When we’ll be able to 3D-print organs and who will be able to afford them | CNN

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What if doctors could just print a kidney, using cells from the patient, instead of having to find a donor match and hope the patient’s body doesn’t reject the transplanted kidney?

The soonest that could happen is in a decade, thanks to 3D organ bioprinting, said Jennifer Lewis, a professor at Harvard University’s Wyss Institute for Biologically Inspired Engineering. Organ bioprinting is the use of 3D-printing technologies to assemble multiple cell types, growth factors and biomaterials in a layer-by-layer fashion to produce bioartificial organs that ideally imitate their natural counterparts, according to a 2019 study.

This type of regenerative medicine is in the development stage, and the driving force behind this innovation is “real human need,” Lewis said.

In the United States, there are 106,800 men, women and children on the national organ transplant waiting list as of March 8, 2023, according to the Health Resources & Services Administration. However, living donors provide only around 6,000 organs per year on average, and there are about 8,000 deceased donors annually who each provide 3.5 organs on average.

The cause of this discrepancy is “a combination of people who undergo catastrophic health events, but their organs aren’t high enough quality to donate, or they’re not on the organ donor list to begin with, and the fact that it’s actually very difficult to find a good match” so the patient’s body doesn’t reject the transplanted organ, Lewis said.

And even though living donors are an option, “to do surgery on someone who doesn’t need it” is a big risk, said Dr. Anthony Atala, director of the Wake Forest Institute for Regenerative Medicine. “So, living related donors are usually not the preferred way to go because then you’re taking an organ away from somebody else who may need it, especially now as we age longer.”

Atala and his colleagues were responsible for growing human bladders in a lab by hand in 2006, and implanting a complicated internal organ into people for the first time — saving the lives of three children in whom they implanted the bladders.

Every day, 17 people die waiting for an organ transplant, according to the Health Resources & Services Administration. And every 10 minutes, another person is added to the waitlist, the agency says. More than 90% of the people on the transplant list in 2021 needed a kidney.

“About a million people worldwide are in need of a kidney. So they have end-stage renal failure, and they have to go on dialysis,” Lewis said. “Once you go on dialysis, you have essentially five years to live, and every year, your mortality rate increases by 15%. Dialysis is very hard on your body. So this is really motivating to take on this grand challenge of printing organs.”

“Anti-hypertensive pills are not scarce. Everybody who needs them can get them,” Martine Rothblatt, CEO and chairman of United Therapeutics, said in June 2022 at the Life Itself conference, a health and wellness event presented in partnership with CNN. United Therapeutics was one of the conference sponsors.

“There is no practical reason why anybody who needs a kidney — or a lung, a heart, a liver — should not be able to get one,” she added. “We’re using technology to solve this problem.”

To begin the process of bioprinting an organ, doctors typically start with a patient’s own cells. They take a small needle biopsy of an organ or do a minimally invasive surgical procedure that removes a small piece of tissue, “less than half the size of a postage stamp,” Atala said. “By taking this small piece of tissue, we are able to tease cells apart (and) we grow and expand the cells outside the body.”

This growth happens inside a sterile incubator or bioreactor, a pressurized stainless steel vessel that helps the cells stay fed with nutrients — called “media” — the doctors feed them every 24 hours, since cells have their own metabolism, Lewis said. Each cell type has a different media, and the incubator or bioreactor acts as an oven-like device mimicking the internal temperature and oxygenation of the human body, Atala said.

“Then we mix it with this gel, which is like a glue,” Atala said. “Every organ in your body has the cells and the glue that holds it together. Basically, that’s also called ‘extracellular matrix.’”

This glue is Atala’s nickname for bioink, a printable mixture of living cells, water-rich molecules called hydrogels, and the media and growth factors that help the cells continue to proliferate and differentiate, Lewis said. The hydrogels mimic the human body’s extracellular matrix, which contains substances including proteins, collagen and hyaluronic acid.

The non-cell sample portion of the glue can be made in a lab, and “is going to have the same properties of the tissue you’re trying to replace,” Atala said.

The biomaterials used typically have to be nontoxic, biodegradable and biocompatible to avoid a negative immune response, Lewis said. Collagen and gelatin are two of the most common biomaterials used for bioprinting tissues or organs.

From there, doctors load each bioink — depending on how many cell types they’re wanting to print — into a printing chamber, “using a printhead and nozzle to extrude an ink and build the material up layer by layer,” Lewis said. Creating tissue with personalized properties is enabled by printers being programmed with a patient’s imaging data from X-rays or scans, Atala said.

