Could 3D bioprinted tissue solve the global organ donor crisis?

The world has moved beyond the COVID-19 pandemic, which put healthcare systems globally in a dangerous predicament and forced governments to rapidly reevaluate how healthcare services are delivered to their citizens. Now, with the increasing rate of chronic disease among their populations, countries worldwide are focusing on how they can reduce hospital stays and assist with quick transplantation options.

Organ donor registries operating in most countries use manual methods to match donor and recipient. This is often done through national organisations, with the help of a few automated systems that match criteria, such as blood group and distance between donor and recipient locations. There are, however, inherent challenges with this system in matching organ demand and supply, these include:

Not every registered organ donor is able to go on to donate, perhaps for medical, religious or other reasons. Organ matches rarely happen internationally or across vast geographies either, this is due to database sharing limitations of available organ donors and, importantly, the challenges of organ transportation

Matching the donor and donee for a possible transplant goes beyond blood groups. Other factors include: ethnicity, body size and geography - as organs have a limited survival time outside the human body, typically a few hours between extraction and transplantation, the distance between hospitals must be taken into account. The liver, pancreas and intestinal organs must be transplanted within 12 hours and the heart and lungs within six hours.

Given the high demand for vital organs, it is those patients in deteriorating health that are preferred and at the top of the transplant waiting list. This jeopardises the chances of a recently diagnosed patient urgently finding a suitable donor, putting them on an indefinite wait for a replacement organ. Every 10 minutes, a new person is added to the national transplant waiting list in the United States alone, further complicating the process and widening the supply-demand gap for organs.

Organ rejection, post-transplant, is also a matter of great concern. Immunosuppressants have to be used to stop the recipient body from rejecting the donor organ, but these drugs have long-term medical side effects that add to the recipient's woes.

The COVID-19 pandemic worsened the waiting periods for organ availability worldwide. There was a sudden shift and pause in priority surgeries and treatments administered by hospitals. The medical fraternity had to work on new and unknown challenges thrown up by the pandemic. Transplants took the back seat while seemingly healthy people lost lives due to this new illness, their infected organs inappropriate for transplant.

The long-term challenges referred to above were exasperated by the indefinite delays in finding suitable organs and the crisis deepened for transplant waiting-list patients. The critically ill deal with the loss of employment and financial concerns due to prolonged hospitalisation; feeling a burden on their family members who double up as their carers; and deteriorating health, due to prolonged treatments to maintain the failing organ. The problems are endless and multiple.

The healthcare expenditures of countries have risen post-pandemic, but it isn’t enough to support the needs of citizens worldwide that require the transplantation of a critical organ. Governments must invest in R&D projects that work towards developing solutions that help bridge this supply-demand gap in organ availability.

3D bioprinting has shown tremendous potential to be a great leveller tool to help bridge this growing gap. 3D bioprinted solutions are patient-specific and created using the patient’s own stem cells. This leads to almost zero rejection of the transplanted lab-grown tissue or organ. Plus, as bioprinted tissue can be created on demand it reduces the challenges of organ transportation, given their limited survival time outside the donor body, and helps reduce the financial burdens on government healthcare system's expenditure and that of patients who pay for their treatment.

Bioprinted tissue, which forms the base for preparing organs that are made up of multiple tissue types, has now reached a mature stage. Working towards organ development in the lab comes with the challenges of matching the complexity of the biological environment of various organs. It is hoped that this will soon be overcome through advancements in bioprinting technologies that help recreate patient-specific complex multi-tissue structures that form organs in the body.

Success stories involving bioprinted tissue have given hope to many, such as war veterans suffering from skin injuries requiring skin grafting. And, there is even vital work being carried out on bioprinted tissue research in space. Utilising bioprinting in surgery in the near future is more fact than fiction.

Technological advancements have leapfrogged in the past decade. We are on the path towards making breakthroughs that will help with the push towards the clinical translation of 3D bioprinting technology. What we need now is a multistakeholder collaboration to collectively drive efforts towards preparing for the mainstream integration of bioprinted tissue solutions into our ecosystem. This involves preparing regulatory frameworks to recognize bioprinters as both medical devices and surgery tools.

We must also regulate bioinks and the raw materials used for bioprinting and train surgeons in this game-changing medical technology through capacity-building programmes. The World Economic Forum’s Centre of Health for Healthcare is a focal stakeholder convener that can bridge the gap between regulators and innovators worldwide.

Next Big Innovation Labs (NBIL), a World Economic Forum Technology Pioneer, is helping drive the transition that the world would like to see towards personalised medicine and precision testing. NBIL’s TRIVIMA line of bioprinters is built with the vision to democratise bioprinting and provide accessible engineering technology to the larger community of researchers, who are innovators in the areas of material science and biotech.

It is starting with supporting the multi-billion dollar testing industry in cosmetics and life sciences in the transition from animal testing towards the more ethical and financially sustainable option of testing on lab-grown bioprinted tissues. It is also looking to service demand from large pharma due to regulatory roadblocks being cleared, thanks to the US FDA’s updated Modernization Act 2.0, which now authorises the use of bioprinted tissues as animal alternatives.

Regulators and researchers need to work collaboratively to rewrite medical rules and regulations to create a pathway towards making bioprinted tissue accessible to clinicians. They must also evaluate the ethical concerns of the potential organ trade and educate the masses to welcome into our lives a potential game-changing Industry 4.0 technology and outcome that will allow us to lead healthier and longer lives.