Ensuring data security and privacy has emerged as a serious concern in the realm of blood supply chain. This is mainly because of sensitivity of donor information, the involvement of multiple stakeholders, and the need for transparent traceability. This paper proposes a novel privacy-preserving, permissioned blockchain framework for blood supply chain management that integrates Hyperledger Fabric, the InterPlanetary File System (IPFS), and a Zero-Knowledge Proof (ZKP)-based authentication protocol. The framework introduces a Pseudonymous Role-Bound Zero-Knowledge Authentication (PRZKA) mechanism that enables donors to authenticate and authorize access to their medical data without revealing their real identities. Context-specific pseudonyms derived through cryptographic hash-to-curve operations ensure unlinkability across different healthcare interactions, while Schnorr-style challenge–response proofs prevent replay attacks and credential misuse. Sensitive donor information is protected using Fabric Private Data Collections, whereas encrypted medical records are stored off-chain in IPFS, with only secure content identifiers recorded on the blockchain. Smart contracts enforce fine-grained, consent-aware access control policies and maintain immutable audit logs of all access events. The proposed system architecture combines an off-chain ZKP gateway with on-chain authorization logic to minimize blockchain overhead while preserving strong security guarantees. Furthermore, a performance evaluation framework is defined, including metrics, workload scenarios, and system configurations, to support future empirical validation. Security analysis indicates that the proposed framework enhances privacy, prevents identity linkage, and enables auditable, consent-driven data sharing compared with existing blockchain-based healthcare solutions.
Riya Sapra, Shal, Ishika Kataria, Sarita · 5 authors
A distributed ledgers information base split throughout the computer group's centres. As a data set, a blockchain stores information electronically in an elevated structure. Blockchain technologies are well-known for their role in cryptographic currency systems, such as Bitcoin, in maintaining a secure and decentralised record of transactions. The benefit of a blockchain is that it ensures the privacy and authenticity of a records while also establishing confidence in the absence of a trusted third party. The suggested system is a blockchain-based decentralised organ transplant app. Patients would use a web application to submit their information, which include their healthcare ID, blood group, tissue type, and state. Until a patient is in serious situation, the program would operate on a first-in, first-out basis.
Katta Sri Lakshmi Madhavi, Chandan Kumar Shah Kanu, Mallidi Rajasekhar Reddy, Kosuri Gnana Sathvik · 5 authors
Management of blood supplies is a very important part of healthcare infrastructure, and the old system is highly dependent on central databases, which cannot be traced, are not transparent, and cannot resist tampering of data. Such restrictions may cause poor coordination, slow emergency response and manipulation of sensitive medical records. To overcome these issues, this paper offers a proposal of distributed ledger architecture to manage blood supply transparently and its tamper-proof. The system that is suggested will exploit blockchain technology and smart contracts to document blood donation, inventory updates, compatibility checks, and allocation transactions in an unalterable and decentralized fashion. To guarantee modularity and scalability, the architecture is designed into layers of components including user interaction, application logic, and blockchain ledger. Smart contracts automate the most important processes like donor validation and blood group matching and minimize human error and administration delays. To achieve privacy and efficiency of the used system, sensitive medical information is stored off-chain, and on-chain cryptographic hash references are used to maintain integrity and auditability. The distributed ledger removes single points of failure and gives a verifiable transaction history available to authoritative stakeholders. This architecture creates a safe, open and resilient architecture that has the potential to enhance trust, coordination and accountability in blood supply networks.
Blockchain technology, characterized by its immutable, distributed ledger, has evolved significantly beyond its cryptocurrency origins, finding application in healthcare and organ donation systems. Specifically, Hyperledger Fabric emerges as a secure, enterprise grade solution for healthcare data management, with a primary focus on patient medical records. Traditional centralized storage of medical records poses challenges for patients, prompting the development of a Hyperledger Fabric-based system driven by smart contracts to enhance accessibility and security. In the realm of organ donation systems, blockchain is proposed as a remedy for the shortcomings of centralized models, offering heightened transparency and security. Notably, while previous solutions often leaned on Ethereum-based blockchains, this research pioneers the use of Hyperledger Fabric. Beyond organ donation, blockchain's attributes, including decentralization, transparency, and privacy, offer transformative potential in healthcare.
