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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2008  |  Volume : 19  |  Issue : 1  |  Page : 127-131
Organ and Tissue Transplantation in Iran

Transplantation and Special Diseases Center, Tehran University of Medical Sciences, Tehran, Iran

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How to cite this article:
Mahdavi-Mazdeh M, Heidary-Rouchi A, Aghighi M, Rajolani H. Organ and Tissue Transplantation in Iran. Saudi J Kidney Dis Transpl 2008;19:127-31

How to cite this URL:
Mahdavi-Mazdeh M, Heidary-Rouchi A, Aghighi M, Rajolani H. Organ and Tissue Transplantation in Iran. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2020 Nov 23];19:127-31. Available from: https://www.sjkdt.org/text.asp?2008/19/1/127/37452

   Introduction Top

Chronic kidney disease (CKD) is emerging in the 21st century as a global public health issue. Currently, more than 1 million patients with end-stage renal disease (ESRD) are on renal replacement therapy (RRT) worldwide, [1] with as many as 2 million predicted to require therapy by 2010. [1],[2] The modality for treatment of these patients is hemodialysis (HD), peritoneal dialysis (PD), and renal transplantation (RTX). Nearly one and half million people receive one of the RRT worldwide. [3] RTX offers enhanced quality of life, and is more medically and economi­cally effective than chronic dialysis. How­ever, it requires a healthy allograft donor, whether living or deceased.

Data collection study demonstrated that 2 to 6 individuals per million populations (pmp) annually receive renal transplants in the developing countries; close to 20,000 trans­plants. [4] Indeed, about 15% of the transplants reported to the United Network for Organ Sharing (UNOS) registry and 15.4% of those reported to the Collaborative Transplant Study (CTS) Group were performed in deve­loping countries in 2000. Donor sources are also widely variable, depending on legal, ethical, and religious considerations in diffe­rent countries. [5]

The Total number of ESRD patients receiving RRT in Iran, with a population of 70,000,000 (in 2006), reached 25,000 in 2005 with a projection of 40,000 after 5 years. Prevalence and incidence of ESRD is 378 PMP and 59 PMP, respectively. Currently 50% are on HD, 47.5% are transplanted and 2.5% on PD. [6]

Transplantation activity in Iran started in 1935, when the first corneal transplant was performed. This was followed by kidney in 1968, bone marrow in 1991, liver in 1993, heart in 1993, and lung transplantation in 2000. [7],[8],[9]

   Organizational Structure Top

There are several governmental, non­governmental and private organizations that are involved in the care of ESRD patients in Iran. Ministry of Health (MOH) is the main sponsor of this program through the Manage­ment Center for Transplantation and Special Diseases (MCTSD). This organization is responsible for provision of support, policy making, and strategic planning for higher standards of management of the disease.

   Deceased Organ Transplantation Top

Regarding transplantation, after legislation for deceased organ donation in 2000, this center developed a network for deceased transplantation and organ procurement with the responsibility to centralized management, supervision, national allocation of organs, scientific national formulary, scientific data registry, and waiting list management.

The number of organ procurement units and Brain Death Identification Units (BDIUs) in Iran, with 30 provinces and area of 1.648 million sq km, is 13 and 18, respectively. There are 25 kidney, 2 liver, 4 heart, 1 lung, 3 bone marrow, and 58 Cornea transplantation centers nationwide. There are also tissue banks (bone marrow 3, bone 1, heart valve 1, cornea 1, amniotic membrane 2 and cord blood 1).

Brain death diagnosis in Iran is determined by five physicians, who are staff in the university hospitals, and one of them is forensic medicine; all of them are appointed by the Ministry of Health. The steps of deceased transplantation include registration of patients at the transplant center, establishing waiting Lists (Local - Regional - - National). It should be mentioned that deceased trans­plantation is purely altruistic and there is no gift to donating families except funeral expenses in few cases. The role of charities in this issue is public education and raising the awareness of the general public to the various positive aspects of the deceased transplantation.

   Living Unrelated Donation Top

Solid organ transplantation from living organ donor is an ethically acceptable and widely used practice. [10] Some experts believe that the application of self interest ( i.e ., financial incentives) to shape human beha­vior is much better employed than altruism. As a result incentives, the number of renal transplant centers and renal transplantations rapidly increased. All renal transplant teams belong to university hospitals. To prevent transplant tourism, foreigners are not allowed to undergo renal transplantation from Iranian living-unrelated donors. Also, they are not permitted to volunteer as kidney donors to Iranian patients. Foreigners can receive a transplant in Iran, but the donor and the recipient should be from the same nationality, and authorization for such transplantation should be obtained from the MCTSD. [11]

Legislation for governmental rewarding donation was passed in 1997. After renal transplantation, the living unrelated donor receives an award, special budget approved by the parliament through the Charity Foundation for Special Diseases (CFSD), and one-year medical insurance. The majority of living-unrelated donors also receive a compensation, overseen by Patients' kidney Foundation, from the recipient; if the reci­pient was poor, one of the charitable organi­zations would provide it.

The potential living donor and recipient work-up protocol is similar in different trans­plant centers. HLA matching is not a routine test; except in selected living-unrelated donors. For living-unrelated donor transplants, any ABO compatible donor with the patient is accepted for evaluation. Transplantation surgery fee and hospital expenses are paid by insurance agencies (90%) and MOH (10%).

