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In theory, a commercial market for kidneys could increase the scarce supply of transplantable organs and give impoverished people a new way to lift themselves out of poverty. In-depth sociological work on those who opt to sell their kidneys reveals a different set of realities. Around the town of Sarghoda, Pakistan, the negative social and psychological ramifications of selling a kidney affect not only the vendors themselves, but also their families, communities, and even the country as a whole. [ABSTRACT FROM AUTHOR]

Background: The importance of including bioethics in the medical curricula has been recognized globally. Certain countries including Pakistan continue to lag behind although some developments have occurred recently., Objectives: The research aimed to provide a snapshot of bioethics education in undergraduate medical colleges in Karachi, Pakistan. The secondary objectives included identifying factors promoting or inhibiting integration of bioethics into the curriculum., Methods: A two-pronged strategy was used to collect data including a website review of medical colleges, in existence for more than ten years, recognized by the Pakistan Medical and Dental Council (PMDC), the regulating body for undergraduate medical education in Pakistan. The other arm employed in-depth interviews with medical educationists in colleges fulfilling inclusion criteria. Data from the website was analyzed and presented as frequencies. Qualitative data was analyzed using content analysis method which involved coding of transcripts, multiple readings and arriving at subthemes and themes iteratively., Results: Thirteen medical colleges were included for the website review, of which four were from public sector. Three medical colleges used the word "ethics" in their vision and mission statement and four had provided a detailed curriculum for ethics on their website. Thematic framework included four broad themes: 1) Need for Bioethics Education, 2) Current Status of Bioethics Education 3) Challenges in integration of bioethics in medical curriculum and 4) Recommendations for integration of bioethics in the Curriculum. Participants were in agreement that bioethics was important in development of future physicians. Participants identified various challenges, foremost being shortage of trained faculty, lack of institutional buy-in and overcrowded curriculum., Conclusion: The study identified sporadic inclusion of bioethics in undergraduate medical curricula, left to the discretion of individual institutions. Since Karachi is a cosmopolitan city, the findings may reasonably reflect the situation in other parts of the country. While bioethics is recognized as an important field, it will continue to remain an orphan subject in the curricula unless the regulatory and accreditation bodies make it compulsory for institutions to include ethics in their curricula., (© 2024. The Author(s).)

Objective: To assess the views of health service providers towards coronavirus disease 2019 vaccination with Cansino, Sinovac and Sinopharm vaccines., Methods: The analytical cross-sectional study was conducted at the Sindh Institute of Urology and Transplantation, Karachi, in May and June 2021, and comprised doctors, nurses, technical staff, and medical social officers. Data was collected using a questionnaire, in Urdu and English languages, assessing determinants of hesitancy. Data was analysed using SPSS 19., Results: Of the 331 subjects, 156(47%) were males and 175(53%) were females. Overall, 183(55%) subjects were aged <30 years, and 7(2%) were aged >60 years. Among the responders, 274(83%) were vaccinated, 49(15%) wanted to delay, and 8(2.4%) were outright refusers. Among the hesitant, 43(80%) were women, and 56(98%) were aged <40 years. Age, gender, occupational group and personal experience with the disease had significant correlations with vaccination status (p<0.05). Personal safety 202(74%) followed by the perception of official requirement 162(59%) were the prime reasons for getting vaccinated. No respondent cited religious inhibitions or social media as the reason behind vaccine refusal., Conclusions: A lack of trust in the safety and efficacy data of the available Chinese vaccines appeared as a factor inducing hesitancy. The resistance of younger respondents, especially trainee physicians, was a finding of concern since they form the backbone of the health system in the country.

Running bioethics workshops one after the other can become a mundane affair, primarily because of the similarity of their content and discourse. However, conducting a workshop for participants from conflict zones such as Palestine provided an entirely new perspective for this author. While the bioethics discourse may translate into useful and actionable guidelines in the free world to help uphold human dignity, to those living in occupied territories and conflict zones, in the face of their lived lives, it appears little more than a self-serving academic exercise by "parachute bioethicists".

Biobanking is an important tool for biomedical research. However, it raises a variety of ethical issues, which are compounded in the developing world. This paper is based on data from three sources on the ethical issues associated with biobanking, including a mixed method pilot study conducted with students in Karachi, Pakistan, a workshop in Karachi, and another workshop held in Bengaluru, India. Findings from these sources reveal a unanimous lack of clarity about what constitutes a biobank. While informed consent was deemed necessary for storage of materials, participants were unsure of how this could be achieved for samples stored indefinitely for future research. Although study participants showed limited understanding of genetic research, concerns were raised in the Karachi workshop. A majority of survey participants found it acceptable to transfer biospecimens across borders, but possibility of misuse was highlighted in both workshops. This paper reveals ambiguities with respect to ethical challenges of biobanking, indicating the need for further discourse.