The administration of data, banking, food science, the Internet of Things, and cybersecurity is just a few of the businesses and professions that benefit from blockchain technology. Even healthcare and brain research have shown a growing interest in blockchain technology. There has been an incredible uptick in curiosity about how blockchain technology may be put to use to improve the delivery of trustworthy healthcare data management. In addition, blockchain is transforming conventional healthcare methods to more trustworthy means, allowing for more precise diagnosis and more efficient treatment thanks to the secure sharing of patient data. Blockchain has the potential to be a technology that aids in providing tailored, authentic, and secure healthcare in the future by centralizing all of a patient’s up-to-date clinical data and presenting it in a modern, safe healthcare environment. In this chapter, investigators examine the recent and ongoing changes brought about by the introduction of blockchain technology to the healthcare industry. Investigators also talk about the blockchain’s potential uses, as well as its current limitations and potential in the future.
Organ transplantation is life-saving but faces major ethical, logistical, and trust-related challenges. Centralized organ donation workflows are susceptible to delays, data tampering, and opaque allocation decisions. We present a full-stack Blockchain-Based Organ Donation Management System that integrates Ethereum smart contracts to deliver immutable audit trails and transparent allocation events while keeping sensitive clinical data encrypted off-chain. The prototype couples a React + Vite frontend with a Flask backend (PostgreSQL, Web3.py) and minimal on-chain logic in Solidity. Evaluation on a private Ethereum testbed shows correct matching, low end-to-end latency on the local network, and acceptable gas usage when heavy computation is performed off-chain. The design is extensible to Layer-2 scaling and privacy-preserving primitives for real-world deployment.
R. Suganya, P. J. Sidharth, C. Vinston Jose, P. R. Lighittha · 6 authors
This chapter explores the integration of blockchain technology and intelligent automation to address long-standing challenges in the global blood supply chain (BSC). The BSC is frequently plagued by fragmentation, traceability gaps, logistical inefficiencies, and compliance hurdles, all of which compromise patient safety and operational efficiency. By combining permissioned blockchains with smart contracts, Internet of Things (IoT) sensors, federated learning, and zero-knowledge proofs (ZKPs), this chapter proposes a modular architecture—BloodChain—that enhances transparency, automation, and data privacy across the supply lifecycle. Experimental implementations demonstrate improved traceability, predictive analytics, and compliance with privacy regulations such as GDPR and HIPAA. The chapter concludes with a discussion on interoperability, governance, and future research directions, offering a blueprint for secure, scalable, and intelligent blood logistics in digital healthcare ecosystems.
Blockchain serves as a transformative mechanism for enabling secure, transparent, and privacy-preserving control over data used to train artificial intelligence (AI) models. This paper explores blockchain-enabled frameworks—including data provenance, smart contracts, federated learning integration, Non-Fungible Tokens (NFTs)/DataTokens, and token-based incentive structures—to address data ownership, access governance, contribution compensation, and accountability. We survey platforms such as Ocean Protocol, federated learning with blockchain architectures, and decentralized compute networks. Through analysis of methodologies and case studies across healthcare, IoT, and AI marketplaces, we assess system performance, privacy protection, trust, and regulatory alignment. Our results indicate blockchain facilitates granular data control, immutable provenance, and fair compensation models, yet challenges persist around scalability, incentive fairness, and legal interoperability. We conclude with a roadmap outlining standards, hybrid computations, legal frameworks, and governance models to foster robust "Data-AI-Blockchain" ecosystems.
Organ donation and transplantation systems are complex, sensitive, and often hindered by inefficiencies, lack of transparency, and data integrity issues. Traditional centralized systems struggle to manage consent, allocation, and tracking of organs in a secure and auditable manner. This paper proposes a blockchain-based application using a private Ethereum network to streamline and decentralize the organ donation process across hospitals. The system employs smart contracts and algorithm-driven matching to ensure secure donor registration, real-time tracking of organs, transparent allocation based on medical criteria, and immutable audit trails. Six core algorithms are implemented to manage consent, priority allocation, organ transport, and compliance verification. The experimental results demonstrate that the proposed system enhances privacy, accountability, and operational efficiency compared to existing methods. This solution not only reduces the risk of organ misuse and illegal trade but also builds trust among stakeholders, laying a strong foundation for ethical and technologically advanced organ donation management.
