The history of organ and tissue transplantation in Iran dates back to 1935 when a patient’s cornea was transplanted in one of Tehran’s hospitals. Kidney transplantation first took place in 1968 and transplantation of other organs and tissues gradually took place in the 1970s and 1980s.

According to the Iranian Society of Organ Donation, there are two types of death in the medical world; Heart death (common death), which accounts for 99 percent of deaths worldwide, and brain death, which accounts for one percent of deaths.

Organ donation is an altruistic decision that can be made by the family members after brain death. Although many organizations and medical centers have implemented various interventions and training courses to increase satisfaction with organ donation, a lack of organs for donation still is a serious problem in the world.

As a result, thousands of patients on waiting lists for transplantation die every year.

In Iran, about 5,000 to 8,000 people die each year from brain death, half of whom, or about 3,000, have transplanted organs. Unfortunately, 1,000 families, or one-third, are satisfied with organ donation.

In Iran, there are over 25,000 patients in need of transplants on the waiting lists of various organs, but unfortunately, 7 to 10 of them die every day due to the lack of a transplanted organ, accounting for over 3,000 a year.

Considering that 7,000 transplant recipients are buried annually due to family dissatisfaction and 3,000 needy patients die, on the other hand, it can be considered that if only half of the buried organs could save the lives of all.

What discourages people to save the lives of others?

But what really pushes away the people from donating their deceased beloved’s organ and save the lives of many?

It is a touchy question, as some experts believe that there is a large disparity between the number of people who only claim that they support organ donation and the number of people who actually register for organ donation cards.

So, the factor keeping people from ultimately donating an organ is something that academics, doctors, and organ donation activists are trying to figure out.

Although, for long we have heard that organ donation is a generous life-saving ‘gift’, some are still unnerved by and skeptical about the donation process.

Making positive decisions about organ donation would likely require resolving tensions between respecting the family, community, and religious values versus their individual autonomy.

Such resistance may be explained by the lack of awareness about transplantation within their communities, dominant influences of older family members, religious myths and misconceptions, fear of premature death, concerns about bodily disfigurement, distrust of the medical system, and concerns of racial discrimination in organ allocation.

Providing targeted education about the process and benefits of organ donation within the community may clarify ambiguities surrounding cultural and religious-based views on organ donation, reduce taboos and suspicion towards donation, and in turn, lead to increased organ donation rates.

Understanding the meaning of neurological death is also another factor helping families to consent for organ donation of their brain-dead member of the family.

Neurological death is defined as ‘irreversible loss of capacity for consciousness combined with the irreversible loss of the capacity to breath’. It is a prerequisite for donation, although to families the body still appears to have life.

Making families of the deceased aware of the fact that they can find a sense of meaning and creating a positive outcome of their tragic loss by organ donation is a must to promote the culture. Families should have a desire to help others and apprehend that the deceased’s legacy will continue to exist through donation.

A lack of trust in the healthcare profession is also a major barrier to deceased organ donation; fears are mainly that doctors would not try as hard to save the life of an organ donor with physicians holding the power to decide whose life to save, as well as the belief that the wealthy are more likely to obtain a transplant.

Iran tops Asian countries in organ donation

Mehdi Shadnoush, head of the Health Ministry’s center for transplantation and disease management, announced in June 2020 that Iran is ranked first for organ donation among Asian countries.

“The country’s organ donation rate is 14.34 per one million people,” he noted.

In February 2019, Shadnoush said that the organ donation rate has increased by 60 times over the past 18 years. Although Iran ranks 26 in organ donation in the world.

Organ donation of brain death has reached up to 60 percent, he said, lamenting that the country ranks 21st regarding organ donation from brain dead patients in the world while ranking 14th regarding organ transplant from alive patients.

According to the figures revealed by the International Registry in Organ Donation and Transplantation (IRODaT), Spain leads the world in organ donation.

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Some countries including China have grown 122-fold in terms of organ donation over the past 10 years, ISNA quoted Mehdi Shadnoush as saying on Monday.

Although, Iran ranks 26 in organ donation in the world, it can claim better ranks given some plans being implemented in this regard, he highlighted, adding, we will achieve better results certainly by the next year (March 2019-March 2020), as many barriers have been removed last year.

In the past, kidneys were mostly removed from a healthy donor and surgically placed in an individual with kidney failure, while currently some 57 percent of kidney donor transplants in the country are among brain-dead donors, he explained.

Referring to the country being successful in liver transplant surgeries, he noted that, some 5,500 liver transplants have taken place in the country so far.

He further explained that Shiraz University of Medical Sciences conducting over 700 liver transplants annually achieved success in this regard.

Expressing that kidney transplant surgery costs one seventh of dialysis, he stated a five-year dialysis period brings economic burden amounting to 3.5 billion rials (nearly $83,000) for the country, while the kidney transplant costs about 500 million rials (about $12,000).

“We tried hard that patients waiting for transplant not to be influenced by the recent economic challenges facing the country,” he said, adding that the fund required for transplant will be provided to the universities of medical sciences nationwide by the end of the next month.

Nationally, over 8,600 people are on the transplant waiting list for kidney, which is hoped to face a decline as soon as possible, he lamented.

Organ donation of brain death has reached up to 60 percent, he said, lamenting that the country ranks 21st regarding organ donation from brain dead patients in the world, while ranking 14th regarding organ transplant from alive patients.

He went on to add that if we move ahead with the current trend, we will achieve 45 percent increase by the Iranian calendar year 1404 (March 2025-March 2026), although, we can enhance the success reaching 75 percent in case of proper planning.

World Health Organization explains that organ transplantation is often the only treatment for end state organ failure, such as liver and heart failure. Kidney transplantation is by far the most frequently carried out transplantation globally.

According to the figures revealed by International Registry in Organ Donation and Transplantation (IRODaT) Spain leads the world in organ donation.

Figures published for 2017 reveal that 2,183 people in Spain became organ donors last year after they died. That’s 46.9 pmp – a standard way of measuring the rate of donation in a country, The Independent reported in July 2018.

Spain’s closest contender is Croatia, with 38.6 pmp (2016). It has maintained its position as the clear leader for the past 26 years. In a press release, Spain’s National Transplant Organization confidently describes the country as unbeatable.

According to the data published on IRODaT by the end of 2017 Iran’s per million population of actual deceased organ donors was 11.43. In 1996 Iran’s per million population of actual deceased organ donors was 0.1, which compared to the current per million people in the population (pmp) shows a great increase.

Some 5,000 people die of brain death annually in Iran, out of 3,000 brain deaths reported last year being qualified to be organ donors, only 926 donated their organs.

In May 2018, the Masih Daneshvari hospital’s manager Ali Akbar Velayati said that some 10,000 people are waiting in transplant lists and every day some 10 people waiting for an organ lost their lives.

Omid Qobadi told IRNA in October 2018 that some 5 million Iranians have organ donor cards.

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