The history
After the 1979 Iranian revolution, materials for dialysis were in short supply and there was no system of cadaveric donation. If you lost kidney function, you either went abroad for transplantation or died in Iran. The Ministry of Health set up two renal transplantation teams in the mid-1980s, the first of which was headed by Iraj Fazel, a surgeon who trained in the US and subsequently became minister of health and medical education.
He told the BMJ that he started to transplant patients “strictly from live related donors, with very limited support and facilities.” Demand rose swiftly, and a surgeon in another institution started to use organs from emotionally related donors and altruistic strangers, he said. Soon rumours developed that money was being exchanged. In the late 1980s the government put in place a regulated programme to support recipients who could not afford to pay for organs. A cadaveric kidney donation system was not started until 2000.
Iranian system
In Iran, a candidate for transplantation can get a kidney from a cadaver, a living relative, or a living stranger. However, in contrast to most countries, 76% of kidneys come from strangers; only 12% of kidneys are from deceased donors.
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It is centralised under the Ministry of Health and removal of organs requires either a donor card signed by the deceased or family consent. 7 Organ procurement organisations and brain death identification units identify potential donors and procure organs, ensuring transparency in the process of matching donors and recipients. In university hospitals, each case of brain death is determined by five physicians, one of them being a specialist in forensic medicine appointed by the Ministry of Health. The cadaveric programme is “purely altruistic” according to the Transplantation and Special Disease Centre, with no money given to families, except funeral expenses in a few