“There's a certain self-satisfaction to being clever for its own sake," Sridhar Tayur said. Tayur is a professor and software entrepreneur who made his name developing novel algorithms to help businesses like Kellogg decide where, when, and how many Poptarts of different types to produce, store, and distribute. He has now—seemingly on a whim—shifted his focus to organ transplantation.
"It has nothing to do whether you helped somebody or made money or got a prize,” Tayur said. “All of those things matter. But there’s this joy when you're sitting alone in your room and you say, ‘Aha! I thought about something in a new way.’”
This time, that something is a particularly intractable issue in organ transplantation. The supply and demand imbalance between organs and the people who need them means that wait lists in New York or San Francisco might be twice that of, say, Kansas or Tennessee. The problem was brought to public attention in recent years by Steve Jobs, who used his resources to travel across the country for a liver transplant. For decades, doctors and policymakers have debated how to move organs or change allocation maps in an effort to eliminate these disparities.
Now, Tayur proposes to turn the problem on its head. OrganJet, his brainchild, is a company that uses an online app to help patients find out where in the country they could go to get a liver or kidney the fastest, and then promises a private jet to fly them there at a few hours’ notice when the organ becomes available.
It might all sound a bit crazy. At 49, Tayur doesn’t have any training in healthcare or in the field of medical ethics. He is a Carnegie Mellon University-chaired professor of operations management with a Ph.D. in operations research, a field that uses mathematical modeling to solve business problems. He knows little about the intricate process of transplanting an organ from one human being into another. But Tayur, who founded and recently sold a supply chain start-up called SmartOps, knows a lot about supply and demand, and how to fix problems. And thanks to his charisma and unique outsider approach to innovation, traditionally staid medical institutions are listening.
“I thought immediately that it was a fantastic idea,” Anton Skaro, a transplant surgeon at Northwestern University Feinberg School of Medicine, told me. “You’re talking about years and years before policy and reforms can get a foothold and reverse this inequity. If you can’t get the organs to the people, get the people to the organs.”
One night in October 2010, Tayur was out to Thai food with Baris Ata, then an associate professor at Northwestern University. Ata studies the organ transplantation system and the topic of geographic disparities in organ transplantation came up.
When it comes to transplantation, the country is divided into 58 groups called “donor service areas,” which make up 11 different regions. When an organ becomes available, it’s offered up to the patient highest in the list in that donor service area. If there’s no eligible match, the search is expanded to the region and, finally, to the country at large. One problem with this system is that the regions were created years ago, and today, some regions have more sick people than others. This means that patients in some areas of the country face longer wait times and a higher chance of dying while waiting for a transplant.
Patients can be evaluated to get on the waiting list in multiple different cities at one time, as Steve Jobs did when he needed a liver transplant. In fact, transplant centers are mandated to mention this option, called “multiple listing.” But given the resources and wherewithal required to find the program with the shortest wait time, and to then make plans either to move or to get there quickly should an organ become available, few people ultimately use that option. There’s been no shortage of proposals with the goal to correct what many see as an unacceptable status quo, in which geography dictates transplant accessibility. But mired in often-politicized debate, change moves slowly.
As a result, the problem was described to Tayur simply as “not solvable.”
This piqued his interest. And in the days that followed, Tayur, who splits his time between Pittsburgh and Boston, started to wonder what he would do if he needed a kidney or a liver. He thought he would list in a hospital somewhere that had shorter wait times, and when the organ became available, he’d get a jet to fly there. “Then I started thinking, how rich would you have to be? Maybe you don’t need to be Steve Jobs and own a jet, maybe you just need access to one. It was a puzzle.”
Tayur knows the private-jet industry. It turns out that to use a private jet, you don’t actually need to own a plane. That’s where the concept of “fractional jets” comes in. For a premium, you can pay to have access to a shared jet, when you need it. This, Tayur told me, is why I’ve never seen a rock star on a commercial flight. Back in the 1990s, Tayur developed complex algorithms to help a fractional-jet company decide which planes to send where, in order to minimize flight time and total cost while accounting for a host of factors like maintenance, crew skills, and future trips. Decades later,while leading his software company, SmartOps, he found himself flying throughout the country to convince companies they could benefit from his software, which would help them with “supply-chain optimization”—that is, how many products to produce and how to distribute them. With a punishing schedule, commercial flights were out and Tayur became a fractional-jet customer himself.
Now, faced with an unlikely market for private jets—patients waiting for an organ at a distant transplant center—Tayur had the inkling of an idea. What if he could promise multiple-listed patients an on-demand jet to get them to a distant transplant center if an organ became available? He would be playing “within the rules of the game,” making change without new policies. Of course, people would have to pay out-of-pocket—at first, at least—until Tayur could prove to insurance companies that his service was worthwhile for them to cover. But patients wouldn’t have to be billionaires to use the service, though it wouldn’t exactly be cheap, either. Tayur estimated the cost at somewhere between $8,000 and $25,000, depending on the length of the flight.
Tayur knew that without buy-in from those in the medical community, the idea would go nowhere. So he floated it around, first to his friend Ata at Northwestern (“He was very quiet,” Tayur said. “‘Is it really stupid?’ I asked. ‘No,’ he said, ‘I think it’s genius.’”) and on to transplant physicians and organ transplantation officials, who were all, he said, receptive. “He’s very persuasive and comes at it from a whole different perspective,” explained James Markmann, the chief of the division of transplantation at Massachusetts General Hospital in Boston. “There’s gridlock in the field. And so in that context, one crazy solution is to fly patients.”
By May 2011, OrganJet was born. Then, after a conversation with a Harvard ethics professor who urged him to find a way to make his service more widely accessible, Tayur created a charitable foundation called GuardianWings, in 2012, to use the profit made from OrganJet to fly people who aren’t able to raise the money on their own. “He fixes problems,” Markmann said. “When somebody said, ‘Well, you’re disadvantaging the poor [with OrganJet],’ he fixes it.”
