Can we disrupt the kidney transplant waiting list?


Jan 11, 2018

Kidney disease is the ninth leading cause of death in the United States. Its growing prevalence is spurred on by the increasing number of people suffering from diseases detrimental to kidney function, such as diabetes and high blood pressure.

The kidney plays the role of selectively filtering what the body considers waste from the bloodstream in preparation for removal. Without intervention, patients suffering from kidney failure cannot remove these toxic wastes from their body on their own, and will die. Thus, treatment has the overall goal of restoring or performing this waste filtering function of the kidney, and it has traditionally come in two flavors: dialysis or kidney transplant.

A kidney transplant is currently the best option for those lucky enough to attain one, but supply is severely limited by the availability of viable donor kidneys, leading to an ever-growing waitlist. Dialysis has become the answer for those in queue.

Unfortunately, as a long-term solution, dialysis does not nearly measure up to a donor kidney. It requires scheduling one’s life around being hooked up to an external machine, while performing the act of filtration less efficiently and selectively than the glomerulus of a donated human kidney. Dialysis, on average, can only afford someone an additional five to ten years of life—threateningly close to the average wait time on the donor list in many states. Clearly, dialysis is merely a temporary fix for a patient suffering from kidney failure, a way to buy time until a donor kidney is available.

Over the years there has been no shortage of effort, spending, and passion invested to better meet the health needs of those on the waitlist for a donor kidney. Alas, despite improving the kidney donor matching process, physical and financial access to dialysis, and the selection of kidneys viable for transplant, we have struggled to keep up with the growing size and amount of time spent on the waitlist. But now there’s an option set to overtake dialysis and potentially disrupt kidney transplants in the process.

The new hope comes in the form of a “bio-hybrid” artificial kidney, made up of human kidney cells grown upon microscopic scaffolding within silicon chips. It seeks to utilize intricate aspects of human kidney filtration by selectively filtering toxins from blood and reabsorbing nutrients and water back into the bloodstream. It also boasts cutting-edge nanotechnology to improve filtration effectiveness closer to that of a real kidney. What’s more, this device can be implanted into the patient, doing away with the need to live one’s life around perpetually traveling to a dialysis center.

So how would the artificial kidney stack up relative to dialysis and kidney transplant?

Purpose of dialysis: help me remain in the best health possible while I wait to receive a donor kidney

The artificial kidney holds potential to be a sustaining innovation relative to dialysis. Sustaining innovations improve existing products. Rather than create new markets, they infuse existing ones with better value.

In this case, by harnessing bio-hybrid technology, the artificial kidney could be better at helping patients survive long enough and remain in the best health possible while waiting to receive a donor kidney. Better yet, the solution could be implanted with a single procedure and payment as opposed to weekly procedures. The time spent traveling to the dialysis center and performing dialysis on a regular basis, the opportunities lost on account of having to schedule around dialysis, not to mention the discomfort and cost, over the span of years could be done away with a single procedure.

Purpose of kidney transplant: replace the function of my kidney over the span of the rest of my life

Currently, the device is not as good as a transplant kidney, and in fact, may never be. Yet, over time, this bio-hybrid technology could improve its selective filtration and reabsorption capabilities along a sustaining trajectory to a point at which it disrupts kidney transplants as a permanent solution that lasts a lifetime.

Disruptive Innovations make products and services more accessible, thereby making progress available to a larger population. Thus, if the artificial kidney does live up to its high hopes, it would no longer act as a better band-aid in lieu of a donor kidney, but perform well enough to last the remainder of a patient’s life. A solution that performs to this standard would in all likelihood disrupt the need for a kidney transplant altogether due to its relative accessibility compared to waiting in queue for a donor.

In this way, an innovation intended to improve upon dialysis, a temporary workaround solution for those in line for a kidney transplant, may end up following a classic path of disruption. By providing a less burdensome solution, the bio-hybrid artificial kidney could reduce the vast amount of human suffering and uncertainty of those on the waitlist, and potentially provide a reliable enough solution to last a lifetime.

For more, see:
Health for hire: Unleashing patient potential to reduce chronic disease costs

As a Research Associate, Ryan investigates potentially disruptive healthcare delivery models and the technologies that will enable their success. He is particularly interested in health information technology and is currently researching Disruptive Innovation in the space of electronic health records.