There are many in need of donor organs that are complex. One day, there may be a light at the end of the tunnel for many more when compared to present. Currently, the probability in the U.S. of receiving a kidney transplant within five years of being added to the waiting list is less than 35 percent, and people age 60 or older who are placed on the waiting list only have a 50 percent chance of ever receiving a kidney transplant, according to Wake Forest Researchers and Colleagues. This is due, in part, to the receipt of defective donor kidneys.

The good news is that Researchers at Wake Forest Baptist Medical Center and colleagues may now further investigate “Recycling’ rejected organs to help address the serious shortage of donor kidneys, based on 2013 study results published in the journal Biomaterials.  

The science of “Recycling”, properly termed regenerative medicine, has been successfully used in medical applications for skin, cartilage, bladders, urine tubes, trachea and blood vessels. Following implantation, the vast majority of the transplanted structures have been able to receive oxygen and nutrients from nearby tissues until they developed their own blood vessel supply.

“With about 100,000 people in the U.S. awaiting kidney transplants, it is devastating when an organ is donated but cannot be used,” said Giuseppe Orlando, M.D., Ph.D., lead author of the study, a Wake Forest Baptist transplant surgeon and regenerative medicine researcher. “These discarded organs may represent an ideal platform for investigations aimed at manufacturing kidneys for transplant.” According to the authors of the study, more than 2,600 donor kidneys are discarded each year in the U.S.

The kidney, liver, heart and pancreas are larger more complex organs because they have dense cellular networks and must thrive on their own oxygen supply to survive. Perhaps, researchers will be able to overcome this stumbling block one day by planting a “seed” of cells from the person needing a complex organ transplant into a donor organ to stimulate a sustainable blood supply, based on preliminary findings in Wake Forest’s study involving pigs.   A potential application to turn defective complex human donor organs into “quality” donor organs may be on the horizon with the aid of continued research.

How It May Work

With the process of decellularization to remove all cells from a donor organ, only the organ structure is left. This structure is known in regenerative medicine as a scaffold. The idea is that by then placing the live individual’s cells into the scaffold, a “custom organ” may be created to thrive without the need for anti-rejection therapy or rejection. The idea offers hope that one day such natural “scaffolding material” may be used for manufacturing replacement organs in the lab using regenerative medicine techniques.

Currently, kidney donor organs may be discarded when defects are present, such as impaired blood vessels. In the case of scarred (fibrosis) vessels in rejected donor organs, early clinical review suggests that “fibrotic lesions are reversible and that the human body has the ability to remodel kidney fibrosis and restore normal anatomy,” according to Orlando. Further research is required to fully assess the use of defective organs in kidney donor applications, but the transformation of this idea into an analysis takes us one step closer.

The research was supported in part by a grant from the state of North Carolina.

Co-researchers were Christopher Booth, B.S., Zhan Wang, Ph.D., Christina L. Ross, Ph.D., Emma Moran, B.S., Marcus Salvatory, M.D., Yousef Al-Shraideh, M.D., Umar Farooq, M.D., Alan C. Farney, M.D., Ph.D., Jeffrey Rogers, M.D., Samy Iskandar, M.D., Ph.D., Frank Marini, Ph.D., Robert J. Stratta, M.D., and Shay Soker, Ph.D., Wake Forest Baptist; Giorgia Totonelli, M.D., Ph.D., Panagiotis Maghsoudlou, M.S., Mark Turmaine, Ph.D., Alan Burns, Ph.D., Paolo De Coppi, M.D., Ph.D., University College London; and Ginger Delario, Ph.D., Carolina Donor Services.

Wake Forest School of Medicine is ranked among the nation’s best medical schools and is a leading national research center in fields such as regenerative medicine, cancer, neuroscience, aging, addiction and public health sciences. Wake Forest Baptist’s clinical programs have consistently ranked as among the best in the country by U.S .News & World Report for the past 20 years.

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