Moreover, there is a lack of transparency around the supply chains. From the time an organ enters a box to the time it comes out, there is often no way to tell where it is. “I can do better with Uber or if I order a swing for my back yard,” says Dr Scalea. He gives the example of a kidney that recently took 29 hours to reach Baltimore from Alabama (780 miles) – he could have driven there and back to collect it in less time, he points out.
The problem is getting worse and there is also a cost implication. The difference between an imported organ and one that is procured locally is on average around $50,000. Charter flights are too expensive, commercial aircraft are too slow and small aircraft at inconvenient hours are dangerous for transplant teams.
Turning to UAVs
UAVs have come on markedly in the last five years, says Dr Scalea. They can spend up to 13 days in the air without refueling and can travel at 200+ mph. There are plenty of companies, from Uber to specialist start-ups such as Blade, looking to commercialise their use.
In a medical context, there is work in Europe to look at the potential for using them to move defibrillators. A simulated study in Sweden found that on average drones carrying a defibrillator could arrive 16 minutes quicker than the emergency services.
When Dr Scalea first raised the idea of drones, he says, the reaction was that he was crazy, that the organ boxes were too big, that it was too hard and too expensive. Despite this, with a small grant, in 2018, an off-the-shelf drone from DJI was purchased. Across 14 test flights, the team monitored all of the data points that were deemed relevant to the recipient, such as atmospheric pressure and vibrations, comparing these with a plane flight.
As the results started to become known, so interest increased and more than $2 million was raised via grants and private funding in a few weeks to take the work forward. This brought together kidney doctors, surgeons, the emergency services, drone engineers and others to devise a system and device. In total, over 100 people were involved.