Geet Bawa, Harmeet Singh, Sita Rani, Aman Kataria · 5 authors
Existing organ transportation management systems face significant limitations as they do not allow patients to monitor the condition of the transplantable organ during its transportation from the donor's place to the recipient's venue. This undermines patients' confidence that the organ allotted to them remains uncontaminated, healthy, and unaffected by fluctuations in parameters including temperature, humidity, and the container's vibration, and orientation. Additionally, there is a lack of technology to ensure that the organ container remains securely closed throughout the shipment. Furthermore, the shipment data is often stored in centralized or with third-party systems, which are potentially vulnerable to security risks and single points of failure. These limitations highlight the need for a more secure, transparent, and reliable solution to improve organ transportation safety and data integrity. This paper addresses these challenges by proposing a cost-efficient, decentralized, and transparent framework for managing organ transportation that enhances data security and traceability. The proposed framework integrates Internet of Things sensors within the organ container and connects them to smart contracts via the InterPlanetary File System. The blockchain ensures data security, immutability, and decentralization, while sensors safeguard the organ by providing real-time updates on its condition. The smart contracts generate alerts for issues and notify stakeholders for prompt action. A key contribution of this work is the novel use of IPFS for off-chain data storage, which reduces blockchain storage requirements, Ether consumption, and overall system costs. A comparative analysis with existing IoT, IPFS, and blockchain-based transportation approaches demonstrates that the proposed framework consumes a negligible amount of Ether; approximately, 0.000023004, equivalent to approximately 5.52 INR; for deployment, while ensuring safe, transparent, cost-effective, and traceable organ transportation.
Advancements in personalized medicine require secure, transparent, and privacy-preserving genomic data management systems. This study proposes a novel hybrid blockchain-based genomic data model integrating Self-Sovereign Identity (SSI), Decentralized Identifiers (DIDs), Verifiable Credentials (VCs), and decentralized storage Interplanetary File System (IPFS) to enable secure, privacy-compliant, patient-controlled genomic data exchange. The model leverages Polygon Proof-of-Stake (PoS) blockchain by deploying a smart contract that enforces fully access control functions applied on 100 samples of synthetic genomic data, ensuring only authorized researchers with valid DIDs and VCs can retrieve genomic data. Later, we performed five tests to evaluate our model performance. Security evaluations confirmed 100% data integrity validation through SHA-256 hash validation on-chain, ensuring tamper-proof genomic data storage. Unauthorized access attempts resulted in zero successful breaches, demonstrating the robustness of SSI-based authentication by showing revoked access. Additionally, IPFS data availability testing confirmed reliable and decentralized data retrieval through the Content Identifier (CID) on-chain. The model's access revocation mechanism enabled real-time patient control over genomic data access, ensuring compliance with GDPR privacy regulations. The proposed model provides a scalable, secure, and privacy-compliant solution for genomic data sharing in precision medicine, empowering patients with full control over their genetic data while facilitating researchers to trustworthy, decentralized data useability for precision research.
Background and aims: Intensive care units (ICUs) face growing challenges with cybersecurity, data interoperability, medication safety, and resource management in an increasingly digital healthcare environment. This review explores how blockchain technology can address these issues and improve critical care delivery. Data sources: Relevant literature was sourced from peer-reviewed journals, healthcare cybersecurity reports, and studies on blockchain applications in medical settings. Study selection: Included works focused on blockchain's role in enhancing data security, drug traceability, consent management, and integration with AI tools in ICU contexts. Data synthesis: Blockchain offers tamper-proof health records, decentralized data sharing, and automated smart contracts, potentially transforming ICU operations. Benefits include improved patient safety, resource efficiency, and decision support. However, challenges such as scalability, regulatory concerns, and implementation costs remain. Conclusion: Blockchain holds strong potential to enhance ICU workflows and patient outcomes. Realizing its impact will require collaborative efforts and further research to overcome current limitations. How to cite this article: Gondode P, Dass C, Kumar S, Malviya A, Ashwin M, Khanna P. Blockchain in Critical Care. Indian J Crit Care Med 2025;29(6):525-530.
Organ donation plays a critical role in saving lives, yet traditional systems often struggle with issues such as lack of transparency, data tampering risks, and inefficient donor-recipient matching. This paper presents a blockchain-based decentralized application (DApp) designed to enhance the security, transparency, and efficiency of organ donation and transplantation processes. By leveraging smart contracts on a private Ethereum blockchain, the system automates key operations including donor registration, organ availability tracking, and recipient prioritization, all while maintaining the integrity of sensitive medical records. The use of a decentralized architecture ensures that data is tamper-proof and accessible only to authorized entities such as hospitals and regulatory bodies. A queue-based organ allocation algorithm is implemented to match recipients based on medical urgency and compatibility factors like blood type and organ requirements. The system is built using React.js for the frontend and Solidity for smart contract development, with Truffle and Ganache supporting local blockchain deployment. This approach not only secures sensitive health data but also improves the fairness and responsiveness of organ distribution. Keywords: Blockchain, Organ Donation, Smart Contracts, Decentralized Application, Healthcare Data Security, Organ Matching Algorithm, Private Ethereum Network
Effectively managing umbilical cord blood (CB) data involves implementing precise attention and strategic solutions within the healthcare supply chain, driving notable advancements in registration, donation, and preservation compared to regular adult blood. These challenges encompass moral, practical, legal, and technical limitations, fostering a conducive environment for innovative thinking and progress. To ensure a fair and efficient process that improves patient experience, sustainability of the donated cord blood and trust, it is essential to have a peer-to-peer (P2P) umbilical cord blood donation management system. In this work, we propose a framework using the ethereum blockchain to facilitate decentralized, secure, traceable, auditable, accountable, transparent, and reliable management of umbilical cord blood procurement. We showcase the intricacies of our system architecture and sequence diagram, effectively illustrating the operational principles of our groundbreaking proposed solution in information management. At the core of our endeavor is the development of smart contracts, which includes the meticulous processes of algorithm generation, precise implementation, comprehensive testing, and thorough validation. Our rigorous evaluation aims to establish the superior efficacy of our proposed solution through in-depth vulnerability analyses and comprehensive comparisons with existing alternatives.
