Animal-to-human transplants – or xenotransplantation – is raising hopes among patients who can’t obtain healthy organs from other humans.
Surgeons in March performed the world’s first successful kidney transplant from a pig to a living human, an encouraging sign for the nearly 100,000 Americans waiting for a kidney. Although the patient, who’d been very sick, passed away after seven weeks, there was “no indication that it was the result of his recent transplant.” And a woman who received a pig heart April 12 was still recovering as of press time.
While patients with new kidneys – human or porcine – will presumably be off of dialysis, hundreds of thousands of Americans still depend on the arduous blood-cleansing process that typically means three or more scheduled in-clinic sessions per week, each lasting up to four hours. Although dialysis can sustain life during the wait for a transplant, it is a tremendous burden. It often prevents them from holding down a job, spending quality time with friends and families, and doing other meaningful activities. It’s a burden on caregivers as well.
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If transplantation has evolved so dramatically, why hasn’t dialysis? Well, it actually has, but most patients haven’t accessed the innovations. Many, through no fault of their own, are stuck in the past technology-wise.
Until very recently, the treatment had not substantively changed in 30 years. Most dialysis systems were costly to operate during that time and depended on highly trained clinical staff. Further, patient outcomes and quality of life have been poor.
Dialysis works better at home
For years, moving dialysis to the patient’s home was floated as a creative solution to the burden of in-clinic treatment, but until now, it’s been too complicated. For patients, families, and even clinical care teams, home hemodialysis was difficult to orchestrate. It also required extensive training, special supplies and onerous 8-to-9-hour preparation sessions before treatment. Despite the numerous programs to increase home dialysis, as of 2021, only 1.6% of ESRD patients were dialyzing at home.
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Fortunately, as in many areas of medical technology, things are changing. Dialysis technology for both the home and hospital is becoming streamlined and user-friendly. Drawing design cues from the consumer tech world, new, sleek home dialysis machines are displacing old, industrial-type equipment – akin to the smartphone succeeding the rotary telephone of the 1970s.
The newest dialysis machines employ a touchscreen interface with 3D animations and step-by-step instructions. This simplicity reduces the typical 100 hours of training time to a few hours. Dozens of sensors and Wi-Fi connectivity enable the device to report to clinicians, hospital EMRs and support agents.
For those who’ve discovered this new technology, prep time has plummeted. New systems can purify tap water and generate dialysate on demand without batching or bags. Operating with a faucet, drain, and electrical outlet, the machines reduce the need for special rooms, equipment, and supplies.
Better outcomes
Outcomes are better at home, too. Home dialysis patients have a 13% lower mortality rate and patients see fewer hospital days. Home dialysis also improves quality of life. They report having more time for the lives they want to live. They feel more relaxed, energetic, and in control. Their sleep improves. And they’re five times more likely to maintain employment compared to in-center dialysis.
A musician I spoke with illustrates the difference. He recalled his first-ever dialysis session, waking up in a hospital bed connected to a “monstrous” machine, then taking on the burden of a standard home dialysis machine with a house full of supplies. Home dialysis required him and his caregivers to invest 30 hours a week mixing dialysate. Since starting treatment with a newer machine, he’s been able to rebuild his life around his family, music career and advocacy work.
So for folks on the transplant waiting list, the wait from now on should be less disruptive. Life should be more pleasant. And all things being equal, one’s condition going into a transplant should be better. Right now, approximately 92,000 Americans are waiting for a kidney transplant. One good way to reduce their suffering immediately is to make dialysis a better experience while they wait. Let’s help them bring it home.
Photo: ericsphotography, Getty Images
Michael Aragon, MD is Chief Medical Officer at Outset Medical, a medical technology company pioneering a first-of-its-kind technology to reduce the cost and complexity of dialysis. Outset is the developer of The Tablo® Hemodialysis System, FDA cleared for use from the hospital to the home, and represents a significant technological advancement that transforms the dialysis experience for patients and operationally simplifies it for providers.
He is board certified in Internal Medicine and Nephrology, receiving his training at the University of Texas Health Sciences Center in Houston. His clinical research focus has been on the expansion and improvement of home dialysis options for patients with renal disease.
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