Challenges and Possible Solutions to Donation After Circulatory Death in Turkey and the Middle East: Panel Discussion Summary Report.

The 20th century has witnessed the development of tissue and organ transplantation as the best therapeutic option for end-stage organ failure; however, organ shortages remain a prominent worldwide issue. Donation after circulatory death is an accepted practice in several countries around the world but also poses many challenges. Presently, controlled donations after circulatory death are not really in practice in Turkey and the Middle East, and the implementation of this practice seems complicated. To gather information about the possible reasons underlying the lack of organs from donors after circulatory death, as well as solutions, a discussion session took place during the International Symposium on "Brain Death and Circulatory Death" on November 29-30, 2023, in Ankara, Turkey. A description on different topics that were discussed is presented.

Impact of Religion on Opinions About Organ Donation and Transplantation in University Students From a Single University in Turkey.

OBJECTIVES: The objective of the present report was to analyze the opinions, attitudes, and practices of Baskent University students with regard to the impact of religion on organ donation and transplantation. MATERIALS AND METHODS: We sent a web-based, 5-point Likert scale questionnaire (1: strongly disagree; 5: strongly agree) to capture the opinions and attitudes toward organ donation and transplantation after participants attended or did not a panel discussion on these topics. RESULTS: We sent 361 E-mails and received 69 responses, of which 46 students attended the panel discussion. Most of the participants who attended were part of the faculty of medicine. Participants who did not attend were composed of students from other faculties at Baskent University. Religion played less of a role with regard to opinions on organ donation in those who did not attend. Of the attendees, 54.3% strongly agreed to become organ donors, 50% believed in the important role of religion in organ donation, and 54.3% believed that media sources play important roles in shaping public opinion on organ donation. The majority felt comfortable discussing organ donation with family and friends. CONCLUSIONS: Although religion has an undeniable effect on the decision-making process, our survey showed that more than half of the participants were willing to become organ donors. Education, through the joint efforts of medical and religious scholars, as well as the media, should contribute to raising awareness on organ donation, thus contributing to increased access to transplantation worldwide.

Management of chronic allograft nephropathy: a systematic review.

Despite improving immunosuppressive protocols in renal transplantation, chronic allograft nephropathy (CAN) remains a major impediment to long-term graft survival. The optimal immunosuppressive regimen for a patient with CAN is unknown. The aim of this study is to evaluate the various immunosuppressive management strategies of biopsy-proven CAN and of chronic allograft dysfunction (CAD) (no biopsy). A systematic review of randomized trials (n = 12 trials with 635 patients) was conducted. Studies included patients who were >6 mo post-transplant. All patients were on a calcineurin inhibitor (CNI), most often cyclosporine, and were randomized to convert to mycophenolate mofetil (MMF), tacrolimus, or sirolimus (Rapa) or to add azathioprine, MMF or Rapa to their current regimen. Follow-up time was 6 to 36 mo. The outcome measures evaluated were renal function in 11 of 12 studies and repeat renal biopsy results in one study. The methodological quality scores of the trials were generally low, using the Jadad scale (median value 2/5). Results varied between studies but suggested that CNI withdrawal is safe and that conversion to MMF or Rapa may be beneficial. The incidence of adverse effects ranged from 0% to 68% between the studies, and medication withdrawal occurred in 0% to 24% of patients. The review did not result in a consensus regarding the management of CAN and CAD. Further studies are required to determine the best therapeutic option for patients with CAD and CAN.

Effect of hyaluronan on xenotransplanted breast cancer.

Hyaluronan is a major glycosaminoglycan component of the extracellular matrix and CD44 is its principal ligand. In previous in vitro studies we have shown that CD44 and hyaluronan are involved in the invasive properties of the human breast cancer cell line Hs578T. The aim of this study was to test whether experimental therapy with hyaluronan interferes with tumor invasion and has an inhibitory effect on tumor growth in vivo. The Hs578T cell line was xenotransplanted orthotopically into the mammary fat pad of nu/nu mice. After tumor growth reached a maximum size of 5 x 5 mm, 50 microg of hyaluronan was injected intratumorally. The tumors of control nu/nu mice were injected with PBS. Four of 12 tumors from the hyaluronan-treated group regressed completely. This effect could be due to a saturation of the hyaluronan-binding sites on tumor cells or to an acceleration of tumor rejection by a non-T-cell-dependent mechanism. This study gives a rationale for future work on the antineoplastic effects of hyaluronan.