How a ‘smart picnic box’ could prevent people from dying while waiting for an organ donor

This year marks 70 years since Dr. Joseph Murray performed the world’s first successful organ transplant at Peter Bent Brigham Hospital in Boston, Massachusetts.

On this historic day in 1954, Ronald Herrick saved the life of his twin brother Richard by donating a kidney to him.

Since then, thousands of lives have been saved or prolonged by the medical miracle of transplanting an organ from one person’s body to another.

If the transplant is successful, it is one of the most cost-effective treatments available on the NHS – after all, there is no better medicine than a healthy, functioning organ.

However, this procedure has long been limited by a number of scientific, ethical and logistical constraints.

Now experts have said AND as they hope the new device, designed and built in northern England, could prove to be a breakthrough that will ensure no one waiting for an organ transplant has to die needlessly.

ScubaTx, as its founder and CEO David Campbell describes it, is essentially a “smart picnic box” that can keep organs alive for at least 24 hours or more, much longer than the current window of four to six hours.

Instead of using ice to keep organs healthy after they are removed — the same method that has been widely used for decades — the box uses a technique called “persufflation,” which pumps humidified gas into the heart, kidneys or liver at carefully controlled pressure.

“We’ve been talking to potential customers about this operation for the last 18 months and they’re incredibly excited, so we’re incredibly excited,” said Mr Campbell. AND.

The breakthrough cannot come soon enough, with the latest NHS figures showing the number of patients waiting for an organ transplant in the financial year ending March 2023 was 6,959 – a 47 per cent increase on the previous year and the highest number since 2014.

A further 3,822 people were temporarily suspended from the transplant waiting list because they were not suitable for the procedure or were otherwise unable to undergo it.

The sharp increase can largely be explained by the fact that the list was reduced to 4,256 as the COVID-19 pandemic took hold in 2020 and 2021 and NHS resources came under enormous pressure.

However, the number of people who died while waiting for an organ transplant in 2023 was 439, an increase of 2% compared to the previous year.

Another 732 patients were removed from the transplant waiting list altogether. The vast majority of them died shortly thereafter because their health prevented them from receiving a transplant.

Some aspects of transplant medicine have improved – since a change in the law came into force in May 2020, England now operates an ‘opt-in’ consent system, meaning that all adults are deemed to have consented to being an organ donor after death, unless they have registered a decision not to donate organs or are in one of the excluded groups.

These groups include people under the age of 18, people whose mental capacity prevents them from understanding the arrangements, and people visiting England.

The systems in the devolved administrations of Wales, Scotland and Northern Ireland are similar.

However, while this has widened the pool of potential donors, the fact remains that only one in a hundred people will die in the right circumstances and in a place that will allow their organs to be used to save someone’s life.

Fortunately, multiple organs can often be obtained from the same donor, meaning that in 2022-2023, 4,533 patients were transplanted after 1,429 people died, as well as 958 patients who underwent transplants from living donors.

On average, one person can improve the quality of life of three or four people, but it could be as many as 10 people – depending on the viability of the organs.

“It’s Hell” – Life on the Transplant Waiting List

Anneka Murphy, 39, has kidney failure and has been on the kidney transplant waiting list for 18 months.

Doctors in Wakefield, near the transplant centre in Leeds, say the average waiting time is two-and-a-half years.

In the case of Anneka, a mother of four, this period may take longer because women who have given birth have more antibodies in their blood, which can make finding a donor more difficult.

She almost got pregnant several times, including when her brother was a donor but was not allowed to donate a kidney because scans showed a small stone.

Anneka, a primary school teacher, said AND how she spends her life waiting for the phone call that will save her life.

“Every morning I think, ‘Is this going to be the day?’ and every night I go to sleep I think, ‘I wish it were today,’” she said.

“I can’t drive anywhere, I always have to be within two hours of Leeds (the transplant centre).

“If I went on holiday abroad, they would have to cross me off the list.

“I can’t get sick because they give me immunosuppressive drugs during the transplant, so something like an eye infection could kill me.

“It’s terrible, it’s hell.”

Anneka’s children are aged between 15 and 18, so she has had to have difficult conversations with them about the future.

“I can’t pull the wool over their eyes,” she said.

“They can help me, but as a mother I want to protect them from that. I don’t want them to have to see their mother like that.”

Even if Anneka decides to have a kidney transplant, she was told it would take at least 15 to 20 years before she would need another transplant.

“It all depends on timing,” she said.

“Medicine has not made enough progress and it is worth trying to do anything to improve this state of affairs.

“There may be more people on the donor list, people need to know the facts.

