Brad Puffer: Welcome everyone to this episode of Field Notes. I’m Brad Puffer on the Medical Office communications team at Fresenius Medical Care North America and your host for this discussion today. Here we interview the experts, researchers, physicians, and caregivers who bring experience, compassion, and insight into the work we do every day. While the best treatment option for a person with kidney failure is to receive a transplant, the process is not easy. Most patients wait three to five years for a new kidney, and some wait even longer. There are simply not enough kidneys for every patient in need. That means no kidney should be wasted, and every available organ needs to get to a patient successfully. In 2020, the Fresenius Medical Care Foundation gave a grant of more than $100,000 to the United Network for Organ Sharing, or UNOS. The goal was to help improve organ transportation, tracking, and shipment. Here with us today is Casey Humphries, the logistical product service line leader for UNOS, who is working to bring some of the innovations recently developed in their lab with funds from that grant to the field. Casey, welcome to Field Notes. 

Casey Humphries: Thank you so much for having me, Brad. 

Brad Puffer: Well Casey, let's start at the beginning. What is UNOS and what is its mission? 

Casey Humphries: UNOS, or the United Network for Organ Sharing, is the non-profit organization that's responsible for running the nation's transplant system under contract with the federal government. So that means we run the IT system with the algorithm that matches patients with donated organs. We also do education, quality improvement, we do research and analysis. We even develop the policies that run organ allocation with a diverse network of both professionals as well as patients and donor family volunteers. So, our mission is a life-saving transplant for everyone in need, and that is truly the foundation for every single decision, every action that we take as an organization. 

Brad Puffer: Well, we still know there are challenges to ensure that every organ gets to somebody in need, and that's one of the reasons the Fresenius Medical Care Foundation provided this grant. What were the parameters of the grant and what did you research? 

Casey Humphries: So, the Fresenius Medical Care Foundation really gave us the support that we needed to accelerate our ability to understand the logistics that go into moving those donated organs across the country. So, there were three key components to this work. 

First, there was a project, funded, that was working with organ procurement organizations, or OPOs, and their couriers to identify the key factors that drive how long an organ is outside of the body before transplant. We piloted an application to identify the possible ways to get a kidney to the accepting hospital in the fastest way possible. And then the third piece that was funded was that we developed and tested a system to actually then track these organs as they move across the country. So, it was a really sweeping grant that supported a lot of different facets around organ, travel, and transportation, and logistics.

Brad Puffer: And tell me a little more about then why this is so important, why doing this research is so important to the field of transplantation? And why is it important for nephrology? 

Casey Humphries: In 2021, the US transplant system saved a record number of lives through transplant. Over 41,000 lives were transformed because of this selfless gift, and more than half of that were kidneys, around 24,000 transplants, in kidney alone. We’re really the best transplant system in the world. But that doesn't mean that there isn't a lot of room to make ourselves more efficient and more effective, and above all more equitable. UNOS and really, the entire transplant community, are really driven by self-evaluation and a commitment to improvement, because that means that there are more lives impacted by transplant. And one of the things that we identified as a real place for improvement is logistics. We know a lot about the processes around organ procurement. You know, we're the experts in organ allocation. We run that allocation system. We know a lot about the outcomes of these transplants. But in-between, how those organs move from A to B is a space that's largely managed by individual OPOs, individual transplant centers, and so there isn't a system level visibility into what's working, what isn't, and where we can improve within logistics. Medical technology is changing and improving, and it allows organs more time outside of the body. Transportation options are growing, there's of course commercial and charter flights, but now there's drones and other types of unmanned aerial vehicles and all sorts of stuff. Kidneys are moving longer distances and they largely move via commercial air, and so we really want to understand the space and help decrease the cold time on organs and especially kidneys, and so we can get them to patients in the most efficient and equitable way possible. 

Brad Puffer: Talk to me a little more about that cold time you mentioned, because that's really critical for an organ being successful for transplantation, correct? How do you measure that? And why is that so important? 

