, 2016). There have been a number of ways that transplant centers and scientists have tried to help with this crisis. One of the ways has been for transplant surgeons to start accepting organs from marginal donors in order to increase the organ supply. “A marginal donor is also known as the expanded criteria donor and this is a donor who is older than 60 years or older than 50 years with hypertension, diabetes, a high serum creatinine and cause of death from a CVA” (Gopalakrishnan G. & Gourabathini S.P., 2007). “There are a number of reports that explain good results of a marginal kidney transplanted into an older recipient that outweigh dialysis” (DePasquale C, Pistorio ML, Veroux P, et al., 2011). “Elderly recipients with end stage renal disease have a greater advantage with renal transplantation from marginal donors than younger donors 18-39 years old” (Schold J.D. & Meier-Kriesch H.U., 2006). “In the case of kidneys, marginal donors are an important factor for use in marginal recipients to limit the morbidity and mortality associated with long term dialysis therapy” (Bozkurt, B., & Kilic., M., 2015). “Another way that scientists are trying to solve the organ shortage crisis is by the process of xenotransplantation. Xenotransplantation is the transplant of an organ from one species to a different species, in this case, from animal to human. However, despite the appeal that xenotransplantation has to medical professionals, there are a number of issues that inhibit this practice namely immunological barriers and physiological incompatibility” (Salvatori M., Peloso A., Katari R.& Soker S., et al., 2014),
The other issue that affects organ transplantation is immunosuppressive challenges that the recipient has to experience for the rest of their life if they have received the gift of a life-saving organ. Immunosuppressive agents are very important in order to prevent against rejection of the organ. These agents are used for induction (heavy doses of drugs in the initial days after transplant), maintenance and reversal of established rejection. Immunosuppressive drugs have three effects: they are therapeutic by suppressing rejection, they promote consequences (infection or cancer) and they produce a non-immune toxicity to other tissues. These undesired effects are harmful to the recipient and there is a very cruel irony involved. In order to be cured from end stage renal disease, one must receive a kidney transplant but the drugs that person is taking to keep rejection at bay may cause an infection or death. In terms of kidney transplantation, infections are the major causes of recipients becoming hospitalized within two years after their transplant due to the anti-rejection drugs. In conjunction with that, cardiovascular events (which are related to immunosuppressive therapy) is the leading cause of death post-transplant. (Dantal J. & Soulillou J.P., 2005)
“Because of the urgent nature of these important issues in organ transplantation, other fields of science have emerged as possibly helping these challenges namely the field of tissue engineering or regenerative medicine. It’s not too surprising that organ transplantation and regenerative medicine share the same history. Alex Carrel is considered a pioneer in the transplant world but he also had a very big impact with his concepts in cell culture growth and organ preservation techniques” (Orlando, Soker, Stratta & Atala, 2014). Interestingly enough, Carrel and the famed aviator Charles Lindbergh collaborated to create the first perfusion pump which was one of the greatest inventions of the twentieth century. That machine allowed organs to live outside of the body and mimics the kidney perfusion pump that organ coordinators use today to preserve kidneys. Because of Carrel’s pioneering efforts on both transplantation and regenerative medicine science may possibly have a way of meeting the needs of finding other sources for organs and immunosuppressive-free transplantation.
One of the ways to possibly meet this need is through the concept of 3D organ bioprinting techniques. This paper will focus on what bioprinting is, different approaches, what this process may look like in the future and some of the ethics surrounding this new field of medicine.