New and old technologies for organ replacement

Abstract

Purpose of review The demand for organ transplantation has increased over time, increasingly exceeding the supply of organs. Whether and how new or old technologies separately or together could be applied to replacing organs will thus remain a question of importance. Recent findings Estimating how the demand for organ transplantation will evolve over the decades and the need to bring forward and test new technologies will help establish the dimensions of the problem and the priorities for investigation. Pluripotent stem cells can in principle expand to sufficient numbers, differentiate, and assemble complex and functional organs. However, the devising of effective and reliable means to coax the stem cells to do so remains beyond the current grasp. Summary Given the time during which novel therapies are devised and applied, which organ transplantation reaches to 2–3 decades, one can anticipate the need for organ replacement will grow dramatically, but advances in science and technology will overcome the hurdles in generating new organs. Whether these advances will address the needs and priorities of society, however, is unclear.

Toward a solution for cardiac failure in the newborn

“…Others might imagine that a heart bioengineered by ex vivo combination of matrix and various sources of stem cells will eventually provide an alternative (85, 86). An approach we would favor, at least from the perspective of cost, is the possibility that an autologous heart fashioned by “in vivo organogenesis” from progeny of the patient’s stem cells or reprogrammed mature cells might eventually provide a solution that obviates the need for repeated surgeries, immunosuppression and induction of tolerance (87–91). If still remote, the concept has attracted increasing interest and enjoyed some progress.…”

Bioengineering Kidneys for Transplantation

“…In addition, post-operative care of the bioengineered organ to ensure long-term viability, and graft longevity will have to be determined. Lastly, reducing cost of personalized organ engineering will depend on developing cost effective reprogramming, differentiation, and regeneration strategies 99 .…”

Xenotransplantation literature update, May–June 2013

“…Platt and Cascalho discussed whether new and old technologies, separately or in combination, can solve the demand for organ transplantation which increasingly exceeds the supply of organs. Generating and testing personalized pluripotent stem cells, expanding the cells to the mass of a kidney or liver and implanting the personalized organ may be vastly more expensive than allogeneic organ transplantation, even if immunosuppression is not needed.…”