In the middle of the night, Erik Finger embarks on vital missions where time is of the essence. Due to the obstacles posed by both the clock and the map, Finger, who is an organ transplant surgeon and associate professor of surgery at the University of Minnesota, has mere hours to lend his patients a new lease on life.
“When I’m practicing transplant surgery, one of the only real things I can modify is the amount of time [an organ] spends in the cooler on ice,” Finger says.
And for his patients, every second counts. A heart, for example, has only about four to six precious hours wherein it can be successfully transplanted.
There were close to 107,000 total patients nationwide waiting for a heart, kidney, liver, or other organ transplant on August 1, 2021, according to statistics from the Organ Procurement and Transplantation Network, which is run by a private, nonprofit organization under federal contract.
And every 10 minutes, a new name is added to that list.
But at the University of Minnesota’s Institute for Engineering in Medicine, a $100 million-plus investment in cryopreservation technology could revolutionize how organs and tissue are stored, shipped, and used in surgeries.
“We can have the organ waiting for the patient, rather than the patient waiting for the organ,” Finger says.
In other words, the difference the research could make for transplantation is like day and night.
“The concept is really to turn transplant surgery into a day job,” John Bischof, director of the U of M’s Institute for Engineering and Medicine, says. “If you could make all these technologies work the way we hope they will, then instead of my friend Erik Finger getting a call at 4 a.m. when an organ happens to be available, he can plan.”
Time For New Tech
Funded by philanthropists, industry partners, and the Biostasis Research Institute, technologies at the recently opened Organ and Tissue Preservation Center at the U of M may sound similar to science fiction, like a carbonite-frozen Han Solo in Star Wars, but they are the result of years of intensive research and planning. Finger, Bischof, and scores of skilled others are ultimately working toward a long-term organ bank.
“When we say ‘organ bank,’ what we mean is a giant, ultra-low-temperature freezer filled with organs. You can pick the one that you need,” Finger says.
Researchers have known how to cryopreserve, or store tissue, at low temperatures for several decades. But there is a catch: Cryogenic storage works only for small cells in suspension, not tissues and organs, because of the ice and cracks that form when researchers preserve a sample at a super-low temperature.
“Just like when you put an ice cube in the middle of a glass of water,” an organ can break into pieces if it is not uniformly cooled and reheated, Finger says. “Really, the technology didn’t exist until our collaborators tried a different strategy called vitrification.”
In simple terms, vitrification is cooling an organ cased in liquid at a very fast rate until it enters a stable state similar to glass—where it behaves like a solid, but does not crystallize like frozen water.
But how to safely thaw a vitrified or cryopreserved organ is still an open question.
The trick, Finger says, is a cutting-edge research center machine that revives preserved organs extremely quickly and in a uniform fashion. The team uses a radiofrequency generator—essentially a supercharged microwave—which heats tiny nanoparticles to warm the organ from within.
This has worked on insect and fish embryos, and the team is now researching a number of larger animal models such as rats, rabbits, and pigs, where Finger says experiments have yielded promising outcomes.
“We’ve had really good results with pancreatic islets, for potentially preserving those for the treatment of diabetes,” Finger says, “islets” referring to small groups of cells. “But really the main focus of our laboratory is to apply this to organs.”
Hopefully, Finger says, they can move on to research human organs in the future. None of the organs that the U of M will work on are organs intended for transplantation. In other words, no organ will be taken away from a potential recipient on a waiting list.
Bischof echoes Finger’s hope. But for him, it is always important to mitigate expectations when sharing these exciting new breakthroughs.
“Minnesota is a cold place and it’s cold technology, so I feel pretty good,” Bischof says with a laugh. “We’re hopeful and optimistic, but we’re also realistic.”
Getting to the Life Source
Hearts, livers, and kidneys are among the most viable organs for research. They are also among the most consistently in-demand organs for transplantation.
So, on the patient and provider side, making sure a recipient is well-matched to a specific organ is a chronic issue. There are tens of thousands of people trapped in waitlist limbo, and inequities abound, according to Julie Kemink, chief operations officer of LifeSource, a Minnesota-based organization that coordinates care for those who need an organ, eye, or tissue donation.
Despite being three times more likely to suffer kidney failure than white patients, Black Americans are systemically disadvantaged when seeking life-saving treatment, according to a report from innovation-funding philanthropy groups Arnold Ventures and Schmidt Futures. Moreover, Black Americans are significantly less likely to receive an organ transplant even when they are on the waiting list.
“Naturally, an African American donor is going to more closely match an African American recipient. So if we have a donor and there’s not a matching recipient right now, and we can freeze that organ to match it in the future, that will increase equity,” Kemink says.
In other words, the Organ and Tissue Preservation Center aims to challenge the daunting consequences of a sick system by storing life.
“So many of these people have lived amazing lives, challenging lives, and this really gives us the chance to connect with our friends and neighbors in the community,” Kemink says. “It’s humanity at its best.”
One Giant Leap
Together, those involved in technology and those interfacing with patients defy time—and maybe gravity, Bischof jokes.
“It’s kind of like an Apollo Mission, if you will, to preserve organs better and tissues as well,” he says.
And although 3D-printing organs in space has been explored by scientists, U of M researchers still have their feet firmly planted on the ground.
That means engineers, surgeons, chemists, radiologists, and others are working together toward a vision of the future, one that is not just specific to transplantation.
For example, Bischof works alongside Kanav Khosla, a research associate who studies cryogenic technology to preserve coral, zebrafish, and shrimp in the natural world. For him, the research is a way to battle climate change.
Unlike the Apollo Mission, there is no countdown to launch. But the gifts that are not able to be transplanted right now can still be used to help the future.
“This is totally Team Science,” Bischof said. “This is something that could only happen with a whole myriad of people kicking in, believing in the mission and actually trying to make a change.”
Learn more at the U of M’s Institute for Engineering in Medicine website: iem.umn.edu