Vivek Balkrishna Kute

Background: Tuberculosis remains a principal cause of morbidity and mortality after kidney transplantation across South and Southeast Asia, where tuberculosis infection is prevalent. India carries one‐quarter of the global tuberculosis burden, yet transplant‐specific guidance for high‐burden settings is scarce. The Indian Society of Organ Transplantation (ISOT) convened a multidisciplinary expert panel to formulate consensus recommendations for the management of tuberculosis infection in kidney transplantation. Methods: A multidisciplinary panel undertook a structured, evidence‐informed consensus process, appraising MEDLINE, EMBASE, Scopus, the Cochrane Library, and national tuberculosis program documents. Statements were refined through successive revision rounds, panel discussion at the ISOT Mid‐Term Conference (Bengaluru, May 2026), and confirmation by all authors, preceding executive committee endorsement. Each statement received an evidence level (1–5) and, where actionable, a recommendation strength. Results: The panel formulated 36 consensus statements across 11 domains. Routine pre‐transplant screening for tuberculosis infection is endorsed, with exclusion of tuberculosis disease before treatment of tuberculosis infection. The interferon‐gamma release assay (IGRA) is preferred, given confounding of the tuberculin skin test by bacille Calmette–Guérin (BCG) vaccination; a Mycobacterium tuberculosis ‐specific antigen‐based skin test (Cy‐Tb) is an acceptable alternative where IGRA is unavailable or unaffordable. Isoniazid‐based regimens are preferred, as rifampicin reduces calcineurin‐inhibitor exposure; isoniazid resistance, hepatotoxicity, and hepatitis C co‐infection warrant individualized therapy. Conclusion: This first India‐specific, society‐endorsed position statement provides context‐adapted recommendations for the management of tuberculosis infection in kidney transplantation and may inform adaptation in other high‐burden settings; prospective multicenter studies are needed. image

Background.: Widely accessible education on organ donation and transplantation (ODT) is a tool to reduce waiting lists, as <10% of transplant needs are met (Global Observatory on Donation and Transplantation). We aimed to assess the current state of access to education on ODT worldwide. Methods.: We surveyed transplant physicians and surgeons worldwide. Respondents were classified according to the mean deceased donation (DD) rate per million population (PMP) of their countries from 2016 to 2021 (excluding 2020): Group (G) 1 (G1) no DD reported, or no data provided to Global Observatory on Donation and Transplantation; (G2) <10 DD PMP; (G3) 10–19.9; (G4) 20–29.9; and (G5) ≥30. We inquired about the availability of education on ODT in countries and regions. Results.: We analyzed 311 respondents. We observed that the availability of education on ODT was as follows: in postgraduate education (77.2% in countries, 70.4% in regions), in undergraduate medical school (52.8%, 50.6%), in elementary school (14.2%, 14.2%), in high school (24.6%, 25.7%), and for the public (58.8%, 57.2%). The highest challenges were observed mainly in countries with lower DD rates. Conclusions.: This worldwide survey suggests that there are areas for improvement at a global level in education on ODT, spanning from schoolchildren to the public and from undergraduate to postgraduate medical students. This is a “Call to Action” to close the global education gap.

Background.: Global organ shortage is well documented; yet systemic barriers constraining access to transplantation remain poorly defined. Our study aimed to identify and map these barriers. Methods.: A web-based survey was conducted from May 2022 to March 2023 among physicians and surgeons involved in organ donation and transplantation (ODT) from transplantation societies worldwide: (1) Hospital structure, legislation and policies, and financial barriers, addressed to program directors; (2) Questions on education on ODT directed to all participants, and questions about donor acceptance for transplant specialists; (3) Questions on donor identification for critical care specialists and questions about organ acceptance directed to transplant specialists; (4) Demographic questions for everyone. Respondents were grouped according to the mean deceased donation (DD) rate per million population from years 2016 to 2019 and 2021: Group (G) 1 (G1) No DD reported, or no data provided to global observatory on donation and transplantation; (G2) <10 DD per million population; (G3) 10–19.9; (G4) 20–29.9; (G5) ≥30. Results.: We present answers from program directors. There were 150 program directors from 438 respondents. Financial barriers ranked highest, negatively affecting access to transplantation worldwide. G1 indicated the highest percentage of challenges. Those from G4 and G5 provided the least amount of challenges; however, training programs remain areas for improvement. Responses from G2 and G3 were similar, positioned between those from G1, and G4 and G5. Conclusions.: The organ shortage emergency is exacerbated by parallel system-level deficiencies. This global survey identifies specific, actionable deficits that must be addressed to build equitable transplant systems worldwide.

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