But patients would have to know where they wanted to fly. And Tayur was surprised to find that many patients he talked with weren’t fully aware that multiple listing was an option. Indeed, studies have suggested that just around five percent of kidney transplant patients get on multiple lists and even fewer do this for liver transplants. Average waiting-list times and outcomes for each organ and each transplant center are publicly available on transplant websites, but the data are buried in lengthy PDFs that hardly could be described as user-friendly. “So what do I do?” Tayur asked. “I’m a software guy. So I’m going to create a little app.” For months, Tayur and a team of engineers pored through the online databases to create an easy, free online program where a person can enter her zip code and the organ she needs (the program only supports livers and kidneys right now) and she’ll get a list of the five closest centers with shortest wait times.
The OrganJet website was how Tayur met Irena Bucci. The Washington-based web developer suffers from a genetic disorder that was destroying her kidneys, and back in 2010, she was told that she would need a kidney transplant. With average wait times of five to six years in centers near her home, she started to ask friends and family if they’d be willing to donate a kidney. Offers fell through, and then she read Steve Jobs’ story of multiple listing and realized that she should pursue listings at different transplant centers. She felt like a “detective,” she remembers, trying to find information about wait times online, traveling from center to center. She ultimately traveled to six different hospitals to get on their transplant lists. None of this was easy. But, she said, “You do whatever you can to survive.”
When she came across the OrganJet website and emailed Tayur, he asked her where she’d listed; she told him. “She’s as educated as you can get, but I told her I wouldn’t have listed in any of those places,” he remembers. Tayur was familiar with the University of Pittsburgh Medical Center, and so he recommended she list there. One night in August 2013, she got a call—could she get to Pittsburgh in five hours? With Tayur’s jets waiting as a back-up, she ultimately booked a commercial flight and got there in time.
The two stayed in touch, and Bucci created her own website with a list of wait times and frequently-updated commercial flight plans that might help them get to a distant center in time for a life-saving organ. “What I’m trying to do is to get people at the shorter wait list centers to balance out wait times across the U.S.,” she explained. “I really think that if you change the behavior of the consumer the system might change.”
When it comes to system change, many note that for OrganJet to really take off beyond a niche market, without worsening existing socioeconomic disparities in access, the service needs to be covered by insurance companies. “At the point where it’s restricted to a very small number of people who have the private means to do it, I fear it will exacerbate the inequalities,” David Axelrod, a transplant surgeon and health services researcher at Dartmouth, told me. He notes that while getting listed for a transplant far from home at a center with a shorter wait time might sound like a great idea, there are drawbacks. For one, you’d undergo a procedure with the potential for complications away from your extended community and support structure. And more often than not, the doctors who performed the transplant would want to see you for follow-up in person, which would mean more trips. But he acknowledges that for some, this might be preferable to the status quo. “At the end of the day, do we really care if the patient goes to the organ or the organ goes to the patient? We don’t care, if it is done equitably.”
This would take business savvy, and math. So last year, Tayur ran his idea past Regina Herzlinger, a Harvard Business School professor who teaches a course on innovation in healthcare. She charged a group of her students to build a business case to convince insurers to include OrganJet’s service as a benefit for those in need of a kidney transplant. After weighing the cost of dialysis, the potential loss of productivity, and the possible benefit of an earlier transplant, the team concluded that an insurance company could afford to cover OrganJet without increasing premiums. With this, Tayur brought the analysis to Highmark, a health insurer in Pennsylvania.
“I must say, I was very attracted to the idea,” said Don Fischer, the chief medical officer at Highmark. “[Tayur] is a very methodical systematic thinker. We need more people like that.” Fischer, who used to work as a pediatric cardiologist, remembered how children and their parents would travel across the country for a transplant with funds raised by their churches or communities. This was a similar concept, he noted. While Fischer told me that Highmark hasn’t committed to including OrganJet to its benefits, he praised the idea for being “a very workable solution … We think it’s a very novel idea,” and Highmark is currently considering it.
Tayur, who knows these sorts of decisions take time, isn’t in a rush. After all, he hadn’t thought much about transplants at all until that dinner just four years ago. And now, his potentially controversial idea might make change. “I’m not the first guy to wake up and say ‘Oops, there’s geographic disparity.’ But then I pop in and say, ‘How about I propose something that requires no change in the law, no UNOS sign-off, no redistricting, and I’m going to work with the insurance companies?’ The reception has been positive and I wonder if one of the reasons is that, in the last 30 years, many other ideas have gone nowhere.”
Transplant surgeons hope that Tayur’s project could spur policy-makers to action. “I hope if OrganJet takes off, people will say, what are you doing shipping patients? Going to that extreme just shows how ridiculous the community is being,” Markmann told me. At Northwestern, Skaro agreed. “If that’s what’s going to need to happen to garner the attention that’s necessary to make change, so be it. In any event, it’s an ingenious idea.”
These days, Tayur gets a “steady drumbeat” of a few emails per week from people throughout the country who are suffering from kidney or liver failure. No one has used one of OrganJet’s private jets to fly to an organ yet. Those who’ve signed up for the service have all been able to get a commercial flight in time, before having to resort to the private plane waiting in the wings. But they are grateful. And while Tayur is still the software guy, driven by the fun of solving a difficult problem, he notes that, almost unexpectedly, a sense of gravitas has crept into his work. “What started as a purely curious thing has become real,” he said, smiling. One of his most recent projects was optimizing ad placements, for products like Coke or Sprite, in video games. “The ultimate irony would be that a flippant guy like me would end up helping people.”
