Innovation ’19: Drones

Game of drones

Stringent FAA safety regulations don’t necessarily mean that medical drones won’t fly as an everyday tool—but it will be a lift.

Frank Diamond
Managing Editor

A flight to remember! Trina Glispy (above) waits for the donor kidney. With its precious cargo, the drone (inset above) travels 2.8 miles in about 10 minutes. Transplant surgeon Joseph Scalea, MD, (inset left) pronounces the delivered organ in perfect condition. (See video below.)

We can’t get there from here. Not yet, anyway. Part 107 of the Federal Aviation Regulations places numerous restrictions on drones or, as the FAA calls them, unmanned aerial vehicles (UAVs). No letting it out of sight. No higher than 400 feet. No faster than 100 miles per hour. No flying over non­participants. No controlling it from a moving vehicle. No weighing over 55 pounds. No night flights.

No!

In other words, says Robert Graboyes, a senior research fellow at George Mason University in Arlington, Va., and an expert in medical innovation: “We’re a long way from integrating UAVs deeply into the health care system.”

Hope, though, can indeed be found, no less at the Federal Aviation Administration, that agency of myriad regulations. “All this stuff just blows my mind,” says an FAA spokesman about the possibility of drones becoming a common feature in our lives. (In general, FAA spokespeople decline to give their names.)

He applauds the flight of that drone on April 19 from a neighborhood in southwest Baltimore that delivered a kidney to 44-year-old Trina Glispy, a woman who’d waited eight years for a transplant. The culmination of a three-year project, the drone flew 2.8 miles in about 10 minutes to the University of Maryland Medical Center. Speed is significant because once removed from a donor, organs become less viable with each passing second. Kidneys “test pilot” medical drones carrying organs because kidneys are relatively durable and—unlike hearts, livers, and lungs—don’t have to be chaperoned by a medical team.

University of Maryland's Schools of Medicine and Engineering first to use unmanned aircraft to successfully deliver kidney for transplant at University of Maryland Medical Center.

The FAA waived many of its regulations to make the April 19 flight happen. For instance, the $100,000 drone was heavier than the weight limit because it carried cameras, the kidney and the specially made container that housed it, and a communication system. Because it flew at night, strobe lights were attached. (Other safety precautions included having police stop traffic at intersections as the drone flew overhead and stationing pilots on the ground who could take control if necessary.)

Glispy is doing well. “Her kidney worked immediately,” says Joseph Scalea, MD, an assistant professor of surgery at the University of Maryland School of Medicine, who performed the transplant. “She is off dialysis and has not required any dialysis since the transplant.”

Yes!

Scalea, who heads the team of around 20 medical, aviation, and engineering experts who built and operated the drone predicts that this is only the beginning. He’s since formed a not-for-profit company—Transplant Logistics and Informatics—that he hopes will facilitate drone usage (see “Insurers Have a Dog in This Flight”). “We’re working incredibly closely with the FAA to” integrate drones into health care, says Scalea.

Insurers have a dog in this flight

Joseph Scalea, MD, is “very interested in partnerships with payers.” Scalea, an assistant professor of surgery at the University of Maryland School of Medicine, leads the team that recently made headlines when the drone it developed delivered a kidney to a waiting patient.

He’s formed a not-for-profit company—Transplant Logistics and Informatics (TLI)—that he hopes will facilitate drone usage. “The reality is that there are no organ drones that you can buy. There are no companies that do that yet, although ours is in the process of essentially doing that.”

He realizes that a viable company will need more than a desire to save lives—it needs funding. “We have to have a solvent business to make this go forward. Otherwise it’s a nonstarter, right? That’s something as a doctor that I am trying to wrap my head around.” Luckily, some of Scalea’s partners have business backgrounds.

And TLI recently secured a contract with New England Donor Services, the agency that manages transplants in the Boston area. Two other transplant organizations are also chipping in to fund the project, but those involved decline to say how much it will cost.

Although the first flight in this and other proposals TLI has in the works will be a short one, akin to the one that made all the headlines in April, the long-range goal is to take expensive, time-consuming airplane-to-ambulance delivery of organs out of the equation. But, remember, this is still the very beginning. The drone used in the famous University of Maryland flight is the only one of its kind so far.

Just why insurers should care comes down to cost-efficiency, argues Scalea. “I can reduce the hospital costs, because I can get an organ there in time. I can reduce the costs of failure by knowing which organs are of lower quality.”

Scalea says that because of the shortage, transplant surgeons will attempt to use every organ possible, even if it means using kidneys from an older donor or a donor with hepatitis, what are known as “marginal organs.” (About 1,000 kidneys a year are discarded for various reasons.)

“If I can give somebody a kidney that works for an additional year because I got it in quicker, or I avoided somebody having to go through many dialysis treatments, you save the system something like a million dollars,” says Scalea.

