Organ Transplantation in Iran before and after Istanbul Declaration, 2008

R enal transplantation in Iran dates back to 1967, when the first transplantation was carried out by Dr. Mohammad Sanadizadeh in Shiraz University, then one of the major and most advanced medical universities in Iran. During the next 12 years, the period prior to Islamic revolution, sporadic cases were transplanted, but despite the high expenses and cultural and language barrier, most of the 114 transplantations performed in this period, were carried out abroad, especially in the United Kingdom. There was no established transplantation program in Iran and those who were transplanted were mostly done on the bases of competition and rivalry, using imported organs from Eurotransplant organ sharing network with sizable expense and guarded quality. The limited renal transplantation activities were completely ceased two years after Islamic revolution in 1979, and qualified transplantation surgeons left the country. Iran was suffering from the post-revolution convulsive social status and a cruel devastating imposed war. All the limited resources spent on war, as well as medical manpower and hospital beds. Due to alarming shortage of hemodialysis facilities and equipment, reports of significant number of death end-stage renal disease (ESRD) patients became a daily incident. In that situation, any suggestion for establishing a renal transplantation program was considered untimely and luxurious, even by medical professionals. Nevertheless, renal transplantation was the most promising solution to remedy the disastrous outcome of ESRD patients, and proved to be the best available mode of therapy. Despite the grim circumstances, the first kidney transplantation after a temporary halt, was carried out in 1984 in Tehran with minimal facilities and support, but excellent outcome [1]. The organ was donated by a brother to his sister. Fifty such transplants, all from live related donors, were carried out in various setups, including charity, teaching and private hospitals in order to examine the different possibilities. This ultimately led to the development of the National plan for renal transplantation, which was formally established in a hospital dedicated to nephrology and urology patients. The hospital was university-affiliated and a mulitdisciplinary team was assigned to manage and govern the program. The excellent success rate, low cost and remarkable outcome encouraged every patient to join the waiting list for transplantation. Soon thereafter, there were ever increasing number of patients with the suitable family donor. The cadaver organ was not available and public acceptance required long period of preparation and education. In addition, the brain death concept needed …