The rising demand for organ transplants, combined with the restricted availability of donors, requires a clear, secure, and efficient system to streamline the matching process. Conventional organ donation platforms encounter obstacles like fraudulent activity, mismatched transplants, and data privacy. This study presents an Ethereum blockchain-based decentralized application (dApp) that links organ donors and recipients. The solution guarantees safe, unchangeable interactions between stakeholders by utilizing Solidity smart contracts. The platform, which was created with Node.js, HTML, CSS, and JavaScript, offers features including pledge and donor registration, transplant matching, and pledge verification. It gives a clear and simple solution. The design, process, and advantages of applying blockchain technology to this important healthcare application are described in this article.
The ongoing human organ transplantation system has some limitations. These include waiting times, ways of allocating organs, and a lack of information sharing among different institutions. These issues lead to some problems, lack of transparency, and also ethical concerns, to some extent. However, every system now can be improved through the use of technology. Blockchain offers Cryptographic hash functions, Digital signatures, Proof of work, double spend problem, Decentralization, Distributed network, Merkle Trees that can address these challenges and transform the organ transplantation process. This paper suggests a framework called B-HOTMS (Blockchain-based Human Organ Transplantation Management System) that aims to improve transparency, better communication and prioritize organ registration process. B-HOTMS uses a permissioned blockchain network along with contracts to automate tasks. This system also confirms data privacy and provides a user-friendly interface for all stakeholders. The application of B-HOTMS can be beneficial to the whole process as it shortens the time of waiting, enhances the level of transparency, leading to the trust and accountability of the stakeholders, improves data security and privacy while, and facilitates the communication among the stakeholders. Collaboration with legal bodies is crucial to ensure compliance with existing regulations while integrating technology into the process. Lastly, addressing concerns will be vital for the implementation of B-HOTMS so that it aligns with moral principles while saving more lives in an efficient manner. In conclusion by harnessing the potential offered by technology, we can envision a future where organ transplantation becomes efficient, transparent and ethical, leading to saving more lives.
Geet Bawa, Harmeet Singh, Sita Rani, Aman Kataria · 5 authors
Background/Objectives: The healthcare sector is rapidly growing, aiming to promote health, provide treatment, and enhance well-being. This paper focuses on the organ donation and transplantation system, a vital aspect of healthcare. It offers a comprehensive review of challenges in global organ donation and transplantation, highlighting issues of fairness and transparency, and compares centralized architecture-based models and blockchain-based decentralized models. Methods: This work reviews 370 publications from 2016 to 2023 on organ donation management systems. Out of these, 85 publications met the inclusion criteria, including 67 journal articles, 2 doctoral theses, and 16 conference papers. About 50.6% of these publications focus on global challenges in the system. Additionally, 12.9% of the publications examine centralized architecture-based models, and 36.5% of the publications explore blockchain-based decentralized models. Results: Concerns about organ trafficking, illicit trade, system distrust, and unethical allocation are highlighted, with a lack of transparency as the primary catalyst in organ donation and transplantation. It has been observed that centralized architecture-based models use technologies such as Python, Java, SQL, and Android Technology but face data storage issues. In contrast, blockchain-based decentralized models, mainly using Ethereum and a subset on Hyperledger Fabric, benefit from decentralized data storage, ensure transparency, and address these concerns efficiently. Conclusions: It has been observed that blockchain technology-based models are the better option for organ donation management systems. Further, suggestions for future directions for researchers in the field of organ donation management systems have been presented.
