Toxicological profile and potential health concerns through metals and trace elements exposure in brick kiln workers from Lahore, Pakistan.

This study examined levels of lead (Pb), cadmium (Cd), chromium (Cr), copper (Cu), mercury (Hg), and arsenic (As) in blood, hair, and nails of 18 brick kiln workers from three brick kiln units located around a metropolitan city, Lahore, Pakistan. All the trace elements except Hg and As were detected in the studied matrices of Brick kiln workers. In general, brick kiln workers reflect the highest concentration of Pb, followed by Cd, Cr, and Cu. Of the pollutants analyzed, Pb has the highest mean (min-max) concentrations at 0.35 (0.09-0.65) in blood (µg/mL), 0.34 (0.14-0.71) in hairs (µg/g), and 0.44 (0.32-0.59) in nails (µg/g) of brick kiln workers. Following Pb, the trend was Cd 0.17 (0.10-0.24), Cu 0.11(0.03-0.27), and Cr 0.07 (0.04-0.08) in blood (µg/mL), followed by Cr 0.11(0.05-0.20), Cd 0.09 (0.03-0.13), and Cu 0.08 (0.04-0.16) in hairs (µg/g) and Cu 0.16 (0.05-0.36), Cd 0.13 (0.11-0.17), and Cr 0.10 (0.05-0.14) in nails (µg/g) respectively. Relatively higher concentrations of metals and other trace elements in blood depicts recent dietary exposure. The difference of trace elements except Pb was non-significant (P > 0.05) among studied matrices of workers as well as between Zigzag and traditional exhaust-based brick kilns. The concentrations of Pb, Cd and Cr in blood of brick kilns workers are higher than the values reported to cause health problems in human populations. It is concluded that chronic exposure to metals and other trace elements may pose some serious health risks to brick kiln workers which needs to be addressed immediately to avoid future worst-case scenarios.

Acute Viral Hepatitis E Infection Complicating Postliving Liver Donor Hepatectomy Recovery.

This study presents a case of a living liver donor who developed a hepatitis E virus (HEV) infection postdonation, complicating his recovery. The donor was a 28-year-old male with no prior health issues who underwent a right lobe hepatectomy. Initially, his postoperative course was uneventful, but on the third postoperative day, he became lethargic and icteric. Laboratory tests showed elevated liver function markers, with peak levels on the 5th day. The HEV infection was confirmed through serological and polymerase chain reaction (PCR) testing. The donor was managed supportively and recovered, with normal liver function at discharge. Unfortunately, the recipient of the liver graft died on the 5th postoperative day due to sepsis, and the impact of HEV infection on the recipient could not be fully assessed due to the complicating factors. This case highlights the importance of considering HEV infection in donors with abnormal postoperative liver functions, especially in regions with high HEV prevalence, and suggests the potential benefit of HEV vaccination for liver donors. Further research is needed to better understand and manage HEV infection in the context of liver donation.

Safety and efficacy of extended thrombophilia screening directed venous thromboembolic events (VTE) prophylaxis in live liver donors: do we really need extended thrombophilia screening routinely?

Background and aims: The study aimed to determine the prevalence of hereditary thrombophilia, and stratify its severity among live liver donors in Pakistan. Also, the authors evaluated the safety and efficacy of thrombophilia profile testing directed venous thromboembolic events (VTE) prophylaxis while balancing bleeding risk and the need for routine thrombophilia testing before live liver donation among living donor candidates. Materials and methods: Protein S (PS), protein C (PC), anti-thrombin (AT) III, and anti-phospholipid antibody panel (APLA) levels were measured in 567 potential donor candidates. Donors were divided into normal, borderline and high-risk groups based on Caprini score. The safety endpoints were VTE occurrence, bleeding complications or mortality. Results: Among 567 donors, 21 (3.7%) were deficient in protein C, and 14 (2.5%) were deficient in anti-thrombin-III. IgM and IgG. Anti-phospholipids antibodies were positive in 2/567 (0.4%) and 2/567 (0.4%), respectively. IgM and IgG lupus anticoagulant antibodies were positive in 3/567 (0.5%) and 3/567 (0.5%), respectively. VTE events, bleeding complications and postoperative living donors liver transplantation-related complications were comparable among the three donor groups (P>0.05). One donor in the normal donor group developed pulmonary embolism, but none of the donors in either borderline or high-risk group developed VTE. The mean length of ICU and total hospital stay were comparable. No donor mortality was observed in all donor groups. Conclusions: Due to thrombophilia testing directed VTE prophylaxis, VTE events were comparable in normal, borderline and high-risk thrombophilia donor groups, but more evaluations are required to determine the lower safe levels for various thrombophilia parameters including PC, PS and AT-III before surgery among living donor candidates.

