X-Message-Number: 6786
From: 
Date: Wed, 21 Aug 1996 14:02:57 -0400
Subject: SCI. CRYONICS transplant market

THE TRANSPLANT MARKET

For a number of fairly obvious reasons, there is a link between cryonics and
cryopreservation of organs for transplant. It is of interest therefore to
look at the potential size of the latter market.

SMALL MARKET? 

>From a narrow perspective, the market seems to be small. From the U.S.
Statistical Abstract 1993, it appears the annual number of transplants in
this country is roughly:

Kidneys 10,000
Livers 3,000
Hearts 2,000
Lungs 400
Heart/Lung 50
Cornea Grafts 40,000
Bone Grafts (mostly autologous?) 400,000

One source tells me that there are only about 5,000 individual donors who die
annually in the U.S., and in most cases the available authorized organs are
successfully harvested. (There are more kidney transplants than dead donors
because often a single kidney comes from a living, related donor.) Not many
go to waste, in spite of the very limited time window during which the organ
remains viable, and during which it must be typed, prepared, and transported,
and the donee prepared. 

(The Columbia University organ preservation solution, patented in 1994 by
Stern et al
(patent # 5,370,989) is claimed to have allowed hypothermic storage of a
baboon
heart for about 24 hours, compared to a maximum 5 hours for simple ice-bucket
storage of a human heart. A baboon lung was preserved successfully for about
22
hours, "far longer than is clinically achievable to date.")

The 5,000 donor figure means that, if the owners of a preservation technology
were to
receive $1,000 for every one of these donors, that would amount to gross
annual revenue of only about $5 million. Profits would of course be only a
fraction of that. 

And in reality the cryopreservation would not be needed in most
cases--because, as
noted above, the present system already seems to be adequate, in a sense. The
reason is that there are plenty of potential donees--people who could benefit
from a new heart or kidney or whatever--but few available donors. Therefore,
whenever an organ becomes available, it is usually easy to find a reasonably
matched donee nearby (200 miles being a common rule of thumb).

Another potential problem with cryopreserved organ banks: In the transition
period,
when you are building an organ bank, there will be pressures to use most of
them immediately rather than bank them, in those cases (most cases in this
country) where there is a nearby donee for every available organ, even if
tissue matching isn't perfect.

LARGE MARKET? 

On the other side, several considerations arise. 

1. Many person-years of life would be saved if organs could be better
matched. Rejection is becoming better controlled, but remains a problem. For
some organs, the time required to type the donors is important. If there were
a large bank of cryopreserved organs, closer matching would be much easier.

2. There are roughly 33,000 accidental deaths in the U.S. annually in the age
group
15 to 44 (presumably mostly healthy and sufficiently mature). This suggests
that the
current 5,000 annual donors could be increased considerably by a public
relations
effort. This would enlarge the market substantially.

3. With time not a consideration, donors could be located anywhere, and the
number
of available donors would be increased. 

Of course, third-world donors would pose problems of several kinds, but
perhaps those problems could be solved or mitigated. 

4. There is also a related issue which I have not seen addressed, and about
which I know very little. The donors must not only be tissue typed, but
should also be screened for disease, especially hepatitis and HIV, probably
others. I don't know how long such procedures take under high priority
conditions, but if cultures are involved they might be matters of days rather
than hours. Here again cryopreservation would solve the problem. 

5. My knowldege here is very limited, but I suspect that (a) a great many
people could benefit from lung transplants, and (b) lung donation poses more
difficulties than other types, and might benefit more from cryopreservation.

Walter Runkel died of pulmonary fibrosis, but was not a candidate for lung
transplant
probably primarily because of age. (He couldn't "ethically" compete with
younger
candidate donees.) Yet he probably had at least another decade of life
expectancy, had he had healthy lungs. 

6. As mentioned by Dr. G.M. Fahy in a recent article, the potential
transplant market
is not limited to vital organs. With large cryobanks, there could arise a
large market
for transplants that "merely" improve health or even appearance, as opposed
to saving lives. For example, women who have had mastectomies might have
breast transplants. Possibly even limbs or hands would become feasible. Such
possibilities could GREATLY enlarge the potential market.
   
7. Finally, there is another question I have not seen addressed, but which
might suggest future potential. That is transplant of glands. 

Many people, for example, have poorly functioning thyroids. Why not thyroid
trans-
plants? There may be technical reasons for the apparent neglect of this area,
but the
potential would seem to warrant considerable work by the endocrinologists.
Some glands (pineal, pituitary) might be very hard to get at, but might also
have rejuvenating effects (as might thyroid replacement).   
                                                
Robert Ettinger
Cryonics Institute
Immortalist Society                               


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