Maria Irene Bellini, Chloë Ballesté, Paulo N. Martins, Ifeoma Ulasi · 6 authors
As a component of the European Society for Organ Transplantation (ESOT) call for action in 2022, Transplant International launched a special issue entitled "Diversity, Equity, and Inclusion in Transplantation" (1). The call for papers focused on sex, gender, ethnic and racial disparities in transplant access, management and outcomes. Emphasis was put on the changes of policies/interventions required to address the existing inequities and the needs to build a true global access and foster a culture of diversity and inclusion in transplantation research.With regards to sex and gender inequity, studies from USA and Nepal demonstrated barriers in the liver and kidney transplant processes, limiting the access to women from entering and completing waitlist evaluation (2,3), highlighting how they face barriers to be considered for surgery. Notably, this also reflects the disparity in the living donation process (4): in a context where countries in Southeast Asia were reported to have the lowest rates of deceased donors, the majority of kidney living donors are women, although the highest proportion of recipients are men. To further explore the disparities in this area, a review compared the top organ donor countries, to elucidate possible interventions and establish a fair transplant process in Southeast Asia (5). This article provides a brilliant approach by analyzing the differences in healthcare systems and how resources and organization can impact the effectiveness of transplant programs in addition to education and cultural attitude. Within the variety of economic and developmental backgrounds, the authors identified Malaysia as one of the potential countries able to build an effective deceased donor program, recognizing the general principle that there is no "one size fits all" for organ donation systems, but that government support through financial inputs in healthcare, and therefore access to publicly funded healthcare, is fundamental for successful donation and transplantation activity.Another interesting report dealing with a sustainable model to overcome the gender and social disparity in renal replacement therapy in Low and Middle Income Countries (6) showed that establishing satellite centers reduces patient time and travel costs, with a model of community-government partnership, where dialysis and transplantation are integrated and offered "free of cost" to all in need.Adequate women representation is a known unmet need in clinical science, with a documented discrepancy between the epidemiological prevalence of a disease and the rate of women enrolled in related clinical trials. Vinson et al. found that in the field of kidney transplantation, women's representation is more adequate when compared to other medical disciplines. However, they remain significantly underrepresented in research trials testing immunosuppressive drugs and surgical interventions. This finding is particularly striking in the context of the known increased risk of rejection for women, raising the hypothesis that this might also be partially related to the disparity in accessing interventional research (7).Inequity in transplant access and management was described for rural and remote populations, as well as specific ethnic and caste groups, where cultural beliefs could be inherent causes of bias (8). Particular emphasis was given therefore to the proposal of eliminating race from eGFR calculations (9) in accessing national waitlist, a decision approved a few years ago by the OPTN Board (10), which settled in this way the tone towards a more equitable assessment of prospective transplant and donor candidates. This remarkable change could have consequences for living kidney transplantation; a UK study (11) investigated how to improve decision making from the healthcare professional's perspective for people from diverse ethnic groups, as this precious resource remains underutilized. An education strategy seems realistic to implement the diversity of the organ donor registry, aiming to gain the support of key influencers (such as religious and community leaders, media editors, local figures) and tackle barriers negatively influencing support for organ donation in minority ethnic groups (12,13). To this purpose, it is relevant to stress how difficult it remains to determine the impact of patient ethnicity, race or immigration background, especially in consideration of the inconsistency of how migrant and ethnic minority populations are defined in European studies (14). This is why when analyzing such complex systems, it is recommended to consider an intersectionality approach (15) i.e., non-medical aspects of an individual's life, as where they live, are raised, engage in recreational activities, and their vocation, to better represent the full environmental context leading to disparity in organ transplantation access, management and outcomes.Luckily, the prevention and elimination of inequities related to patient characteristics is increasingly being recognized in transplant research. It has been reported that the demand for organs can largely be reduced if there is a sustained commitment to public health interventions and culturally competent approaches are implemented in the management of long-term conditions, taking also into consideration the demand from underrepresented minority populations, such as migrants (16). In this regard, the current state of the art in Italy was reviewed (17) and described that minority ethnic background individuals and immigrants present significantly higher rates of cardiovascular disease and endocrinological disorders, potentially leading to organ failure. Unfortunately, despite the presence of a public health system with universal healthcare coverage, non-European born residents are less likely to receive living kidney donation transplantation and more likely to have inferior long-term outcomes compared with European born individuals. These findings are not novel in general and reproduce what was already reported in other health national system realities, such as the UK (18) and USA (19).To complete the insights into organ donation and transplantation in the immigrant population in Italy, a mention to the comparison of refusal rates showed that these were higher, especially in some non-native Italian populations countries, supporting the need for communication approaches tailored for cultural