Formulation and characterization of glipizide solid dosage form with enhanced solubility.

Glipizide, a poor water-soluble drug belongs to BCS class II. The proposed work aimed to enhance the solubility of glipizide by preparing solid dispersions, using polyvinyl pyrrolidone (PVP) and polyethylene glycol (PEG). Solvent evaporation method was used for the preparation of glipizide solid dispersions. Solid dispersions were prepared in four different drug-to-polymer ratios i.e. 1:1, 1:2, 1:3 and 1:4. Mainly effect of three polymers (PVP K30, PVP K90 and PEG 6000) was evaluated on the solubility and dissolution of glipizide. The in-vitro dissolution of all prepared formulations was performed under pH 6.8 at 37°C using USP type II apparatus. In-vitro dissolution results revealed that the formulations having high concentrations of the polymer showed enhanced solubility. Enhancements in the solubility and rate of dissolution of the drug were noted in solid dispersion formulations compared to the physical blends and pure drug. Solid dispersions containing polyvinyl pyrrolidone exhibited a more favorable pattern of drug release compared to the corresponding solid dispersions with PEG. An increase in the maximum solubility of the drug within the solid dispersion systems was observed in all instances. Two solid dispersion formulations were optimized and formulated into immediate-release tablets, which passed all the pharmacopoeial and non-pharmacopoeial tests. Fourier transformed Infrared (FTIR) spectroscopy X-ray diffraction (XRD) and Differential scanning calorimetry (DSC) were used to indicate drug: polymer interactions in solid state. Analysis of the solid dispersion samples through characterization tests indicated the compatibility between the drug and the polymer.

Space-qualifying silicon photonic modulators and circuits.

Reducing the form factor while retaining the radiation hardness and performance matrix is the goal of avionics. While a compromise between a transistor's size and its radiation hardness has reached consensus in microelectronics, the size-performance balance for their optical counterparts has not been quested but eventually will limit the spaceborne photonic instruments' capacity to weight ratio. Here, we performed space experiments of photonic integrated circuits (PICs), revealing the critical roles of energetic charged particles. The year-long cosmic radiation exposure does not change carrier mobility but reduces free carrier lifetime, resulting in unchanged electro-optic modulation efficiency and well-expanded optoelectronic bandwidth. The diversity and statistics of the tested PIC modulator indicate the minimal requirement of shielding for PIC transmitters with small footprint modulators and complexed routing waveguides toward lightweight space terminals for terabits communications and intersatellite ranging.

Hepatitis is still a major health concern in Pakistan: short communication.

