Improving the U.S. Organ Transplant System with Hybrid Cloud

Lifesaving gifts from more than 18,000 organ donors in the United States in 2020 resulted in 39,035 transplants being performed — the second-highest annual total even in the midst of COVID. While we have the best transplant system in the world, more than 100,000 patients are waiting for an organ transplant at any given time.

Making the transplant system even more efficient to help shrink this gap between supply and demand seemed like a formidable task even before the COVID-19 pandemic hit the healthcare system. All of this hasn’t daunted the United Network for Organ Sharing (UNOS) because they built a modern IT operation that’s rising to the challenges.

In an interview with The Forecast, UNOS explained how they built a hybrid cloud IT environment to reliably deliver computing performance and scalability to meet their mission.

“Our mission is to make the organ matching process as seamless, efficient and effective as possible,” said Alex Tulchinsky, Chief Technology Officer at UNOS. “Technology alone is not enough but it’s a vital enabler as lives truly depend on our system running 24/7.”

Contracted by the federal government, UNOS uses cutting-edge private and public cloud technologies, artificial intelligence and machine learning to manage the U.S. organ transplant and donation process, including the national transplant waiting list. UNOS uses technologies to help organ procurement teams match donors with the right recipients, sifting and sorting through data from medical teams, donors and patients.

“So many factors come into play,” said Tulchinsky. “The better the match, the greater the likelihood of a transplant adding years to somebody’s life.”

Their IT systems maintain transplant data stretching back more than three decades. Leveraging this data, computing algorithms based on organ allocation policies help make the best use of the limited supply of organs, giving all patients a fair chance at receiving the organ they need. On top of that, UNOS convenes the organ donation and transplantation community to test and implement innovative ways to continue to improve the system and transplant more organs. As long as people are on the waiting list, the organization is committed to doing all it can to achieve its vision of a lifesaving transplant for everyone in need.

Invisible, Accessible Technologies

Tulchinsky and Tiwan Nicholson, director of IT service operations at UNOS, explained the advantages of hyperconverged infrastructure (HCI), which virtualizes compute, storage and networking so their IT systems operate like a private cloud. HCI enables UNOS to quickly scale up or down computing resources, and leverage public cloud services like AWS, Azure or other providers when more resources are needed.

“We want to be always-on,” said Tulchinsky. “Hybrid is the way forward for us to ensure continuous operation. If on-prem does not work, we can go to the cloud. If the public cloud is not available, then private cloud is an option — or some form of a hybrid.”

The incessant need for computing brings with it plenty of technical hurdles, according to Nicholson. That’s where software-defined IT infrastructure comes into play.

UNOS systems are on all the time, handling tens to hundreds of thousands of transactions weekly.  Driven by donor availability, organ matching is executed on-demand by procurement professionals thousands of times every month. 

“Our transplant system is resource-intensive,” said Nicholson. 

“Organ allocation algorithms are very complex, so performance and resource availability are key. The ability to scale is very, very important. We need to be able to grow as transplant volume grows. And we need to be able to do that without a huge forklift or impact to transplant professionals who rely on UNet to be there.”

Understanding the Transplant Chain of Events

As of March 2021, the national transplant waiting list contained the names of nearly 108,000 patients with their relevant health data, including blood type, body size, physical location, lab scores and when the patient joined the list. When deceased donor organs become available, medical teams at organ procurement organizations (OPOs) use UNOS’ computer system (UNet) to identify suitable matches. 

Next, they make electronic organ offers through UNet to hospitals of the transplant candidates at the top of the computer-generated match list until the organ is accepted. They also schedule recovery operations and handle the logistics of delivering the donated organs.

Things have changed a lot compared to seven or eight years ago, according to Tulchinsky. 

“Back in those days, about 80 people got a transplant every day,” he recalled. “Now, we’re over 110 patients getting transplants every single day.” 

Nicholson sees how technology is helping, but there’s more work to do.

“We stand at the intersection of tragedy and hope, and it’s a huge responsibility and calling for us,” said Nicholson. “Getting to use technology to help people extend their lives or expand their quality of life motivates us all.”

Experiencing Cloud Technology Evolution

Managing the national transplant system is the latest phase in the long careers of UNOS’s tech leadership. 

Tulchinsky got into IT in 1980, at the dawn of personal computing. Nicholson started his IT career in the mid-1990s, just as the internet revolution started to pick up speed. Both have noted the remarkable changes over their careers. 

