>>Adam Grosser: So on a more serious note,
ten years ago a good friend of mine died while
waiting for a heart transplant. And that set
me off on a long journey to see if I can better
understand what is a very byzantine process
and see if there is any possible ways to improve
things.
And so the way it works today is there are
these super regional transplant centers that
are sourced by a bunch of donor hospitals.
And the transplant team and the retrieval
team come from the transplant center. And
a good example is in California there is two
of them, UCLA and Stanford.
And if you have end-stage organ failure, you
want a transplant. In the United States, we
do about 5,000 heart transplants and about
5,000 lung transplants. The rest of the world
does about -- in total, about 10,000 more.
Here's why you want a transplant. You want
to be on that white line. What that white
line says is that 80% of the people are alive
36 months later. Any other form of treatment,
whether it's medical or ventricular assist
or something like that, you are dead in 24
months. Pretty much guaranteed.
Global demand for transplants is increasing
about 10%. The first really great thing I
found was Germany. In Germany, the lists are
actually going down. They have gone through
an incredibly aggressive national matching
system that really helps get through the list
quickly.
The second really big aha is that there is
no such thing as organ preservation. We treat
fish better than we treat hearts, and that
drives everything. I will show you that in
just a second.
But if you accept the premise that the constraint
is preservation, that limits time and that
limits geography because if you only have
a limited amount of time, you can only move
an organ so far. And that limits the recipient
pool. And that's a tragedy because what you
can see here is if you get an organ into somebody
quickly, the odds that they live are really
good. If you wait -- and the cut-off point
is about four hours -- it goes down incredibly
steeply towards zero that you are going to
live.
The third big moment, the two -- the green
and red bars are the amount of organs that
are wasted, that are harvested but not implanted
because they time out. 60% of hearts donated
globally and 80% of lungs donated globally
time out. This means there would be no waiting
list if we could recapture those organs. Organs
on ice are dead. There is metabolic support.
There is no oxygen. There is no nutrients.
There is no way to assess the quality of the
organ the transplant surgeon is actually getting.
So that leads to a really strange situation
today, which is that most people have severe
complications. Most people end up in ICU.
And the data is absolutely crystal clear.
Short and long-term survival is 100% correlated
with the time the organs are outside the body.
So the big aha is, what can we do to create
a situation to -- such that organs can be
metabolically active outside the body, i.e,
ex-vivo support. This has been the holy grail
for a long time.
This is the first attempt to do so. It took
an entire room and a million dollars of hardware.
This was done at the Cleveland Clinic to support
a lung. It proved the point. It was very much
a prototype.
And today, for the first time, there are some
mobile organ carriers that can support organs
outside the body, transmit data back to the
transplant team and qualitatively and quantitatively
assess the organ and, in fact, resuscitate
the organ.
You have -- the time constraint is removed.
If the time constraint is removed -- and in
these sorts of devices, you can support an
organ for up to 48 hours. The time constraint
is removed. The surgeon can actually do things
like do a bypass operation on a heart that
was marginal. You can recapture, re-asses
and resuscitate organs that would otherwise
be wasted. It takes away the entirety of this
red bar, which is the time that the organ
is not metabolically active. You reduce the
time out of the body strictly to the explant
time and the implant time.
Here's the result. The control group, the
normal procedure, 37% of people have organ
failure -- experience some form of organ failure
after 30 days versus 5% when you have ex-vivo
care of the organs. This has been replicated
in the U.S. and Europe as well.
Similarly, the survival rate jumps from an
average of 84% up to 99% and it is staggering.
It is so crystal clear that every transplant
surgeon would like to do this. And it will
be coming. There are a number of companies
working on it.
Heart and lungs are the hard ones. They are
coming first. They are, in fact, available
today in Europe. Livers and kidneys which
are more resilient organs will be available
in about the next 18 months. This is creating
a seat change.
The big thing still missing is once you take
time out of the equation, you have got to
create a global matching database. And that's
where you can think of places like Google.org
being incredibly useful.
Thanks very much. It is a pleasure to be here.
[ Applause ]
