The first successful kidney transplant took place in 1954 at the Brigham & Women's Hospital in Boston. Uniquely the donor of the kidney was the brother of the recipient of the organ, meaning that the transplant was successful for years rather than the months previously associated with the procedure. The surgery was completed by Dr. Joseph Murray, who later received the Nobel Prize in Medicine for his work.
Since this breakthrough transplant, the speed of medical development in transplantation has continued apace. Surgeons now transplant all the major critical organs and, if the surgery is still anything but routine, the number of transplants taking place has grown to a record high of more than 40,000 in the US alone in 2021.
Demand for transplants still significantly outstrips the supply of available organs, however. On any given day in the US there are around 75,000 people on an active waiting list for an organ, but only around 8,000 deceased organ donors each year, with each providing on average 3.5 organs.
No routine surgery – or recovery
Despite a huge increase in the frequency of transplant surgery, this is no such thing as a routine transplant operation. Transplantation is an intervention of last resort – only used for patients for whom the consequences of doing nothing are catastrophic.
In the US, the most transplanted organs are the kidney, liver, heart, lungs, pancreas, and intestines. Patients waiting for a kidney transplant operation will already be facing end-stage kidney disease – a chronic condition that involves taking various medicines and undergoing kidney dialysis to keep the patient as healthy as possible. Typically, a dialysis schedule consists of three sessions per week, for up to five hours per session – all taking place at a medical facility. This treatment is restrictive, inconvenient, time-consuming, and does not offer a cure: only 35% of patients live after five years of dialysis treatment.
In 2017, the average waiting time to receive a kidney transplant was 685 days.4 That is almost two years of managing end-stage kidney disease. A lack of suitable donors means that 12 people die every day while waiting for a kidney transplant.
Risks of surgery
This is not to say that surgery comes without risk. Kidney transplant is a highly complex operation conducted by skilled surgeons. It typically takes several hours, and patients need to be in good physical shape to be operated on. Furthermore, a crossmatch needs to ensure that the patient’s antibodies will not reject the new kidney.
Even once a patient has undergone transplantation surgery, the risks can continue long after the patient is discharged from the hospital. With every transplant surgery - even where a crossmatch has been successful - there is a risk that a patient’s body will reject the new organ or develop other complications later in their life. To prevent rejection, transplant patients take immunosuppressant drugs for the rest of their lives. However, such drugs can have subsequent negative impacts on the patient’s overall health, making it harder to fight off infections, potentially boosting the risk of other diseases, such as diabetes and cancer.
The costs of a transplant are more than surgical
It’s unsurprising that these complex operations come with a significant price tag attached. In 2020, the average kidney transplant in the US cost $442,500. Around half of these costs came from hospital transplant admission – including the cost of a hospital bed, critical nursing care, and medication during the stay. The retrieval, preservation, and transportation of the kidney – are also significant, averaging at $113,900 per kidney transplant. If the organ donor has died, expensive medication is needed to keep the organs healthy for as long as possible. Furthermore, the need to move the kidney quickly from one part of the US to another may facilitate significant transportation costs; chartered flights are often used to collect and transport the organs.
Although these operations are expensive, it is easy to see how these costs are accrued. Transplanting vital organs requires substantial amounts of time and resources, as well as knowledge and expertise. The number of hospital staff required for each surgery is high with transplant surgeons, physicians, coordinators, and dieticians all involved. The patient then spends time in a high dependency ICU with further substantial staffing requirements 24-7.
Of course, there are also costs associated with the needs of patients in the run-up to a successful donor match. Billed charges in the 30 days leading up to the transplant surgery can reach $32,700, covering costs of blood and tissue typing and serum, cross-matching for donor compatibility, lab tests, and X-rays. Even once a match is identified, patients must then also wait for the graft and subsequent delivery of the organ. Approximately $85,500 is spent during the 180-day period following kidney transplantation surgery, including post-discharge facility, hospital readmissions, regular lab tests and the evaluation and treatment of complications.4
But the costs of doing nothing – as well as being catastrophic to the patient’s wellbeing – are also significant. For example, one year of kidney dialysis treatment can cost about $72,000 per patient. Every patient waiting the average length of time for a transplant will need dialysis regularly that will add up to almost $150,000.
Controlling costs in a budget-conscious healthcare system
As the frontiers of what is possible in surgery have widened, people’s expectations of what the healthcare system can do have grown. But the capability to keep more people alive for longer comes at a cost as outlined above. With an increasingly elderly population requiring more healthcare support, managing the cost of care has become a constant focus for healthcare systems.
In most circumstances, transplantation costs cannot be reduced without negatively impacting the success of the transplant. It is not possible to reduce the cost of the testing and treatment required up to transplantation surgery without risking the condition deteriorating quickly. When an organ is available for transplant, minutes count, so fast transportation is critical. The best surgeons in the world train for decades to achieve the most successful outcomes for their patients and expect to be rewarded appropriately. The opportunities for cost minimization are limited.
