Tony Pucciarella and Ryan Henderson (foreground) of the University of Maryland Unmanned Aircraft Systems Test Site attach the donor kidney payload box to the LG1000 c-drone before the flight. The small screen on the box is part of the HOMAL system, which measures and transmits data about the organ's health. Image: UMMC

University of Maryland flies donor kidney by c-drone to transplant patient

Logistics • freight • delivery

In a groundbreaking flight [video], the University of Maryland (UMD) Unmanned Aircraft Systems (UAS) Test Site flew a donor kidney by c-drone, autonomously by Extended Visual Line of Sight (EVLOS), 2.7mi (4.4km) from Baltimore’s St. Agnes Hospital to the University of Maryland Medical Center (UMMC), where the organ was successfully transplanted into a patient four hours later.

The ten-minute flight took place at about 1:00AM on April 19. The custom built c-drone, equipped with a wireless biosensor transmitting the organ’s health status, flew itself along predefined waypoints at 300ft (91m) altitude, mostly over streets, on a path designed to avoid flying over buildings and people. Remote pilots Ryan Henderson, at the donor hospital, and Joshua Gaus, at the UMMC, carefully monitored the flight, ready to assume manual control in case of incident. Baltimore police temporarily closed some streets as a further precaution until the drone landed on one of the hospital’s rooftop helipads. The patient, 44-year-old Trina Glispy of Baltimore, had spent eight years on dialysis waiting for an available donor kidney. She was discharged from the hospital on April 24, saying: “This whole thing is amazing. Years ago, this was not something that you would think about.”

This was a proof-of-concept test flight three years in the making; regular delivery of donor organs by drone is not planned at this time. However, following extensive development and testing, the UMD medical and engineering staff believe this flight has made an important contribution to understanding how such transport services might work in the near future. Transplant physicians and researchers at UMD’s schools worked with the Federal Aviation Administration (FAA), The Living Legacy Foundation of Maryland, startup AlarisPro LLC, General Electric Aviation unit AiRXOS, Baltimore city police, Excella Co., and Maryland Development Center. Several innovations were cited by the participating organizations, particularly the extensive technical and procedural precautions taken to avoid loss of the organ in case of drone mechanical failure or loss of communications, the realtime tracking of the organ’s position and temperature via a biometric sensor linked to a smartphone app, and the autonomous flight over a downtown urban area.

The project was led by Dr Joseph R. Scalea, Assistant Professor of Surgery at the University of Maryland School of Medicine (UMSOM), one of the surgeons who performed the transplant at UMMC, who received a TEDCO Maryland Innovation Initiative (MII) grant for incubator funds to support the project. Dr Scalea said:

As a result of the outstanding collaboration among surgeons, the Federal Aviation Administration, engineers, organ procurement specialists, pilots, nurses and, ultimately, the patient, we were able to make a pioneering breakthrough in transplantation… This was a complex process. We were successful because of the dedication of all of the people involved over a long period of time.

There remains a woeful disparity between the number of recipients on the organ transplant waiting list and the total number of transplantable organs. This new technology has the potential to help widen the donor organ pool and access to transplantation. Delivering an organ from a donor to a patient is a sacred duty with many moving parts. It is critical that we find ways of doing this better.

According to the most recent data from the United Network for Organ Sharing (UNOS), which manages the organ transplant system in the United States:

  • Nearly 114,000 people were on waiting lists for an organ transplant
  • 36,500 transplants were performed
  • Nearly 30,000 organs came from deceased donors
  • About 1.5% of deceased donor organ shipments did not make it to the intended destination
  • Nearly 4% of shipments experienced an unanticipated delay of two or more hours

It is critical for donated organs to be transported as quickly as possible to a recipient; doctors speak of the cold ischemia time or CIT, the time between the chilling of a tissue, organ, or body part after its blood supply has been reduced or stopped and the time it is warmed by restoring a blood supply. French researchers found in 2015 that a kidney with a CIT of 30 hours had a significant 40% higher risk of graft failure and 53% higher risk of death than patients who received a kidney with a CIT of 6 hours. This often means quickly arranging transport logistics, such as next-available commercial flights or expensive chartered flights; rural communities far from airports are underserved both for donors and recipients. Dr. Scalea believes fixed-wing drones will eventually fill that gap, reliably transporting donor organs while transmitting organ viability data in realtime.