“Yes, we have an ‘Opt Out’ system, but if someone doesn’t talk to their family about it, they may not become a donor.”

Lucy Sreeves, Chief Executive of Kidney Research UK, said: AND: “Of the 7,731 patients currently waiting for an organ transplant, 6,205 are kidney patients who are waiting for a life-changing phone call.

“It is important that we find new ways to extend the time in which a donor organ can be transplanted so that the conditions for the operation to be successful are as good as possible.

“Every week, six people die waiting for a kidney, but by creating more opportunities for successful transplants, we can dramatically reduce the number of people waiting and shorten the average wait time to save a life.”

“If you look at something like a heart,” Mr. Campbell said.

“Of the donor hearts that could have been donated, less than 15 percent were actually used.

“There are several reasons – but the biggest challenges really lie in logistics.

“The NHS requires that an organ, particularly a heart, once removed from a deceased person should be kept on ice for no longer than four to six hours.

“Think about the logistics of trying to harvest an organ in, say, northern Scotland, and the eligible donor is in the south of England. Just getting the organ there in time is physically impossible.

“Even for something like a kidney, the storage time can be extended to about 16 hours, which is not a long time.

“The biggest challenge has always been that we have been storing, transporting and preserving organs in the same way for the last 60 years.

“Ninety percent of the organs are still stored in an ice box – there’s no other way to put it, it’s just the way it is, it’s the kind of box that food comes in.”

The concept of organ preservation through persufflation has been around for at least 20 years, but in practice it requires the constant presence of a qualified physician to monitor the patient’s condition and change settings.

ScubaTx, launched in 2020 by Dr Bill Scott, scientific director of the Transplantation and Regenerative Medicine Laboratory at Newcastle University, is an attempt to simplify the technology and make it widely available through an automated device.

Mr Campbell said the intention was to “move from a system run by experts to something that can be implemented at scale, with minimal resources”.

The latest prototype, dubbed “Voyage” by his team, was successfully tested using organs from donors and kept alive for more than 24 hours.

Mr Campbell said that while the device is still the size and shape of a picnic box, the first ScubaTx is “very ingenious”.

“We have very intelligent mechanical systems there, supported by software systems, that allow us to continuously deliver a technology called persufflation,” he added.

In short, ScubaTx sends humidified gas to an organ while controlling its temperature and delivering oxygen.

Mr Campbell says the result is healthier organs that last much longer.

Many of the Voyage devices are currently being used for research in laboratories around the world, but the new version is due to be delivered this year after ScubaTx received a £1.4m capital injection from the GMC Life Sciences Fund led by Praetura.

Mr Campbell added: “We expect to have the first device in the hands of many collaborators around the world early next year.

“Then we expect to be able to go to regulators with our first medical device by the end of next year.”

The breakthrough, which has not yet been tested in clinical trials, could not only improve the prognosis for seriously ill people waiting for a transplant, but also for those with chronic conditions.

Type 1 diabetes is caused by the destruction of insulin-producing cells in the pancreatic islets.

“There is a lot of clinical data that shows that if you can transplant — not the whole pancreas, but just the islets — into a patient, you can get a significant improvement,” Campbell said.

“It works in the UK at the moment, but not on a large scale because preserving the human pancreas is very, very difficult.

“Thanks to the technology we have, we were able to demonstrate together with our research partners that we can very effectively preserve the pancreas, which is a very delicate organ to preserve.”

The benefits of transplant medicine could extend even further beyond current practice, which may raise questions about the need for further regulation.

The NHS is watching the development of ScubaTx and other transplant technologies with interest.

Mr Campbell said he hoped that in the future the ScubaTx device would help improve “underutilisation” of all major organs, including the heart, kidneys and liver.

“If we can increase organ utilization to better levels, we will have enough organs to treat enough people who are currently on the waiting list,” he added.

A spokesperson for NHS Blood and Transplant said: “The challenges caused by the pandemic have lengthened transplant waiting lists.

“While organ donation and transplantation have almost returned to pre-pandemic levels, we are seeing an increase in the number of patients being added to the waiting list than in previous years as donor demographics change and more people develop conditions that require transplantation. The continued hard work and dedication of all those involved in donation, procurement and transplantation, and the support of donors and their families, will help save and improve more lives.

“There is growing evidence that various organ perfusion technologies can maintain organ function outside the body, and we welcome the development of products that could further improve organ donation and utilization. The ScubaTX device is one such device in development. It uses technology that could aid in the donation of pancreas from donors who have died of circulatory death. This type of technology could potentially be applied to other organs in the future.”