The success of degree-level bioethics programmes, a recent development across the world, is generally evaluated on the basis of their quantifiable impact; for instance, the number of publications graduates produce. The author conducted a study of Pakistani graduates who had pursued a higher qualification in bioethics, and on the basis of the respondents' written and verbal narratives, this paper presents an analysis of their perceptions of the internal impact of bioethics degree programmes. Using these narratives, the paper also analyses the reactions of their colleagues to their new qualification.The respondents reported significant changes in their thinking and actions following their education in bioethics. They exhibited more empathy towards their patients and research subjects, and became better "listeners~ They also reported changes in practices,the most significant being the discontinuation of the linkages they had established with pharmaceutical firms to seek support,because of concerns related to conflict of interest. Although some respondents believed that their new qualification was generally welcomed by their colleagues, who considered them aesthetics resources, others reported that their colleagues harboured unreasonable and impractical expectations from them, and that these were impossible to fulfil. They also got the feeling of being ostracized and regarded as "ethics watchdogs~ Whereas the internalisation of bioethics is an encouraging finding in this cohort, the mixed reception that bioethics and those involved in it received indicates a Jack of understanding of the field and is a source of concern.

Despite the majority opinion of Muslim jurists that organ donation is permitted in Sharia, surveys indicate continuing resistance by lay Muslims, especially to donating organs following death. Pakistan, a country with 165 million Muslims, currently reliant on live donors, is considering steps to establish deceased donor programs which will require public acceptance and support. This article analyzes the results of in-depth interviews with 105 members of the public focusing on opinions and knowledge about juristic rulings regarding kidney donations, donor-family dynamics in deceased donation decisions, and attitudes towards buying kidneys. The objective was to determine the influence if any of cultural and religious values, and norms of traditional family structures and kinships, on decisions to donate. Study participants view donation of kidneys, particularly from the deceased, through a different lens from that used by jurists and physicians, one that also does not conform to familiar paradigms defining ethical organ donation. A socially modulated understanding of Islam passed down the generations, and longstanding family-centric norms, shape the moral worldview of many rather than academic juristic rulings or non-contextual concepts of autonomy and rights. The results of this study also highlight that medical science may be universal but its application occurs within particularities of cultural and religious values, social constructs of the self and its relationship with others, and different ways in which humans comprehend illness, suffering, and death. These findings are of relevance both to transplant related professionals and bioethicists involved with this field., (© 2012 John Wiley & Sons Ltd.)

The concept of mandatory ethical review of research involving human participants is gradually taking root in Pakistani institutions. Based on the opinions of Institutional Review Board (IRB) members from institutions across the country, the process faces several challenges which threaten its integrity. The lack of registration or accreditation for IRBs has resulted in a wide variation in the calibre and working of such Boards. Despite the recent growth in numbers of people with formal bioethics degrees in the country, a majority of membership remains without any formal training for the work expected from them in ethical review. External pressures to influence deliberations, conflict of interest issues within board leadership and inconsistent application of review requirements all contribute in undermining the reliability of the process. Some of the most significant threats to independent and uninfluenced functioning of such boards arise from institutional leadership itself. In the opinions of IRB members, the review process has to be uniform, consistent and trustworthy if it is to gain the respect of researchers, and IRB need to be given the autonomous space to make independent decisions. Otherwise there is a real danger of IRBs being relegated to being no more than rubber stamping committees.

Objective: To assess knowledge and perceptions of plagiarism in medical students and faculty of private and public medical colleges in Karachi., Methods: A questionnaire based study was conducted on groups of 4th year medical students and medical faculty members. Group A consisted of medical students while group B comprised faculty members. The questionnaire contained 19 questions that assessed knowledge and attitudes of the respondents regarding various aspects of plagiarism., Results: The total number of medical students (Group A) studied was 114 while the faculty number (Group B) was 82. Nineteen percent Group A and 22% of Group B displayed the correct knowledge about referencing materials from the internet or other sources. Seventeen percent of respondents in Group A and 16% in Group B had correct information about the use of quotation marks when incorporating verbatim phrases from external sources. Regarding Power Point presentations, 53% of respondents from Group A and 57% from Group B knew the appropriate requirements. There was a statistically significant difference among the two groups regarding the issue of self plagiarism, with 63% of respondents in Group A and 88% in Group B demonstrating correct understanding. Both groups showed a general lack of understanding regarding copyright rules and 18% of Group A and 23% of respondents in Group B knew the correct responses. Eighteen percent of respondents in Group A and 27% in Group B claimed to have never indulged in this practice., Conclusion: There is a general lack of information regarding plagiarism among medical students and faculty members.

