Indian Donors Research Articles

Liver Transplant during COVID-19 Pandemic

Introduction: Novel coronavirus affects different individuals in different ways, with most people recovering with mild to moderate illness not requiring hospitalization. Liver transplant for end-stage liver disease is a lifesaving procedure, and though living donor liver transplant (LDLT) is a well-planned elective surgery, it was considered a semi-emergency owing to the decompensation of the recipient posing a challenge to the transplant team owing to the situation of the pandemic. The availability of liver grafts from cadaveric donors in India was 0.65 per million population until 2019 as per the National Organ and Tissue Transplant Organization statistics which was sparse and further accentuated, leaving LDLT as the only option during the pandemic. Aim: This study aims to describe our experience and testing protocol for COVID-19 disease for the patients undergoing liver transplant during the pandemic at our hospital, which is a tertiary care referral hospital. Materials and Methods: This was a retrospective study done at AIG Hospitals, Hyderabad, India. Fifty adult patients who underwent LDLT and deceased donor liver transplant from May 2020 to December 2020 were included in the study. Exclusion Criteria: All recipients and donors with reverse transcription polymerase chain reaction (RT-PCR) positive for SARS CoV2; and COVID-19 disease reporting and data system (CO-RADS) score of 4 or 5 on high-resolution computed tomography (HRCT) chest. Results: The mean age of the recipients was 46 years, and the donors was 36 years; the most common indication being acute-on-chronic liver failure with failed medical therapies and the second common being hepatocellular carcinoma. All the 50 recipients were RT-PCR negative for SARS CoV2; 8 out of whom had a CO-RADS score of 3; and 4 out of the 8 were post-COVID-19 infection who had IgG positive and IgM negative; and the other 4 were both IgG and IgM negative, similarly 4 out of 8 donors were IgG positive. Intraoperative and postoperative period was uneventful. None of the donors or recipients were infected with COVID-19 disease during the hospital stay and up to 1 month postoperative. One patient died within 1 month due to sudden cardiac arrest. Conclusion: In our experience, with meticulous testing and proper care, there is a favorable outcome for liver transplant even during the pandemic.

Molecular basis of RhD-negative phenotype in North Indian blood donor population.

RHD gene typing is highly complex due to homology with RHCE genes. Molecular polymorphism of the RHCE and RHD genes have been characterized among various populations, but no studies have been undertaken among Indians. This study was undertaken to assess the genetic basis of RHD-negative phenotype in Indian blood donor population. Sample from a total of 200 phenotypically RhD-negative blood donors were analyzed for presence of RHD gene using polymerase chain reaction (PCR). RHD genotyping was done using three primer sets designed for exons 4 and 10 and one set for identification of pseudo (RHDΨ) gene between introns (int) 3 and 4. Amplified PCR products were analyzed by gel-electrophoresis (XY Loper, Uvitech, Cambridge) and confirmed by nucleotide sequencing (ABI 3730 xl 96 capillary system). No PCR product was found in 195/200 (97.5%) of study samples indicating homozygous gene deletion. Of the 5/200 (2.5%) showing RHD gene polymorphisms, 4/200 (2%) were positive for presence of exon 10 only (RHD-CE-D hybrid). RHDΨ gene was not detected in any of the samples tested. One sample showed presence of all three tested regions and was negative for RHDΨ gene. RHD gene deletion was found to be the most common cause of an RHD-negative phenotype while RHDΨ gene was, reported to be present in up to 39 per cent of various ethnic populations, but was not detected. RHD-CE-D hybrid gene (found in 2.5% individuals) is important for predicting the requirement of Rh prophylaxis during the antenatal period.

Paired exchange Living Donor Liver Transplantation: A Nine-Year Experience from North India