Hepatitis is often called a 'silent killer' as most patients remain asymptomatic and hence remain unaware of their illness. They are either diagnosed incidentally or get symptomatic when their illness advances years after getting the infection. In Pakistan, transmission has increased due to ignorance of sterilization techniques, sharing personal items, and unsafe healthcare practices and the burden of liver cancers and transplants has risen three-fold during the past 20 years. Chronic hepatitis often goes undetected, leading to a rise in liver cancers and transplants. Pakistan bears the second-largest burden of hepatitis C globally, with a nationwide prevalence of 4.8%. From 2015 to 2019, there was a 5% increase in hepatitis C-related deaths and an 8% increase in hepatitis B-related deaths. During the last 4 years, out of the 110 million population, only 281 578 individuals were screened for hepatitis B and C, and 1 634 614 individuals were registered at various hepatitis clinics. However, only 278 308 patients were treated. Despite a national vaccination strategy, coverage falls short, and regular screening is neglected. The burden of hepatitis-related morbidity is a considerable challenge for the Pakistani government and healthcare system, being a low-income country with limited health resources and limited access to treatment. Increased awareness, education, and emphasizing preventive measures, such as hepatitis B vaccination, is crucial. Careful supervision of healthcare workers and the promotion of safe practices are essential. Pakistan can learn and implement the Egypt model to combat hepatitis effectively. This article aims to discuss barriers and challenges and provides possible recommendations.

Generation of Chemical Space of Compounds for Prostate Cancer Treatment: Biological Activity Prediction, Clustering, and Visualization of Chemical Space.

Designing molecules for pharmaceutical purposes has been a significant focus for several decades. The pursuit of novel drugs is an arduous and financially demanding undertaking. Nevertheless, the integration of computer-assisted frameworks presents a swift avenue for designing and screening drug-like compounds. Within the context of this research, we introduce a comprehensive approach for the design and screening of compounds tailored to the treatment of prostate cancer. To forecast the biological activity of these compounds, we employed machine learning (ML) models. Additionally, an automated process involving the deconstruction and reconstruction of molecular building blocks leads to the generation of novel compounds. Subsequently, the ML models were utilized to predict the biological activity of the designed compounds, and the t-SNE method was employed to visualize the chemical space covered by the novel compounds. A meticulous selection process identified the most promising compounds, and their potential for synthesis was assessed, offering valuable guidance to experimental chemists in their investigative endeavors. Furthermore, fingerprint and heatmap analysis were conducted to evaluate the chemical similarity among the selected compounds. This multifaceted approach, encompassing predictive modeling, compound generation, visualization, and similarity assessment, underscores our commitment to refining the process of identifying potential candidates for further exploration in prostate cancer treatment.

Donor's ability to comprehend and carefully assess the benefits and risks of donation in living donor liver transplantation: a Pakistani perspective - a short communication.

Patients unlikely to obtain deceased donor liver transplantation (DDLT) are offered living donor liver transplantation (LDLT) as an alternative. The success of LDLT is bound to the availability of altruistic donors who undergo smooth and safe surgery. Donor morbidity is reported to be up to 20-30%, while donor mortality is only 0.1-0.5%. Globally, LDLT poses numerous ethical concerns regarding living donors, such as autonomy, non-maleficence, and beneficence. The donor's comprehension of information is a serious issue in LDLT. The donors may underestimate the risk of morbidity and mortality, as well as can ignore the long-term psychological consequences. Furthermore, donor voluntariness may be questionable as the donors may agree to donate under severe family pressure or emotional attachment. We propose open communication with all the donors, ensuring that they should not be subjected to any undue pressure or emotional lability. Donor knowledge and understanding of potential complications and the psychosocial aspect can be augmented by good communication. We also suggest that the donors' education and psychological evaluation should be done in a friendly environment with complete privacy. Interventions should be aimed at improving communication and independent decision-making with the use of e-health educational tools for comprehension assessment.

Socio-demographic determinants of Monkeypox virus preventive behavior: A cross-sectional study in Pakistan.

