Surgery in Practice and Science 9 (2022) 100065
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Surgery in Practice and Science
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Blockchain and non-fungible tokens (NFTs) in surgery: Hype or hope?
Blockchain technology and non-fungible tokens (NFTs) are making
headlines beyond the realms of art and finance, demonstrating oppor­
tunities for adoption in other contexts [1]. Briefly, blockchain is a
generic term used to describe a type of shared append-only database that
stores information digitally, where chunks of data are stored periodi­
cally as blocks and cryptographically chained together. Blockchains are
unique due to their immutability, transparency, and decentralization.
When discussing NFTs, non-fungible is an economic term describing
assets that are not interchangeable. For example, while $1 USD can be
exchanged for another fungible $1 USD, artworks cannot be exchanged
due to their unique properties and are therefore non-fungible. Token
describes the ability of an NFT to represent digital or physical objects on
the blockchain. Therefore, an NFT is simply a blockchain representation
showing the existence of any tangible or intangible asset (i.e., a certifi­
cate of authenticity and ownership for a unique digital record of an
asset).
Although the concepts of digitally representing assets through
unique identifications are not novel, using tamper-resistant blockchain
technology allows NFTs to become potent solutions for problems
involving efficiency, transparency, and permanence. While the unique
construction of NFTs have allowed them to become ideal vehicles to
digitally represent assets in the fields of art and finance [2–4], their
application to healthcare is not beyond imagination. With NFTs, any­
thing may be registered to the blockchain and permanently assigned a
digital representation. The tamper-resistant technology allows NFTs to
solve problems involving efficiency and privacy, both cardinal concerns
in any health system. Blockchain solutions to digital processes such as
blood banking and the sharing of patient health information seem like
logical first steps [5–8]. However, more procedural based medical dis­
ciplines such as surgery may be overlooked as potential beneficiaries of
this new technology. Nonetheless, the application of NFTs in surgery
deserves exploration.
Perhaps the most apparent benefit of NFTs in surgery is more effi­
cient storage of patient surgical data. Although using blockchain alone
may be useful in organizing such records, the unique qualities of NFTs
can optimize patient-level data access. The conversion of patient data
such as surgical history, laboratory values, imaging records, and sur­
geon’s notes into a single digital asset removes the surgeon’s depen­
dence on multiple parties to access a patient’s clinical profile. Whenever
surgeons manage acutely ill patients, they require proper and timely
access to medical histories. The field of transplant surgery combines
both these priorities with rigorous patient-identification standards and
allograft selection. A blockchain and NFT-based system may help
organize reliable access of patient data for transplant surgeons and pa­
tients undergoing organ transplant. Moreover, a decentralized trans­
plant database would allow all parties to monitor the transplantation
process while also mitigating risk of fraud and increasing efficiency by
https://doi.org/10.1016/j.sipas.2022.100065
Received 28 January 2022; Received in revised form 24 February 2022; Accepted 25 February 2022
Available online 26 February 2022
2666-2620/© 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
eliminating unnecessary intermediators [9, 10].
Representing a patient’s pertinent surgical data with NFTs can also
allow for more rapid communication between surgeons and patients.
Various surgical groups often use different electronic health record
systems which tend to lack interoperability. As a result, patient data is
not only fragmented across the different systems but transferring data
between surgeons regarding the same patient is hindered. In an NFT-
based system, the owners of a particular health record NFT would
receive a digital file and retain full ownership. Accordingly, the owner
could be the patient, with surgeons adding metadata (attributes per­
taining to the information in the NFT) directly to the NFT, or vice-versa.
The metadata amendments could include changes in current medication
regimens, additional imaging studies, and information about recent or
upcoming surgeries. The NFT metadata can then be seamlessly trans­
ferred to other surgeons involved in the patient’s care without need for
complex bureaucratic affairs and troublesome navigation of noncom­
patible health record systems.
Alongside the rising utilization of telehealth in surgery, NFTs and
blockchain may be employed to improve data security and patient pri­
vacy. By design, telehealth is an electronic arena where sensitive patient
health information is shared. It is therefore inherently vulnerable to
ethical, legal, and social issues [11, 12]. Telehealth carries many ben­
efits for surgeons, particularly exemplified during the COVID-19
pandemic [13]. These benefits may be strengthened with the use of
NFTs, as they are specifically designed with exclusive digital
certificate-based access to enhance security and privacy. Patient en­
counters, surgical videos, and remote surgeon education all present
opportunities for NFTs to enhance the quality of surgeon
communication.
With concerns regarding data security and patient privacy come
possible impacts on the economics of healthcare. In a proposed block­
chain and NFT-based system, health data becomes decentralized and
belongs more in the hands of each individual patient rather than solely
with the healthcare institutions [10, 14]. Blockchain and NFT applica­
tions may however allow direct combination of clinical outcomes
measurements with cost and reimbursement calculations, shifting to­
ward a more value-based economic model. Overall, feasibility may de­
mand balancing this type of disruption with integration into the current
system.
Robotic surgical systems are also becoming more prevalent, allowing
surgeons to operate on patients remotely via wireless connections.
However, the possibility of malicious actors to compromise telesurgeries
by affecting network connections has raised concerns about security
[15]. Blockchain technology can help improve the security of tele­
surgery by using NFTs to validate the identities of surgeons involved,
adding a crucial layer of protection. NFTs could also be utilized to track
specific surgical equipment, much like their current use tracking blood
S. Batchu et al.
bank specimens, with each surgical tool assigned to a unique token. The
usage history of a surgical device could be incorporated into its token
and the blockchain would allow to trace the device’s activity. Early
adoption of NFT and blockchain systems in robotic surgical systems
could prove vital to their ongoing development and integration into the
global surgical tool kit.
Although there seems to be a plethora of uses for NFTs and block­
chain in surgery, from tracking the use of surgical devices to organizing
patient data, idealism must be balanced with practicality. In other
words, current issues, and the ability of these transformative technolo­
gies to solve these issues, must be clearly defined before any healthcare
system is dismantled and rebuilt on the blockchain, with additional
consideration into costs of initiation and maintenance. NFTs and
blockchain are creative technologies that hold promise to enhance the
field of surgery. Taken together, blockchain and NFTs seem optimal for
integration into fields requiring a decentralized and trustable chain of
evidence, especially one where the integrity and security of historical
data is crucial for success, such as the field of surgery.
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Sai Batchua,*, Owen S. Henrya, Karan Patela, Abraham Hakimb,
Umur Atabekb, Francis R. Spitzb, Young K. Hongb
a
Cooper Medical School at Rowan University, Camden, NJ, USA
b
Department of Surgery, Cooper University Hospital, Camden NJ, USA
*
Corresponding author at: Cooper Medical School of Rowan University,
401 Broadway, Camden, NJ, 08103, USA.
E-mail address: batchu94@rowan.edu (S. Batchu).