Tulchinsky was an IT leader in an early-1990s incarnation of America Online (AOL), the pioneering online community “… which for all intents and purposes was a very early version of the Internet,” he said. 

Holding up his smartphone he said, “The horsepower of the entire AOL plant was much smaller than what it is in this phone today.”

He said the evolution of online technologies accelerated in the past half-decade. Web services and APIs now allow speed, flexibility and scale unheard of earlier in his career. An application programming interface (API), allows disparate systems and applications to share data. For instance, software from Microsoft can share data with apps from Amazon, Salesforce, Oracle and other tech mainstays. Meanwhile, cloud-hosted software-as-a-service offerings use APIs to communicate with software of pretty much any size.

It's not just about gathering and processing data anymore, said Tulchinsky. It’s about putting data to its best use. 

“Data is the means to the end — not the end result itself,” he said. “That's why, for me, APIs have been transformative.” 

Nicholson points to the dramatic improvements in virtualization, which replicates the operations of computers and networking gear. In its early years, virtualization traded convenience for performance. Nothing compared to the speed and power of bare-metal servers. But Nicholson saw for himself that things had changed in the past few years. Skeptics would ask him if virtualization had grown enough to outperform a bare-metal environment.     

"Oh, yeah, it can,” he reassured them. “The technology has advanced just that much."

Even in an IT environment that requires healthcare-stringent security measures to protect patient data, Nicholos said the performance of UNOS’s highly virtualized hybrid cloud IT system amazes his team. 

“I've seen jaws drop when they see the speed that Nutanix brings to resource-intensive applications,” he said. “We're seeing 30% improvement on laborious workloads compared with the previous infrastructure, where some of our big data and deep analytics jobs took days.”

UNOS Taps the Value of Hyperconverged Infrastructure

The UNOS IT team began working with enterprise software company Nutanix to implement HCI nearly three years ago. The software allows them to manage data center operations through a single dashboard, automate the configuration of new virtual machines, allocate storage and handle other tasks that were once time-consuming if done manually.

UNOS’s biggest job — organ-patient matchmaking — puts such a huge load on IT systems that every opportunity to speed things along creates benefits that cascade through the transplant process. One example: It used to take more time to deliver analytics reports that transplant teams depended upon. 

“Because we're using technology like Nutanix, as well as others in combination, we're now built to deliver those analytics and reports much sooner, closere to whene the transactitons took place,” Tulchinsky said.

Nicholson added that simplified data center infrastructure also eases the demand for specific skills. 

“Now, our generalist infrastructure engineers can manage the hardware layer and virtualization layer without the specialized skills needed for a dedicated big data, database or blade server and all those different layers of the stack that we used to have to manage,” he said.

No one spends all day staring at a network dashboard anymore. 

“Our dashboard gives the information we need to make quick decisions, so we can move into higher-value work for the organization and the transplant community,” said Nicholson.

Another major priority is data security. UNOS maintains data for every transplant performed since 1988, so his team must balance security with performance as they leverage private and public cloud resources.

“This is protected health information,” said Nicholson. “As stewards of that data, we want to make sure that we put in the right measures to protect it, so we'll always have some on-premises element to our infrastructure.”

A Plea for Those Waiting for a Chance at Life

“UNOS has truly been able to harness technology innovation to support its mission and deliver a transplant system that minimizes the time transplant professionals spend on entering and managing data, and maximize the time spent on helping patients,” said Cheryl Rodenfels, Healthcare Strategist at Nutanix. 

“Not only this, they have been able to look at technology opportunities and find ways, with Nutanix and other partners, to maximize their existing resources so the UNOS team can spend more time on increasing equity and the number of transplants to help address the donor shortage in the country.”

Technologies are helping and ready to handle more donors.

“The biggest problem is that there simply are not enough organ donors,” Nicholson said. “So, there's something every single one of us can do. Go to unos.org, learn about transplantation. Register to be an organ donor. That's what we're here for — to save those 100,000 lives. We can build the greatest transplant system in the world, but until we get more people willing to donate organs, we won't move that needle where we need to move it.”

Tulchinsky said his IT team is very proud of what they've accomplished. 

“But we don't stop and celebrate because we know it's a never-ending journey,” he said. 

“There’s a unique trust bestowed on us to do this work for those who ultimately benefit from it.”

Tom Mangan is a contributing writer. He is a veteran B2B technology writer and editor, specializing in cloud computing and digital transformation. Contact him on his website or LinkedIn.

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