diversities, when discussing donation with families with a potential language barrier and a non-western cultural background. (20).It is worth remembering that the standard approaches to patient education and management are less likely to be effective with subjects from immigrant and/or ethnic minority groups, and instead tailored interventions to meet the needs of these populations remain a challenge. For instance, a report found that in abdominal transplant recipients language preference other than English was independently associated with delay to vaccination in the USA (21). It would be therefore worth exploring alternative ways, for example by the use of digital technology, as the reconstruction of education after the COVID-19 pandemic (22) revealed an unforeseen potential.Could then modern technology help in pushing the boundaries of the XXI century transplant outcomes? Medical digitalization is nowadays being increasingly utilized in clinical practice, and it was suggested that blockchain technology (23), defined as a peer-to-peer distributed database without centralized authority, could soon become of pivotal importance in overcoming some limitations of transplant programs. In particular, it was suggested that distribution ledger technology could affect the organ donor traffic in the black market, by providing a real integration between different national health systems with real-time auditability.What could be the role of scientific societies, institutions and stakeholders? According to a survey by the Equity, Diversity, and Inclusion Committee of ESOT, reported as a qualitative research approach, the main areas of intervention included initiatives aiming to foster a culture of transparency in selection procedures, always considering diversity when evaluating candidates and anonymizing applications to eliminate inherent bias, using different languages in meetings and diverse panels in conferences, limiting the tenure of Council members, and promoting a bottom-up instead of a top-down organization (24). The recruitment of professionals from a variety of countries, backgrounds, and ethnicities or the facilitation of combining career and family life could be supported by initiatives such as access to digital learning solutions, i.e, webinars and online courses. In fact, the disparities described above could significantly hinder career development, which limits creativity and innovation by professionals from minority groups. Individuals from all backgrounds should instead have equal opportunities to enter and excel in their field and this will also promote scientific advancement and better care for the patients (25).Our modern Society increasingly embraces the general concept of equity for all individuals, and organ donation and transplantation must follow this ethical principle and have a transparent system to assure no discrimination is carried out (26). To achieve health equity, the same treatment options must be available to any individual affected by end-stage organ failure, regardless of sex, gender, race, ethnicity, socioeconomic backgrounds and their interplay. As the transplantation journey is a multistep process, the disparity affecting one or more phases, from clinician's referral for evaluation to the actual moment when transplant occurs, should be explored for possible interventions to reduce the existing evidence in disparity when receiving an organ transplant. The aim of this special issue is to build on the promotion of health care and social equity worldwide, by highlighting possible areas of interventions, following what professional groups in the transplant community have identified as strategic initiatives or explicit goals in their mandates.As a component of the European Society for Organ Transplantation (ESOT) call for action in 2022, Transplant International launched a special issue entitled "Diversity, Equity, and Inclusion in Transplantation" (1). The call for papers focused on sex, gender, ethnic and racial disparities in transplant access, management and outcomes. Emphasis was put on the changes of policies/interventions required to address the existing inequities and the needs to build a true global access and foster a culture of diversity and inclusion in transplantation research.With regards to sex and gender inequity, barriers in the liver transplant process, preventing female patients from entering and completing transplant evaluation were demonstrated in studies both from the USA and Nepal (2,3), highlighting how women, encounter barriers to enter the waitlist. Notably, this also reflects the disparity in the living donation process (4), as countries in Southeast Asia were reported to have the lowest rates of deceased donors. To further empasize this concept, a review compared the top 10 organ donor countries with in Southeast Asia, to elucidate possible interventions and establish a fair transplant process (5): despite the variety of economic and developmental backgrounds making the comparison difficult, the authors identified Malaysia as one of the potential countries able to build an effective deceased donor program, similar to those of the Western world, recognizing the general principle that there is no "one size fits all" for organ donation systems, but that government support through financial inputs in healthcare is fundamental for a successful shortening of the waiting list time.Another interesting report dealing with a sustainable model to overcome the gender and social disparity in renal replacement therapy in Low and Middle Income Countries (6) showed that establishing satellite centers reduces patient time and travel costs, with a model of community-government partnership, where dialysis and transplantation are integrated and offered "free of cost" to all in need.Interestingly, despite the better representation of women in clinical trails in the field of kidney transplantation compared to other medical disciplines, one study highlighted how females remain underrepresented in research trials examining post-transplant immunological related aspects and long-term outcomes (7).Inequity in transplant access and management was described for rural and remote populations, as well as specific ethnic and caste groups, where cultural beliefs could be inherent causes of bias (8). Particular emphasis was given therefore to the proposal of eliminating race from eGFR calculations (9) in accessing national waitlist, a decision approved a few years ago by the