BACKGROUND: Monkeypox (mpox), re-emerging zoonotic infectious disease, is striking the world with serious public health concerns, especially in non-endemic countries. The public's knowledge and attitude towards the monkeypox virus (MPXV) influence their adherence to preventive strategies. Therefore, we aimed to assess the public's knowledge, attitudes, and perceptions (KAP) of MPXV in Pakistan. METHODS: We collected data for this cross-sectional study from 1040 participants via online self-reported questionnaire from July 5th, 2022, to August 1st, 2022. The questionnaire consisted of a total of 29 items in four sections, assessing socio-demographics, knowledge, attitudes, and practices regarding MPXV. The data were analyzed using IBM SPSS V.25, and factors associated with MPXV knowledge, attitude, and practices were identified by using logistic regression analyses. RESULTS: A total of 1040 participants were included. 61.4% were male, and 57.2% had graduation level education. Only 34.4% had good knowledge about MPXV, and 30% knew the effectiveness of the smallpox vaccine against MPXV. 41.7% had a positive attitude, 48.6% agreed that it is a fatal disease, and 44.6% were in favour of banning travel from endemic to non-endemic regions. 57.7% had good practices, and 69.9% would use protective measures if MPXV became an epidemic. Binary logistic regression analysis revealed that gender and education significantly impacted knowledge (p<0.05). While monthly income status had a significant impact on attitudes (p<0.05). The practices were positively correlated with gender and education (p<0.05). CONCLUSION: The majority of study participants had inadequate levels of knowledge, and attitudes regarding MPXV. To prevent the emergence and spread of MPXV in Pakistan, a comprehensive strategic framework for public health education must be established and implemented.

The need for neonatal jaundice screening awareness in the Pakistani population: short communication.

Neonatal jaundice is a common illness that affects around 80% of preterm and 50-60% of full-term newborn infants. It is one of the most common causes of neonatal death. Neonatal jaundice may be physiological or pathological. Physiologic jaundice is far more common than pathologic jaundice and accounts for most hyperbilirubinemia. Physiologic jaundice in neonates is due to greater hemoglobin breakdown compared to bilirubin clearance. While pathological jaundice occurs due to various infections, drug toxicity, inborn enzyme deficiencies, Rhesus fetal-maternal incompatibility, hypothyroidism, and congenital biliary duct obstruction diseases. In many parts of the world, midwives, and nurses perform spontaneous vaginal deliveries and they only rely on visual screening for neonatal jaundice. However, this is not reliable, especially for newborns having darker skin. Educating the mothers on screening for early detection of neonatal jaundice and seeking medical treatment in a country like Pakistan, which is considered a high-risk population, is crucial. Also, as most females give birth at home, hence, midwives' knowledge about neonatal jaundice also needs to be improved.

Physiological effects of some engineered nanomaterials on radish (Raphanus sativus L.) intercropped with pea (Pisum sativum L.).

Intercropping leguminous plant species with non-legume crops could be an effective strategy to maintain soil fertility. Additionally, the application of nano-Zn and Fe in trace amounts can substantially improve the bioavailable fraction of Zn and Fe. We studied the effect of foliar application of some nanomaterials on the agronomic, physio-biochemical attributes under a radish/pea intercropping system. The radish and pea were sprayed with different nanomaterials (Zn-Fe nanocomposite, nZnO, and nanobiochar) at 0 and 50 mg L-1 concentrations. Results indicated that the growth parameters of radish were higher in intercropping than in monocropping, while pea growth was inhibited in intercropping compared with monocropping. The shoot and root length, fresh weight, and dry matter of radish were increased by 28-50%, 60-70%, and 50-56% by intercropping than monocropping. Foliar spray of nano-materials further increased the growth traits of intercropped radish, such as shoot and root length, fresh weight, and dry matter, by 7-8%, 27-41%, and 50-60%, respectively. Similarly, pigments such as chlorophyll a, b, and carotenoids and the concentration of free amino acids, soluble sugars, flavonoids, and phenolics were differentially affected by intercropping and nanomaterials. The yield of the non-legume crop was increased by intercropping, whereas the legume crop exhibited significant growth inhibition due to competitive interactions. In conclusion, both intercropping and foliar spray of nanomaterials could be used as a combined approach to benefit plant growth and enhance the bioavailable Fe and Zn fractions of both crops.

