Commendable Developments in Deceased Organ Donation and Transplantation in Iran

he Regional Perspective Section of Transplantationwishes to focus the attention of the international com-munity on the great strides in organ donation and trans-plantation that are being achieved in Iran.Multiple allografts are now being recovered from morethan 250 deceased donors annually in Tehran. The ShahidBeheshti University of Medical Science Organ ProcurementUnit (OPU) has transferred 281 brain-dead potential organdonors forevaluation (withinTehran and from othercities ofIran) to enable more than 800 organs and 100 tissues to betransplantedsince2004(1).TheShahidBeheshtiUniversityofMedicalScienceOPUisachievinganannualrateof30donorspmp (servicing a population of 10 million within Tehran)with a familyconsentfordonationof93%, asreported by theDirector of the OPU Dr. Katayoun Najafizadeh.The liver transplant center in Shiraz, under the di-rection of Dr. S.A. Malek-Hosseini, is performing more than400 deceased-donor liver transplants each year.The scientific and medical contributions of these de-velopments in Iran are profound. For example, such a ro-bust program of deceased-organ donation enabled the firsthand transplant to be performed from a 24-year-old brain-dead donor by the 15 Khordad Plastic Surgery Team inTehran in February 2013 (2). The Shiraz liver transplantteam has recently reported the association of specific cyto-kines interleukin-6 and tumor necrosis factor-> in thebrain-dead donor with postoperative complications (allo-graft dysfunction) inliver transplant recipients (3). The lungtransplantation program at Masih Daneshvari Hospital iswell established, again under the leadership of pulmonolo-gist Dr. Najafizadeh.An expanded program of deceased donation in Iranpresents an opportunity for the expression of a communitysolidarityVto continue to increase the number of organdonors. The World Health Organization has urged memberstates to achieve a self-sufficiency in organ donation andtransplantation (4). The other Tehran organ procurementorganization, the Iranian Tissue Bank, has recently reporteda reduction in the rate of family refusal from 30.4% to 20%,associated with a more sophisticated donation coordinatorteam (5).Iran has a long-standing history of deceased-donorkidney transplantation but limited until now. The first kid-ney transplant from a cadaveric donor was performed inShiraz in 1968. However, the huge expansion of dialysis andthe cost of patients leaving Iran for a foreign destinationpropelled the widely known living unrelated program. Morerecently, Iranian colleagues have made a candid assessmentthat the national living unrelated program has ethical issuesthat are unacceptable to sustain. In a report from theKhuzestan Province in Southwestern Iran that assessed themotivations of the unrelated kidneydonors, the exploitationof young poor individuals for their kidneys was evident (6).Two hundred ten living kidney vendors were evaluated. Thestudy cohort consisted of approximately 80% men (167);67% (141) of the vendors were less than high school grad-uates, and 20 (9.5%) were illiterate. Not surprisingly, fi-nancial issues were the main motivation for kidney sales inthis regionofIran, butit wasimportantly noted thatmost ofthe vendors were very young and uneducated.Recently, Dr. Mahdavi-Mazdeh has written, again in amost candid manner, that the unrelated program of Iran has‘‘given rise to a black market of brokers and other forms oforgan commercialism only accessible to those with sufficientfinancial resources’’ (7). This article exposes the confronta-tional dynamic between the vendor and the recipient. De-spite an appropriation of compensation to the vendor bygovernment and charity foundations, the initial provision offunds is not the final transaction. The vendor wants more