The custom-built c-drone, dubbed the LG1000, was designed by UMD UAS Test Site researchers with a number of safeguards meant to protect the precious but bulky medical payload of up to 9.7lb (4.4kg), a styrofoam cooler packed with ice holding a specially designed sleeve container for the organ, connected to the separately powered transmitting biosensor. The octocopter is based on a Gryphon Dynamics x8 airframe with redundant power supply, electronic speed controls, and propulsion. The Inertial Measurement Unit (IMU) has triple redundant sensors to insure safe flight. The command and control communications link is also redundant; the primary system is a Silvus Technologies mesh network radio, secondary is a long-range UHF system by Dragon Link. In case of massive failure of the redundant systems in-flight, a Fruity Chutes Harrier spring-actuated parachute is installed atop the drone to insure a soft landing. An onboard camera was trained on the payload during flight. Waypoints were programmed with the Ardupilot open source autopilot. AlarisPro software monitored individual drone components, the overall system, and operational reliability throughout the flight. GE Aviation’s AiRXOS provided its Air Mobility Platform, an Unmanned aircraft Traffic Management (UTM) operations suite which integrates drone flights with manned aircraft at low altitudes, signaling obstacles and monitoring c-drone telemetry and communications.

Matthew Scassero, Director of UMD UAS Test Site, part of the Clark School of Engineering, said:

We had to create a new system that was still within the regulatory structure of the FAA, but also capable of carrying the additional weight of the organ, cameras, and organ tracking, communications and safety systems over an urban, densely populated area, for a longer distance and with more endurance. There’s a tremendous amount of pressure knowing there’s a person waiting for that organ, but it’s also a special privilege to be a part of this critical mission.

In an interview last week at the Association for Unmanned Vehicle Systems International (AUVSI) Xponential industry show in Chicago where the custom-built c-drone with its large box payload was on display, Ryan Henderson, chief UAS Pilot at the UMD UAS Test Site, said:

This is a groundbreaking project, not only for unmanned aircraft, but for transplant recipients. This will add thousands of life-hours to the people who will benefit from unmanned organ-transplant delivery.

Anthony Pucciarella, founder and CEO of startup AlarisPro LLC and director of operations at UMD UAS Test Site, said:

We built in a lot of redundancies, because we want to do everything possible to protect the payload. AlarisPro was developed for exactly these types of missions where risk mitigation is critical. Our team at AlarisPro is committed to bringing the safety culture present in manned aviation into the UAS industry. What better way to illustrate this commitment than with a lifesaving event like this?

Perhaps the most innovative technology used in the flight was the HOMAL or Human Organ Monitoring and Quality Assurance Apparatus for Long-Distance Travel, a “smart” sleeve for transporting an organ. The LG1000’s payload box is a passive system; there is no active cooling. Dr Scalea worked with Maryland Development Center to develop a biometric sensor which measures temperature, barometric pressure, altitude, vibrations and GPS location during transportation, transmitting data over the cellular phone network in realtime to a smartphone app developed by Excella Co. which allows a doctor to track and monitor the organ en route. The HOMAL is attached to the payload, not the drone, and as a separate system does not depend upon or interfere with the c-drone’s power or electronics.

Dr. Scalea, who founded a private data analytics company, Transplant Logistics and Informatics, to develop and patent the HOMAL system, said:

When we started this project, I quickly realized there were a number of unmet needs in organ transport. For example, there is currently no way to track an organ’s location and health while in transit. Even in our modern era, human organs are unmonitored during flight. I found this to be unacceptable. Real-time organ monitoring is mission-critical to this experience.

My vision is that you as a doctor will be able, from your own smartphone, to accept your organ and have that data transferred seamlessly to an unmanned aircraft provider who will move that organ from point A to point B anywhere in the United States. That’s my vision for the future.

Projects such as Zipline’s networks in Rwanda and Ghana, UNICEF Innovation’s projects in Malawi and Vanuatu, and Matternet in Switzerland and now in North Carolina have pioneered fast and reliable transport of medical samples, vaccines and blood. However, none of these projects have realtime tracking of payload temperature, barometric pressure and vibrations, variables which can affect an organ’s viability for transplant.