Introduction: Liver paired exchange donation (LPD) or swap transplantation is an evolving strategy to overcome ABO incompatibility and other barriers like small for size syndrome that confront patients with end-stage Liver disease undergoing Living donor liver transplantation (LDLT). At the same time, for the transplant team to carry out 4 major operations simultaneously is a Herculean effort. Herein, we analyze our experience with LPD program over the past 9 years. Methods: This prospective study includes a total of 2340 LDLTs performed from May 2012 to April 2021. We started the Paired exchange LDLT program in May 2012. LPDs constituted approximately 1.45% (34 of 2340) of the total LDLT procedures. The reasons for LPD were ABO incompatibility in all (n=34) patients. The first and second recipient of each swap pair were divided into R1 and R2 groups for comparative analysis. Results: All patients included in paired exchange LDLT program were Indian citizens and donors were “near” relatives. After donor reassignment through 2-by-2 paired exchange with directed donors, the ABO matching status changed to A to A (n=17) and B to B (n=17) and this made all matches ABO-identical. Donor survival was 100%. The recipient’s (n=34, age 45.5 [11 -59] years; 31 men), UNOS status were 2b (n=5) and C (n=29) and they all underwent elective LDLT surgery with 4 OTs running simultaneously on the same day. The baseline clinical, peri-operative parameters, post-operative complications, median ICU/hospital stay, early deaths were comparable (P>0.1) between the R1 and R2 groups (Table 1). The overall recipient survival was 85.3 % (n=29) over the median follow up period of 20 (0-108) months. Conclusion: Our experience suggests that with careful attention to ethical and logistical issues, LPD program can expand the living donor liver pool and can facilitate a greater number of LDLTs. Keywords: Donor Exchange, Swap Liver Transplantation, Living Donor Liver Transplantation; ABO incompatibilityTable 1Comparative data between R1 and R2 groups of swap liver transplant recipients (n = 34).Parameters (Mean±SD)R1 (n=17)R2 (n=17)P valueAge (years)44.0 (±10.1)47.0 (±5.3)0.296MELD score21.8 (±11.1)19.4 (±6.3)0.445CTP score9.5 (±2.3)10.3 (±2.1)0.294Graft weight (grams)711 (±141.2)796 (±119.8)0.067GRWR1.01 (±0.34)1.18 (±0.26)0.136Warm ischemia time (minutes)32.7 (±7.8)36.1 (±7.1)0.257Cold ischemia time (minutes)109.7 (±61.2)112.6 (±40.9)0.870ICU stay (days)12.4 (±4.6)14.4 (±10.5)0.654Hospital stays (days)16.7 (±4.6)21.6 (±4.7)0.197Complications n (%)Bleeding01 (5.9%)1.00Bile leak02 (11.8%)0.485Acute rejection1 (5.9 %)1 (5.9 %)1.00Hepatic artery thrombosis01(5.9%)1.00Hepatic vein thrombosis2 (11.8%)1(5.9%)0.542Sepsis2 (11.8%)5 (29.4%)0.398Early mortality (Within 1 month)1 (5.8%)3(17.6%)0.6011 year survival16 (100 %)13 (92.8%)0.335Median follow up in months (IQR)27 (8-39)27 (8-43)1.00CTP, Child-Turcot-Pugh; GRWR, graft to recipient weight ratio; ICU, intensive care unit; IQR, inter quartile range; MELD, model for end stage liver disease. Open table in a new tab CTP, Child-Turcot-Pugh; GRWR, graft to recipient weight ratio; ICU, intensive care unit; IQR, inter quartile range; MELD, model for end stage liver disease.

Human leukocyte antigen allele and haplotype frequencies in Singapore bone marrow donors and cord blood units.

We describe the allele and haplotype frequencies seen in a volunteer unrelated bone marrow donor registry, a public cord blood bank, and donor/recipient samples processed by the Health Sciences Authority (HSA) in Singapore. Historical human leukocyte antigen (HLA) typing reports were anonymized and combined. They were checked for HLA typing nomenclature discrepancies or ambiguities using the HLA-net UNIFORMATE tool, and for analysis, the validated data were subsequently separated into Chinese, Malay, Indian, and "Others," according to the race classification system used in Singapore. Individual ethnic allele and haplotype frequencies were calculated with the HLA-net GENE[RATE] pipeline using basic statistics. The Basic Statistics Tool of HLA-net was used to estimate haplotype frequency using an expectation maximization algorithm, given a set of multi-allelic data pairs for a given HLA locus. The outputs downloaded from the site comprised plain text files with haplotype frequency estimates, results of a global linkage disequilibrium test, and standardized residuals (stdres) corresponding to deviations from expected frequencies. HLA typing results from 59,186 individuals met the inclusion criteria, yielding 118,372 analyzable alleles. In our study population, the haplotype A*33:03-B*58:01-C*03:02-DRB1*03:01～DQB1*02:01:01G with a frequency of 4.91% was the most common. This haplotype was also the most common among Singaporean Chinese donors. Consistent with the predominant Chinese population, haplotypes with a frequency greater than 1% were also the most frequently observed haplotypes in the Singaporean population. In the Malay donor population, the most common haplotype was A*33:03～B*44:03～C*07:01:01G～ DRB1*07:01-DQB1*02:01:01G, with a frequency of 3.41%, whereas within the Indian donor population, the most common haplotype was A*01:01-B*57:01-C*06:02～DRB1*07:01-DQB1*03:03, with a frequency of 3.42%. Haplotype diversity and composition statistics within donor pools provide HLA background data required for the targeted recruitment of donors to support the hematopoietic stem cell donor requirements of the country. These data may be used in the future to devise donor recruitment strategies for optimizing the donor pool through targeted publicity and accruals.

