Increase in Cadaver Organ Donation Rate at a Tertiary Care Hospital: 23 Years of Experience

Knowledge, Attitudes, and Practices Regarding Organ Donation Among Medical Students in India: A Mixed Methods Study

BACKGROUND

Deceased organ donation rates are extremely low in India. As future physicians, medical students can advocate organ donation in society. However, their knowledge, attitudes, and practices regarding organ donation remain understudied in India. Therefore, the present study aimed to assess the knowledge, attitudes, and practices related to deceased organ donation among undergraduate medical students in India using a mixed methods approach.

MATERIALS AND METHODS

This is a mixed-method study with a cross-sectional survey conducted among 400 randomly selected medical students at a medical college in India using a pretested questionnaire. Additionally, 20 in-depth interviews were conducted to gain qualitative insights.

RESULTS

Knowledge was high regarding organ donation (90%) but lower for brain death (27.5%). Most had positive attitudes, but only 11% were registered donors, and 10% had discussed organ donation with family. Multivariate regression revealed that having third- and fourth-year-old students, urban upbringing, good knowledge, and positive attitudes were associated with increased willingness to donate. Qualitative findings revealed gaps in brain death understanding, religious myths, lack of conviction, and family disapproval as barriers.

CONCLUSION

Despite good awareness, gaps in the comprehension of brain death persist among students. However, the registration and family discussion rates are very low. Targeted strategies such as integrating ethical issues into medical curricula, public awareness campaigns busting myths, simplifying donor registration, and promoting family conversations are strongly recommended. This can empower students to become physician advocates driving organ donation uptake in India.

I-JAMM-(I): A survey providing an insight into the practices of isoagglutinin titration in ABO incompatible kidney and liver transplantation

BACKGROUND AND OBJECTIVES

ABO-incompatible transplantations allow patients to receive timely transplants. Isoagglutinin titration to ascertain levels of incompatible antibodies in the recipient is important in determining patient selection and transplant survivability. To find out the prevalent trends in India, the largest, first of its kind survey was carried out among the transplant centers regarding their practices in isoagglutinin titration.

METHODS

The survey was drafted by a working group of Transfusion and Transplant Immunology specialists from six different centers. Data was obtained via the use of an online questionnaire.

RESULTS

Results were categorized into four categories, Hospital information, Titration methodology, Role of transfusion specialists and cut-off titers. Most centers had a well-established solid-organ transplant program with considerable number of ABO-incompatible transplantations. Most centers performed isoagglutinin titration in Transfusion Medicine department. Column Agglutination Technique (CAT) was the most common method, using EDTA blood samples and freshly-prepared in-house pooled cells. Most centers had a turn-around time of less than 12 h. While the policy for ascertaining baseline and threshold titers is well-defined in ABO-incompatible renal transplants, variations from center to center still exist for ABO-incompatible liver transplants. Most centers required a Transfusion Medicine consultation for the patients before such transplants.

CONCLUSION

With increasing ABO-incompatible kidney and liver transplants across the country, the role of Transfusion medicine specialists has become vital in pre-conditioning regimes enabling the viability and success of such transplants. This was a unique survey that provided a snapshot of current trends and practices of isoagglutinin titration for ABO-incompatible transplants in India.

In defense of xenotransplantation research: Because of, not in spite of, animal welfare concerns

It is envisioned that one day xenotransplantation will bring about a future where transplantable organs can be safely and efficiently grown in transgenic pigs to help meet the global organ shortage. While recent advances have brought this future closer, worries remain about whether it will be beneficial overall. The unique challenges and risks posed to humans that arise from transplanting across the species barrier, in addition to the costs borne by non-human animals, has led some to question the value of xenotransplantation altogether. In response, we defend the value of xenotransplantation research, because it can satisfy stringent welfare conditions on the permissibility of animal research and use. Along the way, we respond to the alleged concerns, and conclude that they do not currently warrant a cessation or a curtailing of xenotransplantation research.

Immune response against the biomaterials used in 3D bioprinting of organs

Regenerative medicine has developed promising approaches for healing and replacing defective and damaged organs or tissues with functional ones. Three-dimensional (3D) bioprinting innovation has integrated a potential to design organs or tissues specific to the patient with the capability of rapid construction to fulfill the storage of organs and the need for transplantation. 3D bioprinting of organs has the main goal to develop a structural and functional organ or tissue mimic to the original one. The highly complex fabrication of tissue engineering scaffolds containing biomaterials, tissue models, and biomedical devices has made it possible to print small blood vessels to mimic organs to reduce organ or tissue rejection. 3D bioprinting has the concept of bioinks containing biomaterials that may trigger the immune responses in the body. Nevertheless, foreign body response (FBR) is mediated by various cell types such as B-cells, dendritic cells, macrophages, natural killer cells, neutrophils, and T-cells, and molecular signals such as antibodies (Abs), cytokines, and reactive radical species. Typically, the biomaterial is shielded by the fibrous encapsulation that is regulated by molecular signals. This review explored the progress in 3D bioprinting of vital organs and basic immune response against the biomaterials used in this approach. Thus, evaluating immune response against biomaterials used in 3D printed organs is necessary to mitigate tissue rejection after the transplantation.