“With a color printer you have several different cartridges, and each cartridge is printing a different color, and you come up with your (final) color,” Atala added. Bioprinting is the same; you’re just using cells instead of traditional inks.

How long the printing process takes depends on several factors, including the organ or tissue being printed, the fineness of the resolution and the number of printheads needed, Lewis said. But it typically lasts a few to several hours. The time from the biopsy to the implantation is about four to six weeks, Atala said.

A 3D printer seeds different types of cells onto a kidney scaffold at the Wake Forest Institute for Regenerative Medicine.

The ultimate challenge is “getting the organs to actually function as they should,” so accomplishing that “is the holy grail,” Lewis said.

“Just like if you were to harvest an organ from a donor, you have to immediately get that organ into a bioreactor and start perfusing it or the cells die,” she added. To perfuse an organ is to supply it with fluid, usually blood or a blood substitute, by circulating it through blood vessels or other channels.

Depending on the organ’s complexity, there is sometimes a need to mature the tissue further in a bioreactor or further drive connections, Lewis said. “There’s just a number of plumbing issues and challenges that have to be done in order to make that printed organ actually function like a human organ would in vivo (meaning in the body). And honestly, this has not been fully solved yet.”

Once a bioprinted organ is implanted into a patient, it will naturally degrade over time — which is OK since that’s how it’s designed to work.

“You’re probably wondering, ‘Well, then what happens to the tissue? Will it fall apart?’ Actually, no,” Atala said. “These glues dissolve, and the cells sense that the bridge is giving way; they sense that they don’t have a firm footing anymore. So cells do what they do in your very own body, which is to create their own bridge and create their own glue.”

Atala and Lewis are conservative in their estimates about the number of years remaining before fully functioning bioprinted organs can be implanted into humans.

“The field’s moving fast, but I mean, I think we’re talking about a decade plus, even with all of the tremendous progress that’s been made,” Lewis said.

“I learned so many years ago never to predict because you’ll always be wrong,” Atala said. “There’s so many factors in terms of manufacturing and the (US Food and Drug Administration regulation). At the end of the day, our interest, of course, is to make sure the technologies are safe for the patient above all.”

Whenever bioprinting organs becomes an available option, affordability for patients and their caregivers shouldn’t be an issue.

They’ll be “accessible for sure,” Atala said. “The costs associated with organ failures are very high. Just to keep a patient on dialysis is over a quarter of a million dollars per year, just to keep one patient on dialysis. So, it’s a lot cheaper to create an organ that you can implant into the patient.”

The average kidney transplant cost was $442,500 in 2020, according to research published by the American Society of Nephrology — while 3D printers retail for around a few thousand dollars to upward of $100,000, depending on their complexity. But even though low-cost printers are available, pricey parts of bioprinting can include maintaining cell banks for patients, culturing cells and safely handling biological materials, Lewis said.

Some of the major costs of current organ transplantation are “harvesting the organ from the donor, the transport costs and then, of course, the surgery that the recipient goes through, and then all the care and monitoring,” Lewis said. “Some of that cost would still be in play, even if it was bioprinted.”

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Hyperkalemia: Use Good Nutritional Sense

About 3 million Americans have high potassium, or hyperkalemia, because of kidney disease, heart failure, or poorly controlled diabetes. Potassium is an important nutrient that helps your nerves and muscles, including your heart, work the right way. But if you have too much in your blood, it can be dangerous and lead to heart problems.

If you have hyperkalemia, it’s important to work closely with a nutritionist or other health professional to follow a low-potassium diet, says Courtney Barth, a registered dietitian and a nutritionist at the Cleveland Clinic. “It’s a delicate balance — while eating too much can be harmful, eating too little can cause problems, too,” she says.

What to Expect on Your First Visit to a Dietitian

If you have a condition like chronic kidney disease, your doctor will check your blood potassium levels often, usually once a month. Bring any information about your blood potassium levels to your first appointment with the nutritionist.

The levels indicate how high the potassium is:

  • 3.5-5.0 is considered the safe zone.
  • 5.1-6.0 is the caution zone.
  • Higher than 6.0 is cause for more concern.

Ideally, you want to keep your potassium level under 5, Barth says.

