Cost and Future of Mechanical Organs as a replacement of human organs
Introduction
Human organ transplantation is the best treatment for the end-stage diseases. However, there are not enough donors available. For example, in 1999, there were only 2733 donor hearts available worldwide, a much lower figure than the 4000 patients in the United States alone waiting for heart transplantation (Briscoe, 2003). Therefore, the implantable or non-implantable mechanical devices worked as a human organ are more practical. Left ventricular assist device (LVAD) as hear, mechanic ventilator (MV) as lung, and hemodialysis as kidney are the three most popular mechanical devices as replacement of human organs discussed in our topic.
Human Cost
In human cost, we will talk about decreased quality of life, mortality, morbidity and adverse effects. Patients with mechanical medical device support usually have decreased quality of life. Prolonged hospitalization, generalized weakness and fatigue due to illness, feeling of burden, avoiding from social life and damaged self-image such as AV fistula exposed on the arm for dialysis are the general concerns for those patients. In addition, side effects from the medical device also substantially affect the patients’ quality of life, even cause death.
Rose (2001) indicated in their study that serious adverse events occurred in LVAD group about twice as frequently as they did in the medical standard of care group. Infection, bleeding, and LVAD malfunction caused most deaths. Device infection rate at 3 months was 28%, and device failure rate at 2 years was 35%. By contrast, the major cause of death in the medical standard of care group was heart failure.
Ventilator-associated pneumonia (VAP) remains a challenge in the care of critically ill patients. In addition to occurring frequently, VAP is associated with attributable mortality rates that approach to 30%. Moreover, VAP prolongs both the duration of the mechanical ventilation and intensive care unit (ICU) length of stay (American Thoracic Society, 2005).
Patient with acute renal failure requiring dialysis have high mortality and morbidity. Especially the first year mortality in patients initiating dialysis remains high. Besides, some side effects may occur such as infection and clotting of the access (fistula or graft), low blood pressure, dizziness, nausea and vomitting due to too much fluid removal and muscle cramps.
Financial Cost
Generally speaking, mechanic organs as replacement of human organs are expensive. Besides the cost of mechanical device itself, the cost of other maintaining expenses such as the hospitalization, medications and treatment for adverse effects are also a large amount.
Recent studies suggest that a case of VAP costs approximately $40,000 (Warren, 2003). The cost of implanting the LVAD in 10,000 patients is approximately $ 1 billion. But solving the problem of pump housing infection could reduce costs by 50 % (Barclay, 2003).
Komenda (2010) studied a locally delivered home dialysis program in British Columbia, Canada that covered 122 patients and reported the total comprehensive costs per patients-incorporating start-up, home, in-center dialysis, medications, home remodeling, and consumables-was $59,179 for years 2004-2005 and $48,648 for 2005-2006.
Even replacing human organs with mechanical medical support is costly, considering life saving and prolonged life support, “it seems trivial compared with the $ 11 billion annually spent for ice cream for Europe or $ 12 billion spent for perfume in Europe and the United States. “ (Barclay, 2003)
Future of Mechanical Organ Replacement
The ultimate goal of mechanical device as human organ replacement research is to develop a smaller, portable and simple to be maintained system for long-term use in the non-hospital setting.
The use of mechanical cardiac support (MCS) in the 1980s and 1990s has been limited primarily to temporary bridging to patients waiting for cardiac transplantation. Perhaps the most exciting potential application of currently existing technology is what was referred to “destination therapy”. In the coming decade, it is likely MCS devices will be used as a permanent treatment for subgroups of patients with the heart failure. “As the technology is this field improves, it is entirely possible that LVAD will evolve into small, unobtrusive devices that will run on small, portable, long-lasting battery supplies that will not require external connection to the outside.” (Mann,1998).
Human organ transplantation is the best treatment for the end-stage diseases. However, there are not enough donors available. For example, in 1999, there were only 2733 donor hearts available worldwide, a much lower figure than the 4000 patients in the United States alone waiting for heart transplantation (Briscoe, 2003). Therefore, the implantable or non-implantable mechanical devices worked as a human organ are more practical. Left ventricular assist device (LVAD) as hear, mechanic ventilator (MV) as lung, and hemodialysis as kidney are the three most popular mechanical devices as replacement of human organs discussed in our topic.
Human Cost
In human cost, we will talk about decreased quality of life, mortality, morbidity and adverse effects. Patients with mechanical medical device support usually have decreased quality of life. Prolonged hospitalization, generalized weakness and fatigue due to illness, feeling of burden, avoiding from social life and damaged self-image such as AV fistula exposed on the arm for dialysis are the general concerns for those patients. In addition, side effects from the medical device also substantially affect the patients’ quality of life, even cause death.
Rose (2001) indicated in their study that serious adverse events occurred in LVAD group about twice as frequently as they did in the medical standard of care group. Infection, bleeding, and LVAD malfunction caused most deaths. Device infection rate at 3 months was 28%, and device failure rate at 2 years was 35%. By contrast, the major cause of death in the medical standard of care group was heart failure.
Ventilator-associated pneumonia (VAP) remains a challenge in the care of critically ill patients. In addition to occurring frequently, VAP is associated with attributable mortality rates that approach to 30%. Moreover, VAP prolongs both the duration of the mechanical ventilation and intensive care unit (ICU) length of stay (American Thoracic Society, 2005).
Patient with acute renal failure requiring dialysis have high mortality and morbidity. Especially the first year mortality in patients initiating dialysis remains high. Besides, some side effects may occur such as infection and clotting of the access (fistula or graft), low blood pressure, dizziness, nausea and vomitting due to too much fluid removal and muscle cramps.
Financial Cost
Generally speaking, mechanic organs as replacement of human organs are expensive. Besides the cost of mechanical device itself, the cost of other maintaining expenses such as the hospitalization, medications and treatment for adverse effects are also a large amount.
Recent studies suggest that a case of VAP costs approximately $40,000 (Warren, 2003). The cost of implanting the LVAD in 10,000 patients is approximately $ 1 billion. But solving the problem of pump housing infection could reduce costs by 50 % (Barclay, 2003).
Komenda (2010) studied a locally delivered home dialysis program in British Columbia, Canada that covered 122 patients and reported the total comprehensive costs per patients-incorporating start-up, home, in-center dialysis, medications, home remodeling, and consumables-was $59,179 for years 2004-2005 and $48,648 for 2005-2006.
Even replacing human organs with mechanical medical support is costly, considering life saving and prolonged life support, “it seems trivial compared with the $ 11 billion annually spent for ice cream for Europe or $ 12 billion spent for perfume in Europe and the United States. “ (Barclay, 2003)
Future of Mechanical Organ Replacement
The ultimate goal of mechanical device as human organ replacement research is to develop a smaller, portable and simple to be maintained system for long-term use in the non-hospital setting.
The use of mechanical cardiac support (MCS) in the 1980s and 1990s has been limited primarily to temporary bridging to patients waiting for cardiac transplantation. Perhaps the most exciting potential application of currently existing technology is what was referred to “destination therapy”. In the coming decade, it is likely MCS devices will be used as a permanent treatment for subgroups of patients with the heart failure. “As the technology is this field improves, it is entirely possible that LVAD will evolve into small, unobtrusive devices that will run on small, portable, long-lasting battery supplies that will not require external connection to the outside.” (Mann,1998).