January 26 marks National Transplantation Day in Poland, an initiative aimed at promoting the topic of transplantology, including procedures related to organ transplants and post-mortem organ donation. Transplantation saves lives, extends them, and improves quality of life. However, the field has long faced a crisis: the demand for organ transplants continues to grow, with many patients dying while waiting for new kidneys, hearts, or livers. Expert estimates provide little optimism, suggesting that the need for transplantable organs will only increase in the future. But how can the shortage of donors be addressed? New technologies and scientific discoveries certainly offer hope.
Organ transplantation is a life-saving treatment for patients suffering from end-stage organ failure, such as chronic kidney disease, which affects approximately 4.5 million people in Poland. Globally, around 100,000 kidney transplants are performed annually, with about 1,000 of these in Poland. However, this is a drop in the ocean compared to the need. According to the World Health Organization (WHO), half a million patients worldwide are waiting for new organs, and this number is expected to rise. Chronic kidney disease progression leads to end-stage renal failure. While dialysis is often the initial treatment, a kidney transplant is ultimately necessary. This is where the critical issue arises: the lack of donors and organs. As a result, many patients endure years of dialysis because the waiting list for new kidneys is excessively long. Tragically, many die before receiving a transplant.
Statistics
According to the Organizational and Coordination Center for Transplantation Poltransplant, 2024 saw a record number of organ transplants in Poland, with 2,197 organs from deceased donors benefiting 2,151 patients. While the number of transplants from deceased donors is increasing, few people opt to donate a kidney to a loved one, or they fail to meet tissue compatibility requirements. In 2024, 82 kidneys and 24 liver segments were transplanted from living donors, often family members. Living donor transplants generally result in longer organ viability. Kidneys from living donors remain functional for an average of 15 years – five years longer than those from deceased donors – primarily due to better preservation and shorter ischemia times (about one hour versus 30 hours for deceased donors).
Transplant Waiting Lists
Despite the rise in transplants from deceased donors in recent years, especially compared to the pandemic period, the waiting list for new organs continues to grow. As of December 2024, the National Transplant Waiting List included 1,905 patients. The majority were waiting for kidney transplants (1,122 patients), followed by 415 for hearts, 181 for livers, and 139 for lungs. Experts warn that the organ shortage will worsen, particularly as the number of chronic kidney disease patients increases. WHO forecasts indicate that by 2030, the number of dialysis patients could double, many of whom will require kidney transplants. The organ shortage lengthens waiting times, leading to deteriorating patient health and, in some cases, death.
Immunological Challenges
The immune response of transplant recipients to the transplanted organ remains one of the most significant challenges in transplantology. Graft rejection, an immune reaction against the foreign organ, is a primary cause of transplant failure. While advancements in immunosuppressants have reduced rejection risks, these medications carry severe long-term side effects, including higher susceptibility to infections, cancer, and other conditions. The challenge lies in balancing effective rejection prevention with minimizing side effects.
Long-Term Care for Transplant Recipients
Post-transplant care is critical for ensuring the long-term success of transplants. Recipients require ongoing medical monitoring and regular check-ups to assess organ function and address complications. Challenges include managing the side effects of immunosuppressants, monitoring mental health, and addressing social and occupational issues stemming from chronic illness and treatment.
Advances and Future Perspectives
Despite numerous challenges, transplantology continues to evolve, and new technologies and scientific discoveries offer hope for overcoming many of these issues. Research into artificial organs, tissue engineering, and regenerative medicine may significantly reduce reliance on organ donors in the future. Furthermore, advances in immunology could lead to the development of more precise and less harmful immunosuppressive therapies.
Addressing the issues of organ shortages, ethical dilemmas, immunological complications, and ensuring adequate long-term care for transplant recipients are key to the future of this field of medicine. Only by understanding and tackling these challenges can we ensure better outcomes for patients and further advancement in transplantology.
Transplantology is a race against time, says Professor Tomasz Ciach, a board member of NanoGroup, adding: We have found a way to extend this time and, in doing so, not only preserve the full functionality of the retrieved organ but even improve its condition.