Casey Humphries: So cold time, Cold Ischemic Time, CIT, that's the amount of time that an organ can be kept cold outside of the body and still be viable for transplant. Each organ has a different allowable cold time. Kidneys have the most generous cold time, 24 to 36 hours possible outside of the body, while the most time-restricted is heart, which only has 4 to 6 hours. So, all the other organs can fall in between those two. I mentioned there's all these medical technologies that are coming to the market: technologies like perfusion that can keep an organ at body temperature for longer periods of time outside of the body. Cold time is still very much a key factor in evaluating your travel options, and along with many other factors, clinical factors, is a part of the decision whether to accept an organ for a patient. There's evidence that shorter cold times on an organ result in better outcomes for the recipient. And so, we really want to do everything we can to decrease that cold time and to understand the contributors to that cold time. 

Brad Puffer: And I understand some of the research that you did with this grant funding looked specifically at that issue. What did you learn? 

Casey Humphries: This is really exciting work for us because it's long been assumed that longer travel distances mean longer cold ischemic time. But we also want to get the best organ possible to the most urgently ill patient, no matter where they're located. So, we really want to tease out those drivers of cold time so that we can find ways to improve it. So, we worked with OPOs, those organ procurement organizations, and their courier services to identify the various points in the timeline of procuring, and then moving and then transplanting kidneys. We looked at almost 350 kidney shipments and the really fascinating thing that came out of this research was that transit time was not the primary driver of cold time. Not like we previously thought. The times spent on those procurement processes and then out at the receiving transplant center on the other end of that kind of continuum—those were more impactful on cold time than the actual transit time. And that was regardless of whether the organ was driven or flown. So, it's really challenging us to think differently about where there's room to improve cold times, really looking at those bookends if you will, and finding opportunities for improvement. 

Brad Puffer: You know, the equitable access to transplant is certainly one of your main focuses, and so I'm curious how the research you've done has improved the availability and accessibility to transplantation, or how you hope it will? 

Casey Humphries: We want to be introspective. We really want to look at ourselves and our system critically. We want to find ways to improve so that we can save more lives through transplant. Finding that transit time isn't the key driver to cold time and kidneys means that we can really lean towards moving kidneys further, and we can challenge ourselves to think about the system differently and ensure that they get to the patient in most need, so that equitable access piece. And we've really kind of opened the doors to drive that discussion and really pushed us towards, how far can we safely move an organ, and then where else can we improve? Because transit time is not that key driver.

Brad Puffer: Now I heard that some of the other grant funds were used to develop a new application for smartphones and tablets that will help hospitals locate and transfer organs. How exactly does that application function and how has it helped improve organ transport? 

Casey Humphries: So, we call it the Travel app and that's a bit of a misnomer, because right now it's more of a tool and less of a cell phone app. But we are working on bringing the tool to our systems, which have an app format. We've likened the Travel app to an Expedia for transplant because it's a tool that OPOs can use to look up all of the routes from an origin. So that could be where you recovered the organ, or it could be the OPO itself to the receiving hospital. So, I, the OPO, would go in and put in where we're beginning, where our destination is, any other key parameters like, I don't want any connecting flights, or I need one hour at the airport before we, from arrival to the time that it gets loaded onto the flight because of requirements of my courier or requirements of the airline. And then, really hit go and then it'll populate using information from Microsoft and information from a flight database provider. It'll pull drive time, actually, live drive time to the airport from your origin and it will connect to all of the options for flight to get you to the destination and then gives you an estimated drive time on the other end and really compile a master route, master itinerary. We give you all of your options, including direct drive, your direct drive time. 

Brad Puffer: It's great to see how all the technology that we've come to depend on for smartphones and travel, it's all coming to help innovate transportation for kidneys and other organs as well. Really fascinating. I understand you've also developed a tracking service that can then track the movement of organs in real time. Can you speak more to that and how it works? And does it integrate with the travel app as well? 