OPTN Board (10), which settled in this way the tone towards a more equitable assessment of prospective transplant and donor candidates. This remarkable change could have consequences for living kidney transplantation; a UK study (11) investigated how to improve decision making from the healthcare professional's perspective for people from diverse ethnic groups, as this precious resource remains underutilized. An education strategy seems realistic to implement the diversity of the organ donor registry, aiming to gain the support of key influencers (such as religious and community leaders, media editors, local figures) and tackle barriers negatively influencing support for organ donation in minority ethnic groups (12,13). To this purpose, it is relevant to stress how difficult it remains to determine the impact of patient ethnicity, race or immigration background, especially in consideration of the inconsistency of how migrant and ethnic minority populations are defined in European studies (14). This is why when analyzing such complex systems, it is recommended to consider an intersectionality approach (15) i.e., non-medical aspects of an individual's life, as where they live, are raised, engage in recreational activities, and their vocation, to better represent the full environmental context leading to disparity in organ transplantation access, management and outcomes.Luckily, the prevention and elimination of inequities related to patient characteristics is increasingly being recognised in transplant research. It has been reported that the demand for organs can largely be reduced if there is a sustained commitment to public health interventions and culturally competent approaches are implemented in the management of long-term conditions, taking also into consideration the demand from underrepresented minority populations, such as migrants (16). In this regard, the current state of the art in Italy was reviewed (17) and described that minority ethnic background individuals and immigrants present significantly higher rates of cardiovascular disease and endocrinological disorders, potentially leading to organ failure. Unfortunately, despite the presence of a public health system with universal healthcare coverage, non-European born residents are less likely to receive living kidney donation transplantation and more likely to have inferior long-term outcomes compared with European born individuals. These findings are not novel in general and reproduce what was already reported in other health national system realities, such as the UK (18) and USA (19).To complete the insights into organ donation and transplantation in the immigrant population in Italy, a mention to the comparison of refusal rates showed that these were higher, especially in non-native Italian populations from non Western countries, with the exception of individuals from Sri Lanka (20).It is worth to remember that the common approaches to patient education and management are less likely to be effective with subjects from immigrant and/or ethnic minority groups and instead that tailored interventions to meet the needs of these populations remain a challenge, in fact because of language barriers. For instance, a report found that in abdominal transplant recipients language preference other than English was independently associated with delay to vaccination in the USA (21). It would be therefore worth exploring alternative ways, for example by the use of digital technology, as the reconstruction of education after the COVID-19 pandemic ( 22) revealed an unforeseen potential.Could then modern technology help in pushing the boundaries of the XXI st century transplant outcomes? Medical digitalization is nowadays being increasingly utilized in clinical practice, and it was suggested that blockchain technology (23), defined as a peer-to-peer distributed database without centralized authority, could soon become of pivotal importance in overcoming some limitations of transplant programs. In particular, it was suggested that distribution ledger technology could affect the organ donor traffic in the black market, by providing a real integration between different national health systems with real-time auditability.What could be the role of scientific societies, institutions and stakeholders? According to a survey by the Equity, Diversity, and Inclusion Committee of ESOT, a substantial contribution was identified in initiatives aiming to foster a culture of transparency in selection procedures, always considering diversity when evaluating candidates and anonymizing applications to eliminate inherent bias, using different languages in meetings and diverse panels in conferences, limiting the tenure of Council members, and promoting a bottom-up instead of a top-down organization (24). The recruitment of professionals from a variety of countries, backgrounds, and ethnicities or the facilitation of combining career and family life could be supported by initiatives such as access to digital learning solutions, i.e, webinars and online courses. In fact, the disparities described above could significantly hinder career development, which limits creativity and innovation by professionals from minority groups. Individuals from all backgrounds should instead have equal opportunities to enter and excel in their field and this will also promote scientific advancement and better care for the patients (25).Our modern Society inc reasingly embraces the general concept of equity for all individuals, and organ donation and transplantation must follow this ethical principle and have a transparent system to assure no discrimination is carried out (26). To achieve health equity, the same treatment options must be available to any individual affected by end-stage organ failure, regardless of sex, gender, race, ethnicity, socioeconomic backgrounds and their interplay. As the transplantation journey is a multistep process, the disparity affecting one or more phases, from clinician's referral for evaluation to the actual moment when transplant occurs, should be explored for possible interventions to reduce the existing evidence in disparity when receiving an organ transplant. The aim of this special issue was to build on the promotion of health care and social equity worldwide, by highlighting possible areas of interventions, following what professional groups in the transplant community have identified as strategic initiatives or explicit goals in their mandates.