Comparative Survival Benefits of Surgery and Adjuvant Chemotherapy in Neuroendocrine Carcinoma of the Gallbladder: A Population-Based Study with Insight into Future Personalized Therapeutic Approach.

BACKGROUND: Neuroendocrine carcinomas of the gallbladder (NECs-GB) are rare tumors, accounting for <0.2% of all neuroendocrine carcinomas of the gastrointestinal tract. They originate from the neuroendocrine cells of the gallbladder epithelium with associated intestinal or gastric metaplasia. The current study is the largest study from the SEER database on NECs-GB that aims to elucidate the demographic, clinical, and pathologic factors influencing the prognosis and comparative survival analysis of different treatment modalities. METHODS: The data from 176 patients with NECs-GB was abstracted from the Surveillance Epidemiology and End Result (SEER) database (2000-2018). Multivariate analysis, non-parametric survival analysis, and a chi-square test were used to analyze the data. RESULTS: NECs-GB had a higher incidence amongst females (72.7%) and Caucasians (72.7%). Most patients had surgery only (N = 52, 29.5%), (N = 40) 22.7% had chemotherapy only, and (N = 23) 13.1% had chemotherapy with surgery. Only (N = 17) 9.7% had trimodaltiy (surgery, chemotherapy, and radiation therapy), and for (N = 41) 23.3% the status of chemotherapy was unknown, and these cases had neither radiation nor surgery. CONCLUSION: NECs-GB more frequently affects Caucasian females after the 6th decade of life. The combination of surgery, radiation, and adjuvant chemotherapy was associated with better long-term (5 years) outcomes, while surgery alone was associated with better short-term (<2 years) outcome survival.

Oxidative Stress and Dopaminergic Metabolism: A Major PD Pathogenic Mechanism and Basis of Potential Antioxidant Therapies

Reactive oxygen species (ROS)-induced oxidative stress triggers the vicious cycle leading to the degeneration of dopaminergic neurons in the nigra pars compacta. ROS produced during the metabolism of dopamine is immediately neutralized by the endogenous antioxidant defense system (EADS) under physiological conditions. Aging decreases the vigilance of EADS and makes the dopaminergic neurons more vulnerable to oxidative stress. As a result, ROS left over by EADS oxidize the dopamine-derived catechols and produces a number of reactive dopamine quinones, which are precursors to endogenous neurotoxins. In addition, ROS causes lipid peroxidation, uncoupling of the electron transport chain, and DNA damage, which lead to mitochondrial dysfunction, lysosomal dysfunction, and synaptic dysfunction. The mutations in genes such as DNAJC6, SYNJ1, SH3GL2, LRRK2, PRKN, and VPS35 caused by ROS have been associated with synaptic dysfunction and the pathogenesis of Parkinson's disease (PD). The available drugs that are used against PD can only delay the progression of the disease, but they produce various side effects. Through their antioxidant activity, flavonoids can substantiate the EADS of dopaminergic neurons and disrupt the vicious cycle incepted by oxidative stress. In this review, we show how the oxidative metabolism of dopamine generates ROS and dopamine-quinones, which then exert unrestrained OS, causing mutations in several genes involved in the proper functioning of mitochondrion, synapse, and lysosome. Besides, we also present some examples of approved drugs used for the treatment of PD, therapies in the clinical trial phase, and an update on the flavonoids that have been tested to boost the EADS of dopaminergic neurons.

Knowledge, attitudes, and practices of the general population of Pakistan regarding typhoid conjugate vaccine: findings of a cross-sectional study.

