Impact of Multilingual Informed Consent on Lung Transplant Recipients Participating in Explant Tissue Collection at the University of California, San Diego

Impact of Multilingual Informed Consent on Lung Transplant Recipients Participating in Explant Tissue Collection at the University of California, San Diego
S.S. Gaboyan, E. Golts, K. Afshar, J. Verheyden, J. Chin, C. Pathak, I.N. Advani, C.M. Lin, A. Meier, X. Sun, Z. Borok, L.E. Crotty Alexander
American Journal of Respiratory and Critical Care Medicine, May 2025
Abstract
Background
Traditional ischemic times for human lung tissue studies often range from hours to days, compromising transcriptomic data accuracy due to the rapid impact of hypoxia on gene transcription. In 2021 we established a pipeline at UC San Diego for the rapid collection of explanted lungs from the operating room (OR) at time of lung transplantation. Multilingual consent forms were adopted in 2024 to increase inclusivity and improve data accuracy across a diverse range of patient populations and disease states.
Methods
Institutional Review Board (IRB) approval was obtained and all subjects provided informed consent. Initially, only English consent forms were used. In early 2024, Arabic, Hebrew, and Spanish consent forms were added. Descriptive statistics and logistic regression were used to assess changes pre- and post-implementation of multilingual consent forms. Explant methodology: immediately after blood flow cross-clamping, explanted lung is handed to the research team in the OR, and multiple 1 cm³ cubes from upper and lower lobes are harvested. Adjacent segments undergo fresh frozen storage, OCT cryo-embedding, and 4% paraformaldehyde fixation. Sample quality has been validated through single-cell RNA sequencing (scRNAseq) and immunofluorescent staining.
Results
Lung tissues has been collected from 103 lung explants representing various pathologies, including IPF, COVID-19-related fibrosis, COPD, and other interstitial lung diseases. Average ischemic time was 8 minutes (SD=3). Among participants, 39% were female with a mean age of 56 years (SD=12), 62% were non-Hispanic White, 27% Hispanic, and 27% other/mixed. In 35 months, 76 explants (74%) were collected using English consent forms. Following the introduction of multilingual forms, 27 explants (26%) were collected in 8 months, increasing the explant rate from 2.2 to 3.4 per month. Among patients using multilingual consent forms, 37% were female, 50% non-Hispanic White, 33% Hispanic, and 44% other/mixed. These patients were less likely to be White (OR: 0.03, 95% CI: 0.00-0.81) and more likely to require pre-transplant mechanical ventilation (OR: 15.0; 95% CI: 1.1-201.1) or high-flow O₂ (OR: 18.4; 95% CI: 3.2-105.0).
Conclusion
An extremely low-ischemic time bank of explanted lung tissues from a racially/ethnically, and gender-diverse population of lung transplant recipients has been achieved using an established procurement protocol and enhanced with the addition of multilingual informed consent forms. These tissues are well-suited for modern research applications and have already been successfully utilized for scRNAseq across various disease states. Expanding our multilingual consent forms to include Mandarin and Farsi will further diversify our sample population, enhancing future analyses.