V. Sitharamulu, G. Sucharitha, Sachi Nandan Mohanty, J. Shaik · 5 authors
Modern organ transplant and donor procedures present numerous necessities and also obstacles related to Organ procurement, their delivery, and transplanting are all steps in the enrolment, matchmaking, and disposal process. These processes must adhere to various legal, clinical, ethical, and technical limitations. Consequently, there is a need for a comprehensive organ donation and transplantation system that ensures fairness, efficiency, and an improved experience for patients, ultimately fostering trust in the system. In this research paper, we introduce a ground-breaking solution based on the utilization of a private Ethereum blockchain. This approach revolutionizes the administration of organ gift and transplantation by establishing a copiously reorganized, sheltered, appreciable, auditable, cloistered, as well as truthful framework. Our solution is built upon the development of intelligent smart contracts and is accompanied by the presentation of six sophisticated algorithms, including their thorough enactment, trying, and endorsement procedures. To gauge the effectiveness of our projected result, we undertake an extensive evaluation encompassing privacy, security, and confidentiality analyses. Additionally, we conduct a comprehensive comparison against existing solutions to highlight the advantages and advancements offered by our system. By leveraging the potential of blockchain technology and incorporating smart contracts, our solution addresses the complexities and limitations that have plagued organ donation and transplantation systems. This research aims to enhance the overall efficacy and slide of the procedure, ultimately benefiting disease one in require of life-saving tissue relocates.
Organ donation and transplantation have long been critical medical procedures, but they face numerous challenges, including scarcity, malpractices, and complex allocation processes. Also, they are vulnerable to the single point of failure problem due to centralization. Unlike existing blockchain solutions that only cover aspects like donor-recipient matching or medical record storage, our approach integrates hospitals into the system to ensure fair allocation of organs. The proposed organ donation decentralized app Organ Harbour utilizes Ethereum blockchain-based solution to automate this process in decentralized way, also it ensures transparency, privacy, security, and trustworthiness. This ensures secure and transparent registration of donor-patient information, including medical IDs, blood types, and organ details. Organ Harbour streamlines the process, eliminating third-party involvement and reducing transplantation costs. Moreover, by leveraging blockchain's immutability and smart contract capabilities, the system enhances data integrity and prediction accuracy. Overall, this research presents an approach to organ donation and transplantation, fostering security, transparency, and an efficient healthcare ecosystem.
The management of organ donation and transplantation systems is confronted with numerous challenges, spanning registration, donor-recipient matching, organ logistics, and ethical considerations. In response, this paper proposes a decentralized solution leveraging a private Ethereum blockchain framework. This paper establishes a secure, traceable, and privacy-preserving environment by utilizing smart contracts and a suite of innovative algorithms. This approach's robustness and trustworthiness will be highlighted by implementation details, testing procedures, and thorough evaluations that cover privacy, security, and confidentiality. Through comparative analyses, this solution emerges as a promising avenue for enhancing equity, efficiency, and patient confidence in organ donation and transplantation management.
In the context of the increasing importance of digitalization and cybersecurity, exploring the application of blockchain and smart contract technologies in blood donation management aims to enhance data transparency and privacy protection, addressing challenges in current healthcare systems. This paper explores the transformative potential of blockchain and smart contract technologies in digitalizing the blood donation process. By leveraging the Ethereum platform and employing a Browser/Server (B/S) architecture integrated with Solidity programming and web development practices, this paper proposes a novel framework designed to enhance the transparency, digitalization, and shared accessibility of blood donation data. The implementation of this system within a healthcare context promises to streamline the donation process, ensuring the integrity and confidentiality of donor data, thereby fostering trust among all stakeholders involved. The findings indicate that the application of blockchain technology not only facilitates a more efficient and secure management of blood donation records but also sets a precedent for future healthcare innovations.
Ikechi Saviour Igboanusi, Chigozie Athanasius Nnadiekwe, Joseph Uche Ogbede, Dong‐Seong Kim · 5 authors
This work proposes a Blockchain-enabled Organ Matching System (BOMS) designed to manage the process of matching, storing, and sharing information. Biological factors are incorporated into matching and the cross-matching process is implemented into the smart contracts. Privacy is guaranteed by using patient-associated blockchain addresses, without transmitting or using patient personal records in the matching process. The matching algorithm implemented as a smart contract is verifiable by any party. Clinical records, process updates, and matching results are also stored on the blockchain, providing tamper-resistance of recipient's records and the recipients' waiting queue. The system also is capable of handling cases in which there is a donor without an immediate compatible recipient. The system is implemented on the Ethereum blockchain and several scenarios were tested. The performance of the proposed system is compared to other existing organ donation systems, and ours outperformed any existing organ matching system built on blockchain. BOMS is tested to ascertain its compatibility with public, private, and consortium blockchain networks, checks for security vulnerabilities and cross-matching efficiency. The implementation codes are available online.