Typhoid fever, a common enteric disease in Pakistan, caused by Salmonella typhi, is becoming an extended drug-resistant organism and is preventable through the typhoid conjugate vaccine (TCV). Public adherence to preventive measures is influenced by knowledge and attitude toward the vaccine. This study investigates the knowledge, attitudes, and practices of the general population of Pakistan toward TCV. The differences in mean scores and factors associated with typhoid conjugate vaccine knowledge, attitudes, and practices were investigated. A total of 918 responses were received with a mean age of 25.9 ± 9.6, 51% were women, and 59.6% had graduation-level education. The majority of them responded that vaccines prevent illness (85.3%) and decrease mortality and disability (92.6%), and typhoid could be prevented by vaccination (86.7%). In total, 77.7 and 80.8% considered TCV safe and effective, respectively. Of 389 participants with children, 53.47% had vaccinated children, according to the extended program on immunization (EPI). Higher family income has a higher odds ratio (OR) for willingness toward booster dose of TCV [crude odds ratio (COR) = 4.920, p-value <0.01; adjusted odds ratio (aOR) = 2.853, value of p <0.001], and negative attitude regarding the protective effect of TCV has less willingness toward the booster dose with statistical significance (COR = 0.388, value of p = 0.017; aOR = 0.198, value of p = 0.011). The general population of Pakistan had a good level of knowledge about the benefits of TCV, and attitude and practices are in favor of the usage of TCV. However, a few religious misconceptions are prevalent in public requiring the efforts to overcome them to promote the usage of vaccines to prevent the disease and antibiotic resistance.

Dreadful infectious disease outbreaks threaten flood-ravaged pakistan: short communication.

A rise in the incidence of water-borne, communicable illnesses, and viral outbreaks in Pakistan follows periods of heavy rainfall. Due to climate change, floods and droughts have had devastating effects on human health by facilitating the spread of infectious illnesses including cholera, malaria, typhoid, dengue fever, and viral hepatitis A. Food instability, starvation, malnutrition, and a lack of potable water are only some of the indirect effects of flooding on health. Recently, one of the worst floods in history devastated Pakistan, affecting more than 333 million people along with a significant portion of the nation submerged. Malaria, dengue fever, and other ailments are on the rise in Pakistan, threatening to overwhelm the country's healthcare infrastructure. There is an urgent need for preventative measures in Pakistan to cope with dreadful outbreaks.

Comparative impact of streptozotocin on altering normal glucose homeostasis in diabetic rats compared to normoglycemic rats.

Diabetes mellitus is a syndrome and an endocrine disorder, primarily considered as a loss of glucose homeostasis because of the insulin action and/or secretion or both. Currently there are more than 150 million people in the world affected by diabetes mellitus with a higher share of Asian and European countries. The current study aimed to investigate the comparative altering properties of streptozotocin (STZ), based on up-turn and down-turn configuration of biochemical, toxicological and hematological parameters in comparison with normoglycemic male albino rats. This comparative study was conducted among normoglycemic and STZ based induced-type 2 diabetic male albino rats groups. The male albino rats were intra-peritoneally injected with STZ with the dose rate of 65 mg/kg body weight for one time to developed type 2 diabetic model. Biochemical (blood glucose, uric acid, urea and creatinine), toxicological (AST, ALT and ALP) and hematological parameters (red and white blood cells) and their functional indices were evaluated in type 2 diabetic induced group along with normoglycemic rats. The STZ based induced- type 2 diabetic rats showed statistically significance (p < 0.001) higher level in the blood glucose, alongwith the change in the levels of biochemical parameters including urea, uric acid, and creatinine. Toxicological parameters comprising AST, ALT and ALP were also shown significance (p < 0.001) as sufficient after experimental evaluation of biologically important parameter in STZ based induced-type 2 diabetic rats. Likewise, the red blood cells, white blood cells and their efficient components were exposed significantly insufficient after the injecting of STZ to induce the rats as type 2 diabetic. The results of the current study indicates the comparatively higher levels of variation among biochemical, toxicological and hematological parameters in STZ based Induced-type 2 diabetic model as compared to normoglycemic group.

Outbreak of leptospirosis amidst COVID'19 in Tanzania: a new threat? Short communication.