Phenotyping of clinically significant blood group antigens among the South Indian donor population

IntroductionData on the prevalence of clinically significant antigens (Rh, Kell, Kidd, Duffy, MNSs, Lewis, P and Lutheran) among the Indian donor population is sparse. ObjectiveThis prospective study was aimed at determining the prevalence of 21 clinically significant antigens for the first time in the South Indian donor population. MethodA total of 672 regular O group blood donors were enrolled for Rh (C,c, E, e) and Kell (K) antigens typing. Of these, 188 donors were typed for other clinically significant antigens (k, Kpa, Kpb, Jka, Jkb, Fya, Fyb, M, N, S, s, P1, Lea, Leb, Lua and Lub). ResultsAntigen frequencies were expressed in percentages. In our study, R1R1 and rr were the most common phenotypes among D+ and D- donors, respectively. Among the Rh antigens, the e antigen was expressed by 97.5% and 100% of D+ and D- donors, respectively. The K antigen was found in only 0.15% of donors. In the Duffy and Kidd blood group system, Fy (a+b+) and Jk (a+b+) were the most frequent phenotypes, respectively. In the MNSs blood group system, M+N+ and S-s+ were the most common phenotypes reported. The Le (a-b+) was found to be the phenotype with the highest prevalence in the Lewis blood group system. The Lu (a-b+) was the only phenotype found in the Lutheran blood group system. ConclusionKnowledge regarding the prevalence of antigens in a given population is essential in developing cost-effective in-house panels and a rare donor registry comprising donors typed negative for a high-frequency antigen or a combination of common multiple antigens.

Probability of Finding a Matched Unrelated Donor for An Asian Indian Patient Who Needs a Stem Cell Transplant.

Abstract 4343In March 2008 we initiated a matched unrelated donor (MUD) bone marrow transplant program. Forty three searches have been performed through the National Marrow Donor Program USA (NMDP) and through the German Registry (DKMS) and completed data is available on 17 patients. High resolution HLA typing for A, B, DRB1, C and DQB1 alleles was done by Histogenetics (USA), NMDP or DKMS. Of the 17 patients for whom the search process was completed we identified a 10/10 matched donor for 7 patients, a 9/10 for 7 patients and an 8/10 for one patient. The 8/10 mismatch was at the C and DQB1 loci. Thus 15 of 17 (88%) had a suitable donor identified. After the preliminary search 2 patients were unlikely to have a donor. Of the15 matched donors, 4 were Caucasian and 11 were Asian. HLA is determined by the racial background of the individual and therefore the probability of finding a high resolution allele matched donor for an Asian Indian would have been low in registries that are predominantly Caucasian. Identification of matches from among the primarily Caucasian donor pool is interesting and may reflect a Caucasoid background in some of the population in the sub continent. In 11 out of the 17 completed searches an Asian donor was identified (61%). The NMDP has 7.5 million donors of which 553,000 are Asian and Pacific Islanders, 141,462 are South Asian, and 36,790 are Southeast Asian. These data exclude Asian donors reported as being from multiple races. Thus there was a 61% probability of finding a matched donor from among the 141,462 South Asian donors registered with the NMDP.Eleven patients have had a MUD transplant (Acute Myeloid Leukemia: 8, Acute Lymphatic Leukemia: 2 and Myelofibrosis: 1): 3 patients died before engraftment, 8 engrafted, 5 remain in remission, 2 have relapsed and one died of sepsis 100 days post transplant. The remaining four patients with matched donors are awaiting transplant.Since identification of a well-matched donor (allele matched at HLA-A, B, C, DRB1) is important for good outcome after MUD transplantation, these early search data for Indian patients suggest the need for a greater number of donors in India to be available and HLA typed in order to increase the probability of finding a suitable match for patients needing a MUD transplant.Number of SearchesDonor 10/10Donor 9/10Donor 8/10No DonorDonor M/FDonor C/ADonor CMV +/-/?Matched donor able to proceed to collection Yes/NoTransplanted187 [39%]7 [39%]1 [6%]3 [17%]12/34/119/5/411/411C- Caucasian A- Asian Disclosures:No relevant conflicts of interest to declare.

