(US & Canada) Dr. Stuart Knechtle, Professor of Surgery at Duke University School of Medicine, speaks with Dr. Anthony Cristillo, Digital Health Partner at Guidehouse, in a video interview about the healthcare technology space, changing existing systems specific to the organ transplant domain, the role of AI as a tool, the need for transparent data, and the benefits of accurate data.

At the outset, Knechtle shares his perspective on modernization in the organ transplant domain. He notes that the transplant community has been anxious about changing systems, thinking it might bring a halt to the operations and ultimately hurt patients.

According to Knechtle, a potential way to think about it is that change is going to be incremental. He believes that if a system is built in a way that it can be test-piloted in particular regions before country-wide rollout, it would facilitate quality assessment and ensure its functionality and benefits.

In Knechtle’s opinion, building a platform that allows testing locally would be a huge advantage. He adds that the existing IT tools are also aligned with that system.

Shedding light on the need for technological advancements, specifically in organ transplantation, he stresses the current manual system of matching donors and recipients in organ transplantation.

The process, says Knechtle, is highly repetitive for both the donor coordinator and then the on-call surgeon, who has to evaluate the quality of the organ and review the patient before accepting or rejecting that organ. In addition, there are numerous patients on the waiting list.

However, AI can analyze the concerned physician's or a transplant coordinator’s practices by accessing acceptance and evaluation data for a selected number of cases, says Knechtle. Through this, AI can review all the data on recipients and also understand the patterns based on which physicians or coordinators decide.

Addressing the critical factor of bias, Knechtle states that at times his behavior could be influenced by previous outcomes, both positive and negative. AI offers the opportunity to standardize decision-making across surgeons at a particular program and provides insights on past bad decisions, identifying space for improvement.

Therefore, Knechtle positions AI as a quality improvement tool to reduce time demands placed on surgeons and transplant coordinators to match donors and patients, for instance. He advocates that AI can tackle repetitive decision-making and behavior while providing a reliable solution, which should still be subject to a physician’s judgment.

Moving forward, Knechtle states that, through operational improvement and optimization, there could be a transparent communication tool that is accessible to families, coordinators, physicians, and insurance companies. Further, availability of consistent and transparent data is the first step to restoring trust, as there has been a trust breakdown in some sectors of the patient population.

Delving deeper, Knechtle states that these tools could be a huge advantage in reducing organ discard rates in cases of challenging decision-making regarding non-ideal donors. For instance, if the organ offered is not young and perfect but is good enough to keep a patient off dialysis for several years.

In such a scenario, having accurate data in the system could help identify patients who, under the current allocation scheme, cannot get a better organ. Knechtle adds that it could also educate on that front so that they do not refuse to get the kidney, and the surgeon would know that the kidney is the best bet for the patient. In conclusion, he says that this type of granular and finessed data would enable informed decision-making while educating both the surgeon and the patient.

Stuart J. Knechtle, M.D. is the William R. Kenan, Jr. Professor of Surgery at Duke University School of Medicine and serves as Executive Director of the Duke Transplant Center. He graduated from Princeton University with honors in biochemistry and attended Weill Cornell University School of Medicine for his medical degree. He trained in general surgery at Duke under Dr. David Sabiston, and in transplant surgery at the University of Wisconsin under Dr. Folkert Belzer. He was the inaugural Ray D. Owen Professor of Surgery at the University of Wisconsin and Chief of Liver Transplant. He subsequently moved to Emory University, serving as Transplant Division Chief and Chief of Transplant at Children’s Healthcare of Atlanta. He returned to Duke in 2015, and his research, NIH-funded for over 30 years, studies B cell immunity in transplantation. He is co-editor of Kidney Transplantation: Principles and Practice, and serves on the editorial boards of Annals of Surgery, Frontiers in Transplantation, and as Co-Editor-in-Chief of Transplantation Reviews.

CDO Magazine appreciates Stuart Knechtle for sharing his insights with our global community.

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