As the world is still fighting to combat the coronavirus disease 2019 (COVID-19) virus, the United Republic of Tanzania has been confronting yet another bacterial infection called leptospirosis (LS). It is caused by the spirochete bacteria of genus Leptospira, and has been known to infect several people, already claiming a number of lives. It infects 1 million people annually with ~60 000 deaths having a fatality rate of 6.85% worldwide. COVID has profusely burdened the healthcare system worldwide within the past 2 years; it has sabotaged medical management and brought down resources, which has now made it difficult for any country to withstand another pandemic. LS has overburdened the medical care system of Tanzania abjectly; it is now imperative not to overlook environmental factors, like a flood, the presence of rodents, unsatisfactory socioeconomic conditions in areas where dogs reside, substandard wastewater and garbage disposal facilities, or any other factor which might lead to further spread of LS and put Tanzania in jeopardy.

Rising trends of foodborne illnesses in the U.S.: short communication.

Foodborne illness is caused by the intake of food and water contaminated by different bacteria, viruses, and parasites, as well as poisons or toxins. Approximately 31 different pathogens are documented as causative organisms for causing foodborne illness outbreaks. Climatic changes and varying agricultural practices contribute significantly to the increased incidence of foodborne illness. Foodborne illness can also occur due to the utilization of improperly cooked food. The symptoms of food poisoning may appear sooner or later after contaminated food intake. Symptoms may vary among individuals depending on the disease severity. Despite continuous preventive measures, foodborne illness is still a significant public health threat in the United States. Frequent dining at fast-food restaurants and the use of processed foods present an immense risk of foodborne illness. The food supply in the United States is among the safest in the world, yet we see a surge in foodborne illnesses. People should be encouraged to wash their hands before cooking, and the utensils in which food is being prepared should be kept clean and washed properly before using them. Physicians and other healthcare professionals are facing a host of new challenges in responding to foodborne illnesses. Patients should seek a doctor immediately when they experience symptoms like blood in the stool, hematemesis, prolonged diarrhea for 3 or more days, severe abdominal cramping, and high fever.

Obstacles to the deceased donor transplantation in Pakistan.

INTRODUCTION: Transplantation in many Asian countries is moulded by socioeconomic, religious, cultural and health indicators. In most Asian countries, the living-related donation is the common most organ donation. Due to the limited deceased organ donation, live donor programmes flourished in many Asian countries. Another apparent reason for this tremendous growth of living-related programmes in Asian countries is their larger serving population. Several centres from Asia, including Pakistan and India from Southeast Asia and Egypt in Middle East Asia, on the one hand, have recently emerged as leading living donor transplant programmes. On the other hand, a few Asian countries, including Iran and China, have established some of the world's largest deceased donor programmes. DISCUSSION: In Pakistan, thousands of patients die from end-stage organ failure annually, seeking organ transplants for survival. The exact statics are not available, but over 50 000 people are estimated to die each year as a result of end-stage organ failure without getting a transplant, about 15 000-18 000 from kidney failure, and 10 000 from liver failure and the National Centre for Health Statistics labelled organ failure as a leading cause of death. Despite all these efforts, the knowledge of organ donation among Pakistani people was determined to be around 60%. In Pakistan, the lack of deceased organ donation programmes and the unwillingness of people to deceased organ donation contributes to an increased demand for living organ donation and patients continue to rely on living donors. We discuss various obstacles to deceased organ donation comprising various challenges that form a unique combination, including religious, economic, social, demographic and political factors.Conclusion: Every single effort should be made to initiate and establish multiple deceased donor programmes in Pakistan. Developing the deceased donor programmes in the country will be vital to counter the countrywide increasing organ shortage. The mainstay transplant activities like organ procurement and distribution systems need to be adequately developed. It will help achieve national self-sufficiency and decrease living donors' burden. With education, the behaviour of healthcare professionals and common people can be changed and a positive attitude toward deceased organ donation can be obtained. As healthcare professionals, we should come forward and take responsibility by enrolling ourselves in deceased donors' registration. Public awareness, medical community interest and government support are essential in initiating and establishing deceased donor programmes in Pakistan.