Zeroing in on the root cause of the clots in a blood bag: Reinforcing improvement in blood collection practices.

Blood clots in the packed red blood cell [PRBC] unit can sometimes go unrecognized and could eventually give rise to flow problems while administering the same. We herein report our observation of a moderately elongated threadlike clot in a PRBC unit prepared from a whole blood donated by a young Indian male donor. The PRBC unit was returned to us from the ward by the nursing staff citing "flow issues". In fact, this warranted the initiation of root-cause analysis of the entire event led by two faculty members, one post-graduate student and the technical supervisor at our blood centre.

Molecular analysis of HLA Class I and Class II genes in five different South Indian linguistic groups.

South Indians are a heterogeneous population who speak different languages and differ in their life style and physical appearance. Major population movements, social structure and caste endogamy have influenced the genetic structure of Indian populations. The human leukocyte antigen (HLA) system of populations is highly informative because of the high level of polymorphisms. Knowledge of allele and haplotype frequencies of the HLA system is important in the search for unrelated bone marrow donors. We investigated the distribution of HLA A, B, C, DRB1 and DQB1 loci in five linguistic groups from South India. HLA-A*01:01:01~B*57:01:01:01~C*06:02:01~DRB1*07:01:01~DQB1*03:03:02 was the common haplotype with highest frequency in all the five populations studied. A few relevant haplotypes were identified as most common haplotypes in each linguistic group. Comparison of HLA-A, -B and -DRB1 allele distribution in these five linguistic groups with the other Asian population showed that the South Indian populations were closely related to Sri Lankan populations. A large South Indian donor registry might serve as good source of donors for patients from Sri Lanka and vice versa.

Indian blood donor selection guidelines: Review in the context of the ongoing COVID-19pandemic.

The National Blood Transfusion Services under the aegis of the ministry of health and family welfare, India has recently issued guidelines regarding the blood donor selection criteria and the processing of blood. Care has been taken to make the blood transfusions safer. However, COVID-19has disrupted the organization of the voluntary blood donation drives, whole blood donations [WBD] and restricted the donors' movement to the blood transfusion centres all across the world. While sickness and the need for transfusions are very much in place, the gap of demand against blood collection has widened. Additionally, with the monsoon season at hand, and the categorical challenges of a dengue outbreak, the subsequent need for blood components especially the platelet concentrates is going to rise. Some of the criteria laid for deferring a blood donor from his or her WBD need a categorical revision, considering these unprecedented times. We, therefore, critically analyzed the blood donor selection criteria and hereby, suggest an updating regarding the pre-donation haemoglobin, sexually transmitted diseases, lactation, pregnancy and many such subheadings. We also suggest collecting smaller blood volumes in the blood bags for the optimal benefit of the recipients both for now and also as a measure of pandemic preparedness for future use.

Renal angiographic evaluation of prospective renal donors: Single-center data and outcome analysis from South India - A retrospective observational study

Introduction: In countries without a well-developed deceased donor program, living donors form the backbone of the renal replacement strategy. Computed tomography (CT) angiography forms an integral part of the predonation evaluation. The course, number, and morphometric evaluation of the renal vasculature provided by CT angiography help to identify which kidney to harvest and which kidney to exclude from the donation. The characteristics of the Indian renal donor are a rarely studied topic with only a few studies on the same to date. Methodology: This is an observational study done over a period of 3 years noting the clinical and morphometric characteristics of the renal donors from a database. Results: In this study, 57 prospective living renal donors were included. Most donors were women. The length of the renal artery and renal vein was shorter in this cohort than in previously known statistics. The diameter of the renal vessels was also smaller than previous data. The left side kidney was more commonly harvested compared to the right. Conclusion: Renal angiographic morphometric data among the Indian population were different from previously known statistics. Angiographic data correlated well with intraoperative findings in the majority of patients.

Characterization of age-related macular degeneration in Indian donor eyes.