Informed consent enjoys an unassailable position in both clinical and research situations as a safeguard of patients' rights. Keeping the patient involved in the decision making process is easier when there is direct communication with the individual. The Pakistani milieu offers challenges to this process because crucial decision making is often done by family members or is left entirely up to the attending physician. There seems to be a general acceptance of this shifting of focus from the individual to other players. This also raises certain ethical dilemmas for physicians who may feel uncomfortable with communication which excludes the patient or in accepting a paternalistic primary decision making role. The objective of this informal qualitative study was to ascertain physicians' perceptions regarding the process of information delivery to the patient in the Pakistani context and the various influences acting upon it.

Health research for progress in the control and conquest of disease afflicting man is unquestionable. Concerns arise when motives other than the advancement of scientific knowledge and benefit for individuals and society are the driving force behind clinical trials. These conflicts of interests become even more pronounced when dealing with populations rendered vulnerable by virtue of poverty and ignorance. South Asia with its teeming millions represents one such region. This essay examines the reasons that make this population vulnerable to exploitation. Informed consent in the process of research is an area where such conflicts are prone to arise. In order to ensure that conflicting interests of researchers and funding agencies are kept in check, the processes of informed consent and ethical review of research need to be strengthened. Suggestions are put forward to modify the consent process to match the needs of South Asia and to strengthen the ethical review process for safeguarding the rights of the study subjects. But perhaps the most important safeguard against exploitation is the virtuous researcher himself with noble intentions.

Objective: To review the experience in the use of Intra Aortic Balloon Pump (IABP) in patients undergoing Coronary Artery Bypass Grafting (CABG) at a tertiary care hospital with a new Open Heart surgery program., Design: Retrospective study., Setting: The Aga Khan University Hospital, Karachi., Patients: Medical records of all patients undergoing CABG between November 1994 and July 1997 were reviewed and those in whom IABP device was used, were included in this study., Results: A total of 15 patients had IABP support during the study period. Four surgeries were done urgently while two were emergencies. There were three mortalities. Ejection fractions in all but one patient were impaired. Among the surviving patients, the average pre-IABP Cardiac Index was 2.6 litres/min/meter2 which registered an average increase of 21.15% after the initiation of the IABP. The Pulmonary Artery Wedge Pressure also showed an average reduction of 29.11% from the pre IABP levels reflecting an increase in the cardiac output with the use of the IABP., Conclusion: This series represents the early experience of a new cardiac surgery center in Pakistan in the use of IABP. Although the numbers in this study are too small to derive any conclusions, the overall morbidity and mortality in this short series are within acceptable limits in the high risk patients included.

Urolithiasis is a major source of morbidity in children of the third world. Since its advent in 1982 and despite uncertainties about the long-term effects on the kidney, extracorporeal shock wave lithotripsy (ESWL) has rapidly replaced traditional surgery in the management of this condition. A retrospective study was conducted to compare the outcome of ESWL with that of open surgery in the management of paediatric urolithiasis in a single institution between November 1988 and December 1991. Emphasis was placed on the rate of stone clearance, complications, duration of follow-up, and cost of treatment of each modality. A total of 83 patients under 14 years of age underwent management of 101 stones; the stones were located in the kidneys (63), ureters (13), or bladder (25). Thirty-one patients who enrolled directly through the Lithotripsy Clinic underwent a total of 65 ESWL sessions for 44 calculi (mean, 2.1 sessions per patient). The overall stone clearance rate was 82%, with an 83% clearance rate for renal stones. There were three failures. Nine patients did not return after the first ESWL session, and by the end of 6 months, 93.5% were lost to follow-up. The cost of ESWL ranged from $600 to $1,000 (mean, $780). Fifty-two children were managed through the Pediatric Surgery Clinic and underwent open surgery (57 stones). The overall stone clearance rate was 96%, with a clearance of 88% for renal calculi. There were two wound infections and no deaths. All patients returned for the first follow-up visit, but by the end of 6 months, only 34.5% were available for follow-up. The total cost of treatment ranged from $520 to $900 (mean, $580). The authors believe that with the present level of knowledge, use of the lithotriptor should be restricted to children with small stones and/or those for whom long-term follow-up is possible.