There is one area, however, where the potential to reduce cost – and at the same time improve patient wellbeing – is increasingly capturing the attention of healthcare systems and insurers. Increasing the speed of recovery, and ensuring successful recovery is more likely, can help to significantly reduce post-surgical costs.
A strategy for enhanced recovery
By reducing the amount of time spent in hospital post-surgery, and by addressing the primary reasons why complications take place in recovery, healthcare professionals can create a virtuous circle – reducing the time a patient spends in recovery and saving costs.
The average hospital stay for patients undergoing kidney transplants is between six and seven days.4 Reducing the time patients spend in hospital post-operation is one of the most effective ways that healthcare systems can reduce the wider costs of a kidney transplant. Healthcare systems are increasingly looking to introduce innovative solutions to enhance recovery from transplantation surgery and decrease the healthcare risks for patients in the 180 days post-transplant discharge.
One of the most effective ways to manage costs is by reducing hospital readmissions. Around one- third of all kidney transplant patients are readmitted into the hospital within 30 days of discharge. If patients have the capability to better manage their recovery at home following discharge, readmissions can be cut.
Making recovery more effective with Medtech
One of the primary ways that healthcare systems can achieve this is via medical technology devices. In the last 20 years, the application of technology in healthcare has grown exponentially. According to a report from BCC Research, the medtech industry will boast a compound annual growth rate of more than five percent from 2020 to 2025, reaching revenue of nearly $800 billion by 2025.
Fundamentally technology is a powerful tool in delivering predictable outcomes to complex issues reliably. As more technology is applied across multiple medical challenges, the potential to improve medical outcomes for patients while reducing costs for healthcare systems is prompting the industry to deploy medtech applications far more widely, challenging traditional perceived care standards.
There are ways medical device manufacturers can contribute to reducing costs of transplantation surgery. Devices that significantly reduce time spent in hospital post-surgery, allowing patients to recover quicker and relocate their recovery into the home setting sooner, can contribute to a reduction in the costs associated with recovery. To achieve this, the device should be able to demonstrate its ability to address post-operative complications associated with transplantation surgery, such as oedema, surgical site infections, and medical conditions associated with limited mobility, and do so at a lower cost than the treatments currently available.
Medical device companies need to carefully consider how devices are designed, iterated, and manufactured to enhance the care pathway that already exists, while also demonstrating it is more cost-effective. Ensuring a device can work alongside existing treatments can improve patient outcomes through faster recovery, reducing costs. If a device is designed to enable self-administration, it should come with clear instructions that will allow simple self-application during recovery in a home setting.
Existing medtech is already making breakthroughs in post-surgical recovery. A randomized controlled trial conducted by Lawson Health Research Institute (LHSC), in Ontario, Canada, found that kidney transplant patients that wore a wearable medical device during recovery experienced shortened hospital stays by more than one day and reduced surgical site infections by nearly 60%. Surgical wound infections can cost more than $20,000 per patient. As transplant patients are at significant risk of infections, and infections are the primary reason for re-admission to hospital, devices that reduce infection risk benefit the patient as well as reducing financial burden.
Improving long-term outcomes while reducing costs
Healthcare professionals are looking to patient recovery as the place where innovation can be most effective. Technology that helps reduce infection rates, decrease the length of a hospital stay and – crucially – increase the quality-of-life following transplant surgery delivers cost benefits to the system and wellbeing benefits to patients. Medtech devices that speed up recovery or reduce risks of readmission to hospital post-surgery offer healthcare systems the opportunity to help patients manage their recovery more effectively from home, driving better health outcomes and reducing costs simultaneously.
 Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP). Transplant Safety Overview. 2019. [Website]. Accessed April 2022].
 Organ Transplants Without Life-Long Drugs. National Institutes of Health. 2012. [Website]. Access March 2022. https://www.nih.gov/news-events/nih-research-matters/organ-transplants-without-life-long-drugs.
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 United States Renal Data System. 2021 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2021. https://adr.usrds.org/2021
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Bernard Ross, CEO and founder, Sky Medical Technology
Bernard Ross is CEO and founder of Sky Medical Technology (Sky). Sky creates world-leading medical devices that saves lives while saving healthcare systems money. Sky’s biomedical devices use its proprietary bio-electronic nerve stimulation technology – OnPulse™ – clinically proven to increase blood circulation in the deep veins of the calf. The result is the company’s multi-award-winning device, the geko™ – a wristwatch-sized wearable applied to the knee delivering painless electrical impulses to stimulate blood flow, without the patient having to move. It has been globally adopted into healthcare systems to treat a range of medical conditions including the prevention of venous thromboembolism and the treatment and prevention of oedema (swelling).
Bernard is a serial entrepreneur with more than 20 years’ senior experience at private and public board level across multiple industries including pharmaceutical, technology development and FMCG. Bernard is a former Head of International Development at CMI plc, Senior Vice President, Cardiovascular of Bioaccelerate Inc. (BACL) and former CEO of Innacardio Inc.