Enter the characters you see below Sorry, we just how Much Money Is A Kidney Worth to make sure you’re not a robot. Enter the characters you see below Sorry, we just need to make sure you’re not a robot. Get Our NewsletterWIRED’s biggest stories delivered to your inbox. Their alternatives: Find a kidney transplant or die. In the US, dialysis is a roughly 40-billion-dollar business keeping 468,000 people with end-stage renal disease alive.
The process is far from perfect, but that hasn’t hindered the industry’s growth. That’s thanks to a federally mandated Medicare entitlement that guarantees any American who needs dialysis—regardless of age or financial status—can get it, and get it paid for. The legally enshrined coverage of dialysis has doubtlessly saved thousands of lives since its enactment 45 years ago, but the procedure’s history of special treatment has also stymied innovation. Today, the US government spends about 50 times more on private dialysis companies than it does on kidney disease research to improve treatments and find new cures. We thought, if people are growing ears on the backs of mice, why can’t we grow a kidney? Now, after more than 20 years of work, one team of doctors and researchers is close to offering patients an implantable artificial kidney, a bionic device that uses the same technology that makes the chips that power your laptop and smartphone. Stacks of carefully designed silicon nanopore filters combine with live kidney cells grown in a bioreactor. The device would do more than detach dialysis patients—who experience much higher rates of fatigue, chronic pain, and depression than the average American—from a grueling treatment schedule.
It would also address a critical shortfall of organs for transplant that continues despite a recent uptick in donations. There are still plenty of regulatory hurdles ahead—human testing is scheduled to begin early next year1—but this bioartificial kidney is already bringing hope to patients desperate to unhook for good. They sort the good from the bad—a process crucial to maintaining a stable balance of bodily chemicals. Diabetes, high blood pressure, and some forms of cancers can all cause kidney damage and impair the organs’ ability to function. Which is why doctors have long been on the lookout for ways to mimic their operations outside the body.
The first successful attempt at a human artificial kidney was a feat of Rube Goldberg-ian ingenuity, necessitated in large part by wartime austerity measures. In the spring of 1940, a young Dutch doctor named Willem Kolff decamped from his university post to wait out the Nazi occupation of the Netherlands in a rural hospital on the IJssel river. In some ways, dialysis has advanced quite a bit since 1943. Vaarwel, sausage casing, hello mass-produced cellulose tubing. But its basic function has remained unchanged for more than 70 years. Not because there aren’t plenty of things to improve on. Design and manufacturing flaws make dialysis much less efficient than a real kidney at taking bad stuff out of the body and keeping the good stuff in.
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Other biological functions it can’t duplicate at all. 30,000 price tag—and it wasn’t covered by insurance. But the government accountants, unable to see the country’s coming obesity epidemic and all its attendant health problems, greatly underestimated the future need of the nation. In the decades since, the number of patients requiring dialysis has increased fiftyfold.
But Shuvo Roy, a professor in the School of Pharmacy at UC San Francisco, didn’t know any of this back in the late 1990s when he was studying how to apply his electrical engineering chops to medical devices. Fresh off his PhD and starting a new job at the Cleveland Clinic, Roy was a hammer looking for interesting problems to solve. Cardiology and neurosurgery seemed like exciting, well-funded places to do that. But the more Fissell told him about how stagnant the field of kidney research had been, how ripe dialysis was for a technological overhaul, the more interested he got. And as he familiarized himself with the machines and the engineering behind them, Roy began to realize the extent of dialysis’ limitations—and the potential for innovation. Dialysis does a decent job cleansing blood of waste products, but it also filters out good stuff: salts, sugars, amino acids. Blame the polymer manufacturing process, which can’t replicate the 7-nanometer precision of nephrons—the kidney’s natural filters.
But as he and Fissell looked around them at the advances being made in live tissue engineering, they started thinking beyond a better, smaller, faster filter. It turned out, someone had already tried. Humes figured out how to extract them from cadaver kidneys not suitable for transplant and grow them in his lab. In clinical trials at the University of Michigan Hospital, it improved the mortality rates for ICU patients with acute renal failure by half.
To work, the patient had to be permanently hooked up to half a hospital room’s worth of tubes and pumps. The first time Roy saw Humes’ set-up, he immediately recognized its promise—and its limitations. Fissell had convinced him to drive from Cleveland to Ann Arbor in the middle of a snowstorm to check it out. The trip convinced them that the technology worked.
It was just way too cumbersome for anyone to actually use it. It performs the vast majority of the biological functions of the natural kidney. In 2000, Fissell joined Humes to do his nephrology fellowship at Michigan. Roy stayed at the Cleveland Clinic to work on cardiac medical devices.
But for the next three years, nearly every Thursday afternoon Fissell hopped in his car and drove three hours east on I-90 to spend long weekends in Roy’s lab tackling a quintessentially 21st century engineering problem: miniaturization. They had no money, and no employees. The silicon filters had another advantage, too. Because Roy and Fissell wanted to create a small implantable device, they needed a way to make sure there wasn’t an immune response—similar to transplant rejection.
Stacks of silicon filters could act as a screen to keep the body’s immune cells physically separated from Humes’ kidney cells which would be embedded in a microscopic scaffold on the other side. 3 million grant from the NIH to prove the concept of their implantable bioartificial kidney in an animal model. 15 million, enough to take the project through human clinical trials. Roy moved out west to UCSF to be closer to the semiconductor manufacturing expertise in the Bay Area. By then though, their kidney project had taken on a following of its own. Patients from all over the world wanted to see it succeed.