   Immunosuppressive Drugs Top

The available immunosuppressive drugs consisted of cyclosporine (Neoral), generic azathioprine and prednisone. In 2000, mycophenolate mofetil (CellCept) was added to the national formulary instead of azathio­prine, and now over 95% of patients are on it. The government imports and greatly subsi­dizes these essential immunosuppressive drugs (Neoral, CellCept). All patients with ESRD including renal transplant recipients are called "Patients with Special Diseases" and are eligible for a government-provided medical insurance. As a result, the majority of transplant recipients who receive these immunosuppressive drugs are insured. The remaining patients pay a slight amount of money per month for these drugs. If a transplant recipient was poor and could not even afford the drugs at the much reduced price, then the charitable organizations would pay for it. This is one of the reasons that all patients, either poor or rich, have equal access to renal transplantation in Iran.

Induction therapy with anti-thymocyte globulin and in some cases with IL2 receptor antibodies are widely used. Tacrolimus, which is now only subsidized for liver transplantation accompanied by sirolimus will be added to the national formularies of renal transplantation with subsidization by Food and Drug Secretary of MOH in 2008.

   Budget Allocation for Renal Replacement Therapy Top

Although the total health expenditure of GDP is 6%, and GDP - per capita (PPP) is $8,900 (2006 est.), [12] different modalities of RRT are free of charge and is accessible for all. There is a fixed reimbursement rate for dialysis and transplant in both public and private hospitals. The expenses of pro­cessing and procurement of organs is paid by MCTSD. Moreover, charitable organi­zations are very active in providing the drugs, and paying any expenses of renal transplantation to poor patients.

   Role of Charity Top

After evaluation of potential donors or recipients in different clinics or private offices, patients are referred to the Patients' Kidney Foundation (PKF), which is super­vised by MOH.

The staff of PKF call up the donors and recipients for final appearance and review before the operation, and to sign the consent for the transplantation, to which the atten­dance of guardians, and spouses is mandatory for the consent of parental and spousal with a valid identity certificate and they should sign the consent.

   Surveillance on the Program Top

In Iran at present 41 medical universities and faculty of medicine are responsible for implementing different treatment and pre­vention programs of MOH. In each univer­sity, one coordinator supervises the affairs of hemophilia, thalassemia, hemodialysis and transplanted patients in the different centers affiliated with that university. The coordi­nator is in direct contact with the MCTSD. Moreover, the coordinators survey treatment and distribution of immunosuppressive the­rapy over the country with the collabora­tion of colleagues in Food and Drug Deputy and the MCTSD.

   Transplantation Statistics Top

Up to 2005, 19501 kidneys, 203 livers, 104 hearts, 13 lungs, 28362 corneas, 1,468 bone marrows, 1,382 heart valves, and 1283 bone transplants were performed in Iran. Since the implementation of the deceased legis­lation, the number of tissue and organ transplants have increased considerably, [Figure - 1].

The rate of brain death organ donors is 1.6 pmp, non-heart beating tissue donors are 26 pmp, and living donors are 23 pmp. Graft survival at 1 and 2 years post renal transplantation is 89.08% and 87.68%, respectively.

   Acknowledgment Top

The authors would like to acknowledge the leadership role of all transplant surgeons and specialists in establishing transplan­tation well organized activity in the whole country.

   References Top

1.Nwankwo E, Bello AK, El Nahas AM. Chronic Kidney Disease: Stemming the Global Tide. Am J Kidney Dis 2005;45:201-8.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Xue JL, Ma JZ, Louis TA, Collins AJ. Forecast of the number of patients with end-stage renal disease in United States to the year 2010. J Am Soc Nephrol 2001; 12:2753-8.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Inaugurating World Kidney Day-The fact sheets. Available from: http://www.worldkidneyday.org. [Last accessed on 2006 Mar 9].  Back to cited text no. 3    
4.El Nahas AM, Bello AK. Chronic kidney disease: The global challenge. Lancet 2005; 365:331-40.  Back to cited text no. 4    
5.Barsoum RS. Overview: end-stage renal disease in the developing world. Artificial Organs ;26:737-46.  Back to cited text no. 5    
6.Annual report of Management Center of transplantation and Special Diseases (MOH) 2005.  Back to cited text no. 6    
7.Malekhoseini SA. The first liver transplan­tation in Iran. J Med Council Islamic Republic Iran 1975;14:165.  Back to cited text no. 7    
8.Foroozannia S, Hoseini S, Rafiii M. The first heart transplantation in yazd province. J Yazd Univ Med Sci 2004;Spring:70-5.  Back to cited text no. 8    
9.Broumand B. Transplantation activities in Iran. Exp Clin Transplant 2005;3:333-7.  Back to cited text no. 9    
10.Michael A, Adams M, Adams P. Consensus statement on the live organ donor. JAMA 2000;284:2919-26.  Back to cited text no. 10    
11.Ghods A, Savaj Sh. Iranian model of paid and regulated living-unrelated kidney donation. Clin J Am Soc Nephrol 2006; 1:1136-45.  Back to cited text no. 11    
12.World factbook. Available from: http://iran:www.cia.org.  Back to cited text no. 12    

Correspondence Address:
Mitra Mahdavi-Mazdeh
Associate Professor of Nephrology, Director General of Transplantation and Special Diseases Center (MOH), Tehran University of Medical Sciences, Tehran
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PMID: 18087142

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