Updating aims and scope of IJAO: Artificial organs,medical technology and biomedical engineering

The field of artificial organs has characterized the origin of biomedical engineering, with important development of pioneering programs in kidney and heart replacement, as well as organ function assistance. These pioneering achievements have been followed by development of several artificial systems used in the clinical setting to substitute or assist the function of other organs and tissues. The important progress in these technologies and in medicine allowed the conventional use of artificial organs in the clinical settings. These treatments obtained the important goal of prolonging life and changing the destiny of millions of people worldwide. We celebrated few years ago the 40th anniversary of our journal that was started at the beginning of the artificial organ era, from their development to use in the clinical settings. ¹ Since then, a continuous improvement in artificial organs technology and in the clinical outcome characterized the following decades. Artificial organs have been consolidated in the clinical practice; they changed patients’ management and the industrial approach to this challenge.^2,3 In more recent years, however, we assisted to a continuous decrease in experimental and clinical research in the field of artificial organs not only from the clinical side, but especially from the scientific and engineering side. The clinical use of artificial organs is today a common practice, the technologies are well established, and the efforts of the industry in this sector is to provide medical devices and services that allow efficient delivery of these treatments, economically affordable, rather than to continue investing in scientific and clinical innovation. In this scenario, research and development continued to decrease in quantity and few advancements have been introduced in this field in recent years and only in selected areas, mainly in the mechanical circulatory support systems.

However, the field would need continuous research and development to improve two important limits of the clinical use of the artificial organs. The first is the need to reduce the complications that develop in patients chronically treated with artificial systems that substitute or assist only partially organ functions. As an example, this is the case of hemodialysis (HD) treatments. In patients in which renal function is replaced by an extracorporeal treatment, several important complications develop with time that involve the entire organism, especially the cardiovascular system. All these complications reduce the life expectancy in these patient populations and increase the cost of patient management. According to literature data, patients receiving HD have significantly higher mortality than the general population. The mortality for these patients is higher than that of many types of cancer. ⁴ Several complications also develop in patients treated with left ventricle assist devices (VAD). Despite these devices are able to prolong patients’ survival for up to several years, ⁵ in average about 7 years, during this treatment complications arise mainly related to thrombosis, bleeding and infections and they are the often responsible for fatal events.^6,7 To improve the clinical outcome of the artificial organs in general there is need to develop innovative research programs, at experimental and clinical level, to combine new technological development with clinical investigation. However, these efforts have been reduced with time and, as mentioned previously, the clinical use of artificial organs is now a consolidated clinical practice based on a steady technological level. Clinicians and industry are focused on the use of consolidated practice rather than investing in scientific and clinical research and development.

The second need that requires advancing scientific research in this domain is related to the prohibitive costs of existing treatments. Managing patients with end-stage renal disease or heart failure currently requires extraordinarily expensive interventions, placing a significant strain on both public healthcare systems and private insurers, to the point where financial sustainability becomes a concern, even in high-income nations. ⁸ Consequently, there is a tangible risk that life-sustaining treatments may be rationed or denied to elderly patients due to resource limitations. To overcome these financial and practical barriers, technological innovation is imperative. Developing novel strategies for organ substitution and support is the only viable path to wider accessibility. Paradoxically, however, this field is currently witnessing a progressive withdrawal of engagement from the scientific and clinical community.

This situation is affecting also the contributions for publication that are received by our journal, that are decreasing in quantitative and qualitative terms. Thus, the number of manuscripts submitted to our journal is progressively reducing with time, and also the quality of the investigations at scientific and clinical level is progressively lower. In the meantime, however, the progress in several technological fields, as well in the clinic field, is continuously improving, with important achievement in the use of artificial devices for diagnosis, treatment and disease monitoring. At the clinical level, the continuous discovery of cellular and molecular biological processes responsible for pathophysiological processes, open new avenues for improving clinical outcome based on organ transplantation, new pharmacological treatments as well as cell therapy. More recently, gene editing is opening new important perspective in cancer treatment, as well as rare diseases. At the technological level, the development of new biomaterials, new sensors and clinical data capture and analysis, including artificial intelligence, innovative imaging and robotic systems are revolutionizing clinical activities and medicine in general. Today the hospitals, as well as home care, are massively based on the use of medical technologies and in particularly of medical devices for diagnosis and treatment. This scenario has changed the field of biomedical engineering, from the original artificial organ context to the more heterogeneous and wider general field of medical technology.

In light of this transformation, it is time for our journal to update our aims and scope. While our focus remains the scientific research, at technological and clinical level, in the field of artificial organs and tissue, from bench to bed side, we recognize that science, engineering and medicine are facing a wider and heterogeneous mission, based on the use of technology to improve outcome and efficiency of clinical care. This is obtained by artificial devices that are used inside or outside the body to replace tissues, not only organs, to assist in surgical procedures, to collect data and images for diagnosis, treatment, rehabilitation and monitoring. According to this evolving scenario, there is an urgent need to update the aims and scope of the International Journal of Artificial Organs (IJAO). Our definition of the aims and scope of the journal was based on fostering “the development and optimization of artificial, bioartificial and tissue-engineered organs, for implantation or use in procedures, to treat functional deficits of all human tissues and organs.” In agreement with our Editorial Board, we have updated these aims and scope in: “The International Journal of Artificial Organs publishes peer-reviewed interdisciplinary research focusing on the science, technology, and clinical implementation of artificial organs and tissues for patient treatments. The disciplines involved range from medicine, biomedical engineering, medical technology, data science, and artificial intelligence.” In line with this change, also the sub-title of the journal will be updated with the new version: “Artificial organs and medical technologies: from engineering to patients.”

According to this Editorial decision, we announce the readers and the contributors that the journal field is now expanding from the original “artificial organs” to include the scientific and clinical research based on medical technology to replace or assist organ and tissue functions. We aim to expand the role of the journal to deal with the biomedical engineering area and in particular its impact in the clinical settings. The journal will continue to support the fruitful collaboration between clinicians and scientists in the fields of artificial organs and in that of the related medical technology. We aim to apply a natural extension of our role to the place where engineers and medical doctors continue to share the results of their investigations. We think this is of vital importance for bringing new discoveries to the clinic in industrialized countries, as well as in emerging countries, where larger populations have more access to medical care. In these contexts, new medical technologies are fundamental to increase quantity and quality of patient care. The increase in contributions from these countries to our journal is a sign of this import global transformation.

In conclusion, the update of the aims and scope of our journal, extending the artificial organ area to medical technology and to biomedical engineering is necessary to follow the important new progress in medicine and technology. These changes will continue to make the journal to be the place where medical doctors and engineers share the results of their investigations, in line with the long-lasting tradition of the journal.