They’re not the only ones. The FAA’s Integration Pilot Program (IPP) is overseeing 10 drone experiments throughout the country, two of which involve drones in health care. “It’s important to note that the IPP programs were proposed to us,” says the FAA spokesman. “We didn’t go out and say, ‘OK, we want a medical facility to use drones.’ They approached us with the need that they had.”

While the life-saving potential of drones has not gone unnoticed by health care stakeholders in the United States, it has also not gone untapped in developing nations, many of which have poor road systems.

In Rwanda, the first country with a nationwide system of medical drones, the government and Zipline—the American company that manages the unmanned aircraft system—uses drones to deliver blood supplies, pharmaceuticals, and medical equipment in situations where “conventional transport would have arrived too late,” says Graboyes.

Architect Eduardo Egea designed a drone-friendly hospital after Hurricane Maria disrupted the supply system for hospitals in Puerto Rico. Egea told the architecture and design magazine Dezeen that he envisions drones dropping whatever’s needed into a net, the supplies sliding through a valve, and then into a cabinet right inside the patient’s room.

Keeping eyes on the prize

Interesting but apply caution because a major mishap could stymie the momentum behind drone innovation. One of the worst things that could happen to the pro-drone movement would be a drone-on-airplane collision. “The Hindenburg disaster largely ended commercial dirigibles, and the last thing UAV developers need is an analogous 21st century disaster,” says Graboyes. “For now, the operator’s eyes contribute critically to safety.”

M2 quadcopters, made by Matternet, fly blood samples and other lab work from one end of WakeMed’s sprawling campus to the other in about three minutes. It takes about 20 minutes by car.

Such is the case in the IPP at WakeMed Health & Hospitals in Raleigh, N.C., which was requested by the North Carolina Department of Transportation. Other participants in the WakeMed project include UPS, which basically serves as the airline, and Matternet, the makers of the M2 quadcopters that can carry up to 4.4 pounds of cargo. WakeMed drones transport blood samples and other lab work across the huge campus, a 20-minute trip by car. Drones can do the job in three.

The other medical drone project, requested by the city of Reno, Nev., would allow drones to deliver defibrillators to remote areas of the state. That’s still being developed. Graboyes describes defibrillator delivery as a “situation where one might say, darkly, ‘When every second counts, an ambulance is just minutes away.’”

Robert Graboyes

“A plane that loses touch with the ground still has a pilot,” points out Robert Graboyes of George Mason University, and an expert in medical innovation. “Not so with a drone.”

At WakeMed, what the FAA calls a ground observer controls the takeoff and the flight until the drone is out of sight, at which point another ground observer takes over (via joystick), and on down the line through as many ground observers as the trip may take.

See the problem?

But to do away with observers, communication will have to be as reliable, if not better, than communication between airplane and control tower, says Graboyes. “For now, the operator’s eyes contribute critically to safety. A plane that loses touch with the ground still has a pilot. Not so with a drone.”

Drones not requiring visual monitoring would need satellite communications and “lightning-fast sense-and-avoid capabilities,” says Graboyes. And they’d have to be hack-proof. “Reliability of the whole system is essential; you don’t want to lose precious cargo en route to stricken recipients.”

Some technological advances are also needed. Currently, drones run on batteries that cannot support long-distance flight. Neither can drone engines. “Ultimately, they’ll need highly dependable miniaturized internal-combustion engines, and the development costs for such engines will be many, many millions of dollars,” says Graboyes.

Matt Scassero, director of the University of Maryland’s Unmanned Aircraft Systems Test Site, disagrees about the need for combustion engines on long-range drone flights. “That is one option,” says Scassero, who sees plenty of “design freedom” in the array of technology that drone designers have at their disposal: electric motors, solar power, evolving battery technology.

Scalea says that his specially made drone can fly 100 to 200 miles an hour and travel 100 to 200 miles. The drones used at WakeMed can stay aloft 12 and a half miles and up to 25 minutes. Whatever the model, drones need to do a much more delicate dance with health care than with any other industry. “When you’re moving a medical payload—and, most importantly, moving an organ—that’s a high-value payload; it’s not like a pair of slippers or a roll of toilet paper ordered on Amazon,” says Scalea.

Scalea’s drone took off and landed on a calm, clear night. That’s not always going to be the case, points out Andreas Claesson of the Karolinska Institute in Stockholm, who cowrote a study comparing drones and ambulances in JAMA in June 2017. “The most obvious point is how the organ or medicine ‘experiences’ drone flight, meaning prolonged—sometimes heavy—vibrations, differences in barometric pressure depending on altitude, differences in temperature,” Claesson said in an email.

Graboyes predicts that “some of the more interesting applications of medical drones will be ideas no one has yet had (or at least announced). Entrepreneurship always leads to the unexpected innovations.”

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