A nutritionist may also ask you to keep a food diary for about 3 days, says Melissa Prest, a Chicago nutritionist and spokesperson for the Academy of Nutrition and Dietetics. Healthy people should normally get 3,500-4,500 milligrams (mg) of potassium each day. A potassium-restricted diet is usually about half that, or roughly 2,000 mg per day.

Your nutritionist may also ask you to provide a list of all the medications and supplements you’re on, Prest says. Certain ones can raise potassium levels, including:

  • Blood pressure medications, such as ACE inhibitors, ARBs, and beta-blockers. Kidney patients often take these to control hypertension and help keep their kidneys working well. They also help keep kidney disease from getting worse.
  • Herbal supplements. Some, such as milkweed, lily of the valley, Siberian ginseng, hawthorn berries, preparations from dried toad skin (bufo, chan su, senso), noni juice, alfalfa, dandelion, horsetail, or nettle can raise potassium levels.
  • Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. These are common drugs used to reduce fever or treat headaches and other pain.
  • Nutritional supplements. Some nutritional supplements contain potassium. Always tell your health care provider which ones you’re taking.

How a Dietitian Can Help You

Your dietitian will help tweak your diet to lower your potassium intake. This may include:

  • Advising you about eating the right fruits and vegetables. “Oftentimes, patients tend to overly restrict foods with potassium, so as a result they don’t get enough fruits and vegetables, which are still important for overall health,” Prest says. Some good lower-potassium options include:
    • Apples
    • Apricots (canned in juice)
    • Asparagus
    • Blackberries
    • Blueberries
    • Broccoli
    • Cabbage
    • Carrots
    • Cauliflower
    • Cherries
    • Corn
    • Cucumber
    • Grapes
    • Kale
    • Lettuce
    • Mandarin oranges
    • Peaches (one small fresh or canned)
    • Pears (one small fresh or canned)
    • Pineapple (or pineapple juice)
    • Strawberries
    • Yellow or zucchini squash

Just remember that for most of these foods, a portion is a half-cup. “If you eat more than a portion or two, it can turn a low-potassium food into a higher-potassium food,” Prest says.

Fruits higher in potassium include bananas, avocados, melons, oranges, prunes, and raisins. But always check with your nutritionist before cutting out those foods, Prest says. “If your potassium levels are normal, then there’s no reason why you can’t safely eat these fruits, which are all good for you.”

  • Going for the white stuff. Surprisingly, white breads, pastas, and rice are recommended over whole-wheat varieties if you have kidney disease. This is because the more bran and whole grains in the bread, the higher the potassium. “Whole-grain products have more potassium, so they need to be limited if you have kidney disease,” Barth says. Just don’t overdo it on the starchy stuff, she says, because they can cause you to gain weight. That’s bad if your hyperkalemia is caused by a condition like chronic kidney disease, heart failure, or diabetes.
  • Helping you come up with a low-potassium meal plan. Even though you may know what you should and shouldn’t eat, it can be tricky to put it all together so that you only get about 2,000 mg of potassium a day. In general, each day you should aim for:
    • 1-3 servings of low-potassium fruit per day
    • 2-3 servings of low-potassium vegetables per day
    • 1-2 servings of low-potassium dairy like cottage, cheddar, or Swiss cheeses
    • 3-7 servings of low-potassium protein like eggs, chicken, turkey, tuna, shrimp, or unsalted peanut butter
    • 4-7 servings of low-potassium grains, like white rice

Most of these foods have less than 200 mg of potassium per serving. A dietitian can teach you how to measure portion sizes and calculate the total amount of potassium in each meal so that you stay around an average of 2,000 mg per day.

  • Teaching you how to leach your veggies. You can still enjoy higher-potassium veggies like potatoes, sweet potatoes, carrots, beets, and winter squash, Barth says, as long as you leach them. This will help pull some of the potassium out. Here’s how to do it:
    • Peel and place the vegetable in cold water.
    • Slice the vegetable an eighth of an inch thick.
    • Rinse it in warm water for a few seconds.
    • Soak it for at least 2 hours in warm water.
    • Rinse the vegetable under warm water again for a few seconds.
    • When you cook the vegetable, use five times the amount of water to the amount of vegetable.
  • Showing you how to read food labels. Ingredients are listed in order by weight, with the item of the most weight listed first. “If potassium chloride is in the ingredient list, it has a high potassium content,” Barth says. She also advises looking at the percentage of daily value. It should be less than 6%, or 200 mg, of potassium.

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