Purpose:The purpose of this study was to test the reliability of fundus stereomicroscopy in postmortem eyes to assign severity of age-related macular degeneration (AMD) using the Minnesota grading and confirmation by histology using Alabama and Sarks grading scales and to assess the incidence of AMD pathology in donor eyes from a South Indian population.Methods:Eyes (199) from 153 donors (55–95 years) after obtaining fundus images were processed for histology. Fundus images were graded according to the Minnesota grading system based on drusen size, area of depigmentation, and atrophy. At least one eye from each donor displaying the AMD phenotypes were subjected to histological examination. The fundus grading was correlated with histology and the stages of AMD assigned for early AMD by the Alabama AMD grading system and for both early and advanced AMD by the Sarks classification.Results:Stereoscopic examination of the fundus found that 10 of the 153 donors had features of early AMD and 3 advanced AMD. Following histological examination, one of the early AMD eyes was reclassified as advanced AMD. Early AMD features that were observed on histology included soft drusen (>63 μm), basal laminar deposits, photoreceptor outer segment degeneration, disorganization of retinal pigment epithelium (RPE), Bruch's membrane thickening. Advanced AMD features observed in histology are extensive atrophy of RPE, choroidal neovascularization and disciform scar formation.Conclusion:Identification of either early or advanced AMD using stereomicroscopic assessment (SMA) showed high sensitivity and specificity. However, misclassification between AMD stages can occur when only SMA is used.

Outcomes of Spousal versus Parental Donor Kidney Transplants: A Comparative Study.

Introduction:Parents and spouse constitute 70% of organ donors in India. Some centres use induction immunosuppression (IS) for all spousal transplants considering it as an immunologically high risk. This study was designed to compare the outcomes of transplant recipients who received parental donors (PDs) and spousal donors (SDs) without any induction IS.Methods:It was a retrospective study conducted at a tertiary care hospital in South India. Adults aged 18 years or above who underwent renal transplantation from a SD or PD between January 2006 and December 2016 were included in the study.Results:Our study included 154 patients with PDs and 75 patients with SDs. The mean recipient age of the PD group was 27.79 ± 6.85 years and of the SD group was 45.62 ± 7.96 years (P < 0.001). However, the follow-up period was significantly higher for the PD group (P < 0.05). There was no significant difference between acute rejection, patient loss, mean survival, graft survival (uncensored), and death censored graft survival between two groups.Conclusion:The outcomes of immunologically low-risk transplant recipients who have received PD and SD are similar and induction immunosuppression can be avoided in these patients.

PREPAREDNESS TO ORGANIZING A VOLUNTARY BLOOD DONATION CAMP

Introduction: Human blood is an important element of human life with no substitute. Voluntary blood donors are the cornerstone of a secure and adequate supply of blood and blood products. The safest blood donors are voluntary, non-remunerated blood donors from low-risk populations. Blood donors in India, as across the world, are of three types; voluntary donors, replacement donors and professional donors. Most donations are as a result of replacement donations, which are non-remunerated donations, provided by the relatives of patients. Professional donors are those that donate blood in exchange for money. Replacement and professional donors could also be compelled to donate blood, though their health conditions are unsuitable to donate blood. They do not help to maintain a stock of blood for emergency situations. Moreover, they do not provide rare blood groups. These points are indicating the necessity and importance of voluntary blood donations. The success of blood donation camp depends on people that organize the camp and bank team. Aim: The aim of this report is to debate about the importance of voluntary blood donation and to guide the camp organizer, medic, and also other team members involving in voluntary blood donation camp to arrange the camp efficiently. Discussion: The aim of blood donation camp is to pick an appropriate donor whose blood is safe to the recipients, and who himself shall not in any way be harmed by blood donation. Outdoor voluntary blood donation camps in India are organized in three phases. They are pre-camp phase, camp phase, post-camp phase. Conducting voluntary blood donation camp in the regular basis will increase the stock of blood units in bank which is required for optimum functioning of the health-care system. Conclusion: The organization of blood donation camp should be best and safe to the patient/recipients and to the donor also. With increase in population and development of more advanced medical and surgical procedures, the necessity for blood is ever increasing. Only voluntary blood donors can help to take care of an adequate supply of blood to save lots of the lives of these who in need. They were the sources of safe blood also.

Analysis of Donor Safety in High Yield Plateletpheresis Procedures: An Experience from Tertiary Care Hospital in South India.