The organ perfusion system designed by the Polish company comprises the innovative NanOX perfusion fluid, the NanOX Recovery Box perfusion device, and an advanced data analysis model combined with an organ perfusion protocol.
NanOX is a comprehensive, proprietary system that includes an innovative device and fluid for extracorporeal organ storage and regeneration for transplantation, developed in our Warsaw laboratory, explains Piotr Mierzejewski, Vice President of the company. It consists of the NanOX 4K perfusion fluid, the universal NanOX Recovery Box perfusion device, which monitors the vital functions of the organ, and a proprietary perfusion protocol.
The usefulness of the solution has been confirmed through numerous experiments, the most recent of which, conducted in 2023, successfully achieved kidney perfusion lasting approximately six days. In July 2024, a team led by Professor Maciej Kosieradzki from the Medical University of Warsaw, President of the Polish Transplant Society, performed an autotransplantation procedure.
This was likely one of the most complex and technologically advanced procedures currently conducted in Poland as part of preclinical and clinical research. At the same time, it should be emphasized that we were the first to successfully perform kidney autotransplantation using a synthetic preservation fluid devoid of hemoglobin under subnormothermic conditions. In practice, this was a successful preclinical trial, but since the subject could not yet be a human patient, we carried it out on a domestic pig, said Professor Kosieradzki, who combines his work on the project with his duties as Head of the General and Transplant Surgery Clinic at the Dzieciątka Jezus Clinical Hospital.
The experiment involved removing one kidney from the animal after a 30-minute circulatory arrest (simulating a 30-minute cardiac death of a patient), performing perfusion of the organ with the NanOX fluid and using the NanOX Recovery Box device under extracorporeal subnormothermic conditions, that is, at a temperature of 25 degrees Celsius, for 12 hours.
This technology, combined with the unique NanOX 4K fluid, which uses nanoparticles to deliver oxygen to the organ and remove carbon dioxide, provides the organ with the necessary substrates for metabolism, oxygenation, and nourishment. In practice, this means that the kidney not only retained its viability for transplantation during this time but also underwent regeneration processes.
In the next phase, after the researchers removed the second kidney, they transplanted the organ, which had previously undergone extracorporeal perfusion, back into the animal. Subsequently, intensive monitoring of the patient’s health and the functioning of the transplanted kidney was carried out over the following two weeks.
By the eighth day after the procedure, the animal regained full fitness, as did the transplanted kidney, which was confirmed by biochemical test results, recalls Dr. Hab. Jarosław Woliński, Professor of the Polish Academy of Sciences.
Professor Kosieradzki believes that this groundbreaking discovery could soon become a standard in treating patients waiting for new organs. The solution developed by NanoGroup is a true revolution. The ability to maintain organs in extracorporeal conditions for many days while simultaneously regenerating them could significantly increase the number of transplantations performed. This is an opportunity that tens of thousands of patients worldwide have been waiting for years, says the expert.
The successful autotransplantation is an important step toward commercializing the NanOX system, according to Piotr Mierzejewski. The results of our experiment open new possibilities in the field of transplantation. We have proven that our system not only allows for significantly longer organ storage but also enables their regeneration, and who knows, maybe even extracorporeal treatment in the future, assesses the Vice President of NanoGroup S.A.
This is a solution that, until now, could only be seen on television screens in sci-fi movies. Thanks to this unique innovation, we not only gain time for performing transplants. Most organs are transplanted from deceased donors who often suffer from various conditions that can damage kidneys, livers, or hearts. Perhaps with this solution, we will be able to cure some of these diseases or eliminate their effects in isolated organs. Truly vast opportunities are opening up before us, explains Professor Kosieradzki, a member of the newly established Scientific Council and head of one of the research teams.
Research into the innovative system for storing organs for transplantation, conducted by NanoGroup’s subsidiary, is being carried out in collaboration with the Jan Kielanowski Institute of Animal Physiology and Nutrition of the Polish Academy of Sciences, as well as a team led by Professor Maciej Kosieradzki, MD, PhD, and Professor Wojciech Lisik, MD, PhD, from the Department of General and Transplant Surgery at the Medical University of Warsaw.