Įven if a viable organ is successfully excised, patient-donor compatibility concerns can prevent transplantation from occurring. A report in 2017 by the Global Observatory on Donation and Transplantation found that data comprising 82 member states, whose data was representative of approximately 75% of the global population, showed that the 139,024 organ transplantations performed that year barely accommodated 10% of the global need. International organ transplantation data illustrates a similar trend globally. In addition to the disparity between number of donors and number of patients on the waitlist, the shortage of transplantable organs is exacerbated by the fact that on average, only 0.3% of individuals die in a way that makes their organs viable for transplantation, as deaths caused by old age, disease, or severe physical trauma can compromise the functionality of organs. This large difference in organ supply and demand contributes to the deaths of 20 people every day who are on a transplant waitlist. Figure 1 graphically represents the disparity resulting from different growth rates of individuals in need of organs and number of transplants performed. From 1991 to 2019, the number of individuals on the waiting list for organ transplants has rapidly increased from around 23,000 to over 112,000, while the numbers of organ donors and organ transplant operations performed have increased relatively marginally from 7000 to 19,000 and 15,000 to 39,000, respectively. However, while organ transplantation is an immensely beneficial technology, it is significantly limited by the shortage of transplantable organs. Kidney transplants have been shown to improve patient survival when compared to dialysis, and transplants of the liver, heart, and lungs are life-saving. While various therapies can mitigate the progression of organ disease, autologous organ transplantation is currently the gold standard for end-stage organ failure. Chronic kidney disease had a prevalence of 15% in the US, or approximately 37 million people, in 2019, with over 661,000 of these individuals having progressed to end-stage renal disease (ESRD). Heart disease is particularly burdensome to the healthcare system, having been the leading cause of death in the US for the past decade, with heart failure contributing to 1 in 8 deaths in 2017 according to the Center for Disease Control. In this review article, we describe the foundational principles of whole organ engineering, discuss key technological advances, and provide an overview of current limitations and future directions.Įnd-stage organ failure affects millions of people every year in the United States alone. These advancements give hope that organ engineering will become a commercial reality in the next decade. Key technological advancements include (1) methods of whole organ decellularization and recellularization, (2) three-dimensional bioprinting, (3) advanced stem cell technologies, and (4) the ability to genetically modify tissues and cells. There have been numerous developments in bioengineering of whole organs over the past two decades. Organ engineering is a discipline that merges developmental biology, anatomy, physiology, and cellular interactions with enabling technologies such as advanced biomaterials and biofabrication to create bioartificial organs that recapitulate native organs in vivo. The concept of whole organ engineering offers a promising alternative to organ transplantation that overcomes these limitations. Those patients fortunate enough to receive a transplant must then be subjected to a lifelong regimen of immunosuppressant drugs. However, due to a critical shortage of organs, only a fraction of these patients are able to receive a viable organ transplantation. The only curative treatment option currently available for patients diagnosed with end-stage organ failure is organ transplantation. End-stage organ failure remains a leading cause of morbidity and mortality across the globe.
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