The apheresis platelets are the preferred blood components for the thrombocytopenic hemato-oncology patients. The one of the important factors for post transfusion increment is the dose of the platelet product infused. The minimum platelet product yield is defined but the amount of maximum possible platelets collection from a single donor is not universally defined. There is lots of apprehension in our country for apheresis procedures harvesting more than a standard unit. This retrospective observational study was conducted to determine safety of high yield plateletapheresis collection among Indian donors This retrospective observational study was conducted for a period of 15months including all consecutive plateletapheresis procedures. The informed consent had been obtained from all donors including high yield plateletapheresis (Yield ≥ 5 × 1011). The apheresis product was subjected to platelet count. The donor adverse reactions were recorded along with procedural details. Post procedure complete blood count was done for the donors who consented for post procedure blood sample draw A total 569 procedures were performed during this period including 174 high yield procedure. The 526 procedures were analyzed for adverse donor reactions. The 43 were excluded for adverse donor reaction analysis due to yield less than 3 × 1011 (n = 43). The adverse reactions rate between high yield procedures (18/174, 10.34%) and normal yield (20/352, 5.68%) were not statistically different (p = 0.052). The phlebotomy related complication (3.23%) followed by citrate toxicity (2.28%) were the two most common adverse reaction observed. The adverse reactions associated with high yield plateletapheresis procedures are comparable to normal yield procedures in term of overall adverse reactions observed and post procedural platelet counts. This can be beneficial to patients by providing products of greater yield.

Assessment of rhesus and kell blood group antigens, phenotypes, and their allelic frequencies in North Indian blood donors

BACKGROUND:Prevalence of rhesus (Rh) and Kell antigens in a population vary with race, ethnicity, and geographical location. With advances in immunohematology, non-D antigens, and their corresponding antibodies are increasingly being found to be culprits for alloimmunization.MATERIALS AND METHODS:Assessment of the phenotype of Rh and Kell blood group antigen in the healthy donor population from North India was done, and estimation of the frequencies of these alleles in our population was performed.RESULTS:The most common antigen in the North Indian donor population was “e” (95.6%) followed by “C” (89.6%), “c” (57.7%), and “E” (17.29%) in that order. The most prevalent phenotype in the Indian population was found to be “CDe” followed by “CcDe” and “CcDEe.” “K” antigen was found to be positive in 1.81% of the population.DISCUSSION:Knowledge of the Rh antigen profiles in a given population can be very helpful in formulating transfusion guidelines specific to a particular population with an aim to minimize the cost and maximize the benefits. With this aim in mind and considering the problems encountered in developing countries like ours, we conducted Rh and Kell antigen profiling of donors. Comparative analysis with other population studies and implications for transfusion protocols is evaluated.CONCLUSION:Assessment of Rhesus antigen profile of a particular population is useful to develop cost effective ways of providing maximum benefits of blood transfusion with least resources.

333.5: Organ donation by foreign donors in India.

Background: Inward foreign tourism in India is on the rise and the tourists are equally at risk of fatal road accidents and stroke leading to brain death. This provides an opportunity for organ donation; however, no guidelines are available on how to proceed in such cases. The Transplantation of Human Organs Act 1994 is silent on this aspect. This paper seeks to lay down recommendations and guidelines for hospitals, healthcare professionals, Transplant Coordinators and the state machinery allocating such organs on how to proceed with such cases. Methods: Three such donations by foreign nationals in India were examined and based on the experience of coordinating them, guidelines have been drawn up. Results: It was seen that families agreed readily where the individual had expressed the desire to be an organ donor (by opting the same on the driving licence or coming from a country that follows presumed consent). Effective counselling also encouraged consent in case of no prior wish. However, absence of guidelines and standard protocols creates confusion. Conclusions: In order to increase the donor pool, donations from foreign nationals in India should be streamlined. Also, from a human rights perspective, India needs to enable the choice of organ donation for every person who is declared dead within its territory.

Impact Analysis of the National Guidelines for Blood Donor Selection in India: A Single Center Study.