Casey Humphries: So, a large portion of the fund that contributed to this work went towards the organ tracking pilot. What we did is we worked with a variety of tracking partners and several OPOs in the community, to really deploy tracking technology. There's a lot of ins and outs of it. There are different types of tracking technologies, different types of trackers. And there's different ways that we could deploy tracking, and we didn't know what exactly it would look like. So, we got a lot of folks to the table, started just sending devices out to Organ Procurement Organizations… where do you attach the tracker, what data do we need to see? And we worked with those OPOs to really build out the needs of a tracking system. And then we did focus groups with additional OPOs and transplant hospitals to get additional needs altogether identified that we needed to integrate a tracking solution into the system we already have, to package and label organs and then to allocate those organs. And so, we built this integrated organ tracking solution and brought on several OPOs to test that with us. And I think one of the exciting things about it is just having that transparency and visibility into what happens to the organ once it leaves your OPO. And, until it arrives to the transplant center it can pass many hands. You have couriers, you have airlines. I mentioned earlier, particularly for kidneys, they travel commercial. You know, imagine taking your luggage to an airport and leaving it there and you take another route. You go separate from your luggage and you just assume that your luggage is arriving at your destination, right? That's kind of what we're doing with organs. They're being separated, and there are processes in place to protect and watch those organs. However, having a tracker on that box really gives peace of mind that they can look at any given point and know that yes, it did make its flight, yes, it's at the connecting airport, yes, it's at its destination, you know, so it's been fun to kind of bring this to the system because prior to this funding, there wasn't really a system level solution to track organs. 

Brad Puffer: And are you seeing some success stories now that you have this implemented, now that it's working? Any stories or anecdotes that you can tell that really drive home the impact? 

Casey Humphries: One instance where it was identified, because we had a tracker on the box, it was identified that the courier had, I guess, had been sent to an additional pick up inadvertently, and so they were going the opposite direction of the airport and there was a pretty limited amount of time before that flight was taking off. They really did get kind of the next flight out to move that organ across the US. Because there was real time tracking on that organ, they were able to call the courier and get the driver turned around, and they were able to get to the airport to then get it loaded successfully on the flight, shipped to the receiving hospital and then it was successfully transplanted. So, by the end of the pilot, we had tracked I think a little over 730 or so organs and at this point now that it's in the hands of more OPOs, we've tracked over 2000 organs. You know, we've really heard that peace of mind, and that transparency and visibility is just so important for members of the community, so that they know that organ is getting to the patient who needs it. 

Brad Puffer: And every one of these, right, that gets to that patient in time is a life saved and had it been delayed, who knows if that would have been a successful transplant or not? Really, really great to hear the direct impact of your work. I'd love to just close and hear, what are your thoughts about the future of transplantation and the impact of this research and some of the other research that you've been working on? How optimistic are you that the future will only get better for improving transplantation? 

Casey Humphries: I'm always optimistic about how our community takes data and then uses it to drive processes and policies and decision-making to make the system better. We have a lot of learnings from these efforts and there's a lot more to learn. And, we have this organ tracking solution and we have the travel app that we're now working to fully integrate into our system. Some of the things that we learned through the course of developing the travel app and some of the things we've learned in the “Understanding CIT Project,” we're now working with airlines. We're starting to have those conversations with them, with charter companies, with really data driven conversations to identify other ways that we can all work together to get organs to the patients who need them the most in the most efficient, effective, most timely way possible. The future is really bright for these collaborations and how we can all work together to really make a huge impact on patients across the country. 

Brad Puffer: Well Casey, your research is fascinating. I certainly learned a lot, and I wish you all the best as you bring some of these innovations into action and really make an impact to improve transplantation. Thank you so much for taking the time today. And to our audience, thank you for joining us. Please know your feedback is always welcome. If you have comments on today's episode, topics of interest to you or speakers you want to hear from, let us know by clicking the feedback link featured on the Field Notes website on FMCNA.com. And don't forget, you can find Field Notes on the Apple Store or Google Play or right here at FMCNA.com, where you can also find our Annual Medical Report and other featured articles. Until next time, I’m Brad Puffer and you've been listening to Field Notes by Fresenius Medical Care. Take care, everyone.