27 Mar Someone could die: Blockchain in the highest trust situations
Now for something completely different. Could blockchain save a life?
This special post is from my friend and colleague Dominika Warchol Hann.
Blockchain and Health
If you’re an avid reader of DigitalOilGas.com, you know we think a lot about blockchain and its applications in the oil and gas industry. For some, our projections about the transformative impacts of blockchain can seem a bit abstract. Many of the challenges that blockchain addresses have been somewhat mitigated by other, less-efficient means: paperwork, repetitious processes, databases, contracts, repetitious processes, and yet more repetitious processes. Use cases like trade reconciliation exist, but they don’t exactly drive a strong emotional reaction.
In short, if something goes wrong in the supply chain of an oil and gas project, most probably, no one is going to die. But what about industries where someone could die if the supply chain went wrong?
Consider a different application of blockchain in a separate industry, such as healthcare. Let’s consider a case study, one which requires storage of data, absolute and instantaneous data transfer, consensus between multiple parties on separate and incompatible systems, and the highest levels of privacy and security. If any transaction goes wrong, someone may die.
I’m writing of organ donation.
The challenge of organ donation
The organ registry in Alberta currently includes 7% of Alberta’s population (sadly, the lowest in Canada), and must try to meet the needs of over 1,000 Albertans (in 2015, 383 people received a transplant, 772 were on a waiting list, 69 withdrew—some because they became too ill to receive a transplant—and 41 died while waiting). This is not an unusual result. Regardless of where on earth you live, you are more likely to need an organ within your lifetime than to donate one.
As scarce as organs are, and as difficult as many of the procedures can be, the organ donation supply chain itself is simple to understand. Its challenges are those common to many other: a scarce resource must be obtained, matched to a recipient, and complete a journey of transactions from extraction to implant. Multiple verifications are critical to ensure success.
Presently, the Alberta network has deteriorated , due to its fractured nature and lack of data. But let’s imagine that a new solution implemented by healthcare professionals is one based on blockchain technology.
The blockchain solution
The blockchain would act as a secure auditable record and repository of all the transactions that occur over many years, and many parties in the process of donating an organ and implanting it in a recipient. A blockchain solution could act as a transparent and real-time view of each transaction. In this way, the application and blockchain would replace manual paper records, multiple electronic records, and many incompatible computer systems to provide an end to end view of the organ donation supply chain. It is this application and single view of transactions in the supply chain that would act as the “ledger” (you will be hearing a lot about this shortly).
Presently, there are multiple health authorities, multiple hospitals, individual family members, registrar offices, and transportation hubs that all play a role in the organ donation supply chain. All of the players rely on various systems and databases that don’t necessarily “speak” to each other, nor have a clear way to identify the one individual (and their organs) in question. As each “ledger”, transaction, and related data (e.g., electronic health records) would be “attached” to the organ, instead of an existing database, the data would avoid infrastructure and jurisdictional hurdles.
Ideally, the chain will start with an individual renewing their driver’s license, and informing the registrar that they would like to be identified as an organ donor. The agreement between this individual and the province (acted on behalf of the registrar) would represent the first transaction within an organ donation blockchain.
The transaction then lies dormant for (hopefully) many years. The next step begins when the individual dies. Their body is admitted to a hospital and transactions pertaining to their organ begin, starting with a series of sign offs across multiple stakeholders critical to ascertaining the donor’s consent and their suitability:
- First, can the organ be donated? Only individuals who died of brain death and do not have any other contraindications (i.e., HIV or metastatic cancer) can donate their organs. This is ascertained by two doctors (brain death) and by a lab (blood work)
- Secondly, is the person a registered donor? This is ascertained by reviewing the block transactions
- Thirdly, does the family of the donor consent?
Ahead of an organ being removed from the donor, complete consensus must be reached by these parties, and one of them is already deceased. A single ledger with at least six signatures, all auditable, is key to successful organ donation and the safety of a future recipient. An uncontested ledger is passed. The donor’s organs are identified in a registry, and recipients’ are found. Each donor can save up to five people’s lives with their organs. It is therefore critical that the right organ is matched with the right recipient.
A recipient for one of the organs is identified. Another series of contraindications are tested, on the recipient side (e.g., blood type, sex, weight, age, size and a myriad of other factors are considered). At the donor’s hospital, another series of sign offs by the recipient, the recipient’s doctor, the surgery room / schedule at the donor’s hospital, the surgery room / schedule at the recipient’s hospital, and others. Another ledger is created and consensus gained.
Once all parties agree on a date and time for the organ transplant, the organ is removed (consensus must be reached that the correct organ has been removed – was it the left side kidney or the right side kidney?) and packed for transport. The organ is transferred from operating room, to packaging, to transportation, to another transportation, to another hospital, to another operating room. At this point, the supply chain resembles a food cold chain (a supply chain that has to maintain product within a temperature range): the organ must be kept at a specific temperature to keep it healthy. Furthermore, time is of the essence, as every hour that an organ exists outside of a human body increases the chance of organ rejection in the recipient. Once the organ reaches the hospital, the organ must be identified correctly and it must be matched to the correct recipient.
How to blockchain the organ
The potential for an error in this system to cost someone’s life is high. The current process for organ transportation is highly regulated, highly paperwork-intensive. In a blockchain, each transaction would be managed by a shared ledger, the chain tracking:
- The organ’s temperature throughout the journey using an onboard sensor to create contraindications as needed
- An onboard GPS to communicate the status of the organ
- The identity of the organ in question, and its match to the correct transportation mode
- Arrival and reception of the organ by the right hospital
- Match of the right organ to the right recipient
- Inclusion of the donor’s medical record and recipient’s medical record to create a common view of the organ
At any point in time, if a contraindication is marked, the ledger will not allow the transplant to go forward, potentially saving the recipient’s life. Furthermore, throughout the process, the real-time nature of the ledger will enable the donor’s hospital and the recipient’s hospital to maintain the same view of the organ, see its location and status, and ensure that the right organ is matched with the right patient at the right time.
Could blockchain save the day?
Blockchain is not the magic bullet to address all organ donation woes. Issues around supply, incomplete medical records, lack of effective algorithms matching donors to recipients, and many more continue to plague the system. But it would present a good first step to bridging the nodes of a dispersed and complex system.
When we speak about a secure, distributed, shared ledger in our day to day transactions, the applications may seem abstract, but in one of our most critical supply chains the applications become significantly more self-evident. Consider similar applications in your day to day operations, where you may also require:
- A highly transactional process or item, with many parties operating across many systems and platforms
- Complete agreement and alignment between all parties in the process
- Real-time insights into the state of the transaction
- An auditable transaction record that spans the full life of the transaction, regardless of how long it takes or how many transactions are enacted on it
- A way to associate multiple types of data / set data ownership to the transaction
- Complete privacy and data security
If your transactions meet three of the above indicators, you may wish to consider a blockchain application in your business. Others have already begun to identify and benefit from this imminent technology, from food safety in Walmart’s Pork supply chain and LNG energy trading. It may not be heart surgery, but it may get to the root of inefficiencies in your business.
My friend and colleague Dominika Warchol Hann wrote this post from the heart. She works for Deloitte and has a passion for healthcare and digital.