National Blood Transfusion Council recently released the national guidelines for blood donor selection in India. Some changes in the currently used donor selection criteria have been proposed. However, its effect on future donor availability and deferral has not been studied. To enumerate the changes in current donor selection criteria and analyze its impact on the future blood donor availability vis-à-vis current deferral rate. One year data for both selected and deferred whole blood donors was analyzed retrospectively. Questionnaire forms of the selected donors were screened to analyze the responses given at the time of donation. A total of 4494 donors presented for whole blood donation and 995 (22.1%) were deferred for the various reasons. NBTC has proposed 12 major changes in the currently used donor selection criteria with 11 resulting into increased deferral of the blood donors. These changes would lead to an additional deferral of 32.5% of the currently eligible blood donors mostly due to the change in the blood pressure cut off. National blood donor selection guidelines in the current form would lead to a very high deficit of available blood donors in India. There is an urgent need to reconsider the merit of the changes suggested in these guidelines.

Nucleic acid amplification test: Bridging the gap in blood safety & re-evaluation of blood screening for cryptic transfusion-transmitted infection among Indian donors.

Background & objectives:Nucleic acid amplification test (NAT) in blood donor screening not only detects window period (WP) donors but also those with chronic occult infections which are negative by routine serological screening. This study was conducted to determine the time trend of NAT positivity and seroprevalence of transfusion-transmitted infections (TTIs) through a period of six years and evaluate the strength of NAT as a supplementary test in identifying the cryptic carriers in blood donor population.Methods:A total of 1,01,411 blood donations were screened between January 2011 and December 2016 by the ELISA and individual donor (ID) NAT Procleix Ultrio Plus Assay. Additional molecular and serological assays were done on the NAT yield samples to differentiate the type of cryptic carriers.Results:NAT yields comprised 0.05 per cent (50/101411) of the total samples tested with a yield rate of 1/2028. Hepatitis B virus (HBV) contributed to 80 per cent of the total NAT yields and the rest 20 per cent due to hepatitis C virus (HCV). Majority of HBV NAT yields (75%) were from chronic occult donors and 25 per cent were WP donors. Both HBV and HCV NAT yields had a wide range of viral count. There was no HIV NAT yield. A significant decline in the prevalence rate of TTIs through the study period of six years was observed.Interpretation & conclusions:The cryptic infections found in blood donors increase the risk of TTIs. Blood screening by both serology and NAT can reduce this threat.

Matched unrelated donor hematopoietic progenitor cell transplantation: A report based on a single registry in India

IntroductionCurrently, more than 10,000 matched unrelated donor transplants (MUDT) are performed annually worldwide. India has recorded a significant increase in the number of hematopoietic progenitor cell transplantation (HPCT) centers reporting transplants. The number of HPCTs increases by approximately 10% every year, with 1878 transplants reported by Indian stem cell transplant registries in 2016. However, published outcome data of MUDT in India are scant, with reports limited to autologous and allogenic matched unrelated transplants, which motivated us to present our MUDT data. Aims and objectiveTo review the operations, and more importantly, the patient outcome data of a new registry in India. Materials and methodsWe accessed an Indian HLA donor database with high-resolution HLA typing results of 7682 (until 31st July 2018) volunteer HLA donors. The typing results were uploaded to proprietary software. The search result was considered a “match” when a 10/10 potential HLA match was found. Patients who were found to be alive through mail communication and did not exhibit signs and symptoms of disease were considered to have disease-free survival (DFS). ResultsDuring the six years of operations of the database, 1165 searches resulted in 68 10/10 matches from the registry. Of these, 11 were MUD HPCT records. At a minimum follow-up of almost 11 months, seven recipients continue to exhibit DFS. ConclusionsThe patient DFS data prove that even a small registry with slightly more than 7000 donors can yield reasonably good patient outcomes.

A descriptive study of community-based profile and attitudes of body donors of an urban conglomeration in Western India

BackgroundBody donation is considered an altruistic act done by people for advancement of science. There has been a significant depreciation in the availability of cadavers for teaching and research all over the world. Unlike India, many countries have studied the profile and attitudes of potential body donors to improve body donation. With a huge health sector, this Indian study studied the profile and attitudes of body donors and their role in aiding science through body donation. MethodsFour hundred thirty-one survey forms with informed consent were sent to registered body donors. The questionnaire focused on demographic parameters and their perception on body donation. The data were collated, compared and interpreted with similar studies done worldwide. ResultsThe study shows an interesting pattern among the Indian donors in comparison to the West. An Indian donor is a male individual in 70s, highly educated and religious with good social background. Despite many similarities, there are important distinguishing features unique to our country and many myths surrounding body donation. ConclusionThe Indian donor is highly educated male and charitable with strong belief in God. He believes in aiding medical science through body donation.