Over 100,000 people in the UK are waiting for an organ transplant and every 8 minutes another person is added to the list. However, there is a huge shortage of suitable donors meaning 17 people die each day waiting for a transplant.

With so many patients waiting and so few donors, when an organ becomes available for transplant, the decision of the correct recipient can be a difficult one. To aid this decision, healthcare providers use algorithms to decide who is next on the list to receive a transplant. Should a computer be trusted with such a life-or-death decision?  

31-year-old Sarah Meredith fell victim to this algorithm whilst waiting for her liver transplant. Sarah was not made aware of the National Liver Offering Scheme (NLOS) algorithm that would be used to influence her wait time. When a liver becomes available for transplant, the algorithm calculates a transplant benefit score (TBS) for each patient based on 28 variables, mostly from the recipient – whoever has the highest TBS is offered the liver. Whilst the overall number of deaths whilst waiting for transplant has dropped since the introduction of this algorithm, younger patients are being made to wait far longer than before – Sarah waited over 2 years after being informed her wait time would be 68 days. 26 to 29 year olds are now waiting an extra 116 days due to the algorithm, suggesting it might disadvantage certain individuals.

My thoughts

The complexity of prioritising patients on waiting lists puts a heavy moral responsibility on medical professionals. Therefore, the use of an algorithm seems like a practical solution to take pressure off medical professionals and aid this difficult decision. However, in practice, a computer lacks the empathy and judgement of the human brain, so I don’t think they can be trusted to make decisions in life-or-death situations. Additionally, this algorithm overlooks reduction in life expectancy with increased transplant wait time – should we prioritise older, more vulnerable patients when doing so takes years off the lives of younger patients?

The solution?

Whilst current algorithms in use may not be 100% fair, I don’t think they should be scrapped. A new technology developed by the University of Bradford, OrQA (organ quality assessment), has been nominated for the Medipex NHS Innovation Award. OrQA uses technology similar to facial recognition to assess donor organs and match them to a recipient. AI like this, based on information from the donor rather than the recipient, provides an unbiased solution which will help healthcare providers reduce transplant waiting times. It is estimated to allow 100 more liver transplants a year; but, is this enough with over 10,000 people waiting for a liver transplant?

Are pigs the future?

Growing new organs for transplant would quickly reduce waiting times. Scientists have explored the possibility of using pigs and xenotransplantation to do this. In 2022, David Bennet received the first ever pig heart transplant. The pig heart was genetically modified before being transplanted, and Bennet was given drugs to prevent immune rejection of the pig heart. Bennet lived for 2 months with his pig heart before it failed. In the current situation, I’m sure many would agree with me when I say I would be skeptical receiving a pig organ transplant. However, with more research, breeding genetically modified pigs and harvesting their organs for xenotransplantation could revolutionise the organ transplant process and remove the need for patients to put their lives in the hands of a computer.

Since the development of the Egyptian ‘Cairo toe’, prosthetic limbs have developed greatly. The Cairo toe was made from pieces of wood sculpted into the appearance of a toe and held together by leather thread. This simple model contrasts drastically to the modern-day prosthetics often constructed using metals and synthetic materials such as plastic and silicone which can provide individuals with high levels of functionality and are available with a range of different aesthetics.

Scientists are constantly trying to improve prosthetics for their recipients. Recent developments have focused on the ability to control prosthetics in the same way we would control the natural limb – with our minds. Johns Hopkins University have developed the APL bionic arm which can be controlled by the human brain. In 2016, Melissa Loomis, who lost her arm after being bitten by a wild racoon, became the first recipient of this prosthetic and one of the only amputees at the time to be able to control her prosthetic with her mind. The arm receives inputs from her nerves in her nervous system which are interpreted by the arm and result in the desired output of movement. The prosthetic also has a range of sensors across it which send signals back to her nervous system allowing her to be able to detect temperature and provide some of the senses, such as touch, to the limb. This could be life changing to amputees like Melissa who said touch was ‘the thing she missed the most’ in an interview with Motherboard.

Whilst this was a huge leap forward in prosthetic science it is not without its disadvantages. The APL bionic arm is extremely expensive, and patients need to undergo a long invasive surgery known as targeted sensory innervation to allow the prosthetic to be connected to the patients nervous system. Whilst currently these factors make the prosthetic less accessible, it still provides an exciting glimpse into the future of prosthetics for amputees.

However, for those who are unable to consider this advanced APL bionic arm, prosthetics such as the MiniTouch, recently described in nature,  may be desirable. The MiniTouch technology allows the detection of temperature through prosthetic limbs without the need for surgery. The technology works similarly with temperature sensors on the prosthetic that deliver thermal information to the patients’ neurones through points on their skin. It can be attached to many different prosthetic limbs already on the market making it much more accessible to amputees.  

Developments like these were unimaginable during the time of the Cairo toe indicating that the possibilities with prosthetics could be endless. One limb amputation happens every 30 seconds and there are over 2.1 million people living with a limb amputation in the US alone. Therefore, these advancements provide a promising glimpse into the future of prosthetic limbs with increased functionality and accessibility.

As the war in Ukraine continues there has been reports of an increased need for limb amputation. Therefore, prosthetic limbs could be more important than ever in Ukraine. This interesting article describes how Aether Biomedical has partnered with the Ukraine based Superhuman Centre to increase the availability of prosthetics to those injured in Ukraine. So far they have raised over $7 million and successfully fitted patients in Ukraine with the company’s flagship product ‘Zeus hand’.