Suchergebnisse

Objectives: The Organization of Islamic Cooperation consists of 57 member states whose people are mainly followers of the Islamic religion. During the past several decades, organ transplants have been increasingly used for the treatment of end-stage organ failures worldwide. This study is to investigate the current status of organ transplant in Islamic countries. Materials and Methods: For data collection a literature, review was carried out. Information from international registries was used and key persons from some countries were contacted. Results: In all 5 Islamic countries of North Africa, living-donor kidney transplant was performed. Tunisia was the only country with deceased-donor organ transplant in North Africa. In 22 Islamic countries of sub-Saharan Africa, living-donor kidney transplant was performed only in Sudan and Nigeria. Deceased-donor organ transplant was illegal and nonexistent in this region. In all 14 Islamic countries of the Middle East, living-donor kidney transplant was an established practice. Turkey, Iran, and Saudi Arabia had the highest rates of organ transplant activity. In 2013, Turkey performed the highest rate of living-donor kidney and liver transplants, and Iran performed the highest rate of deceased-donor kidney and liver transplants. For 7 Islamic countries of Central Asia, organ transplant was nonexistent in Afghanistan and Turkmenistan; in the other 5 countries, a limited number of living-donor kidney or liver transplants were performed. In all 6 countries located in South and Southeast Asia, living-donor kidney transplant was performed. Only Malaysia had a limited-scale deceased-donor transplant program. Albania in the Balkans, and 2 countries (Suriname and Guyana) in South America, were also member states of the Organization of Islamic Cooperation; in these countries, only few living-donor kidney transplants were performed. Conclusions: The organ transplant rates, especially for deceased-donor transplant, in most Islamic countries were less than expected. Some of the causes of low transplant activity included lack of public education and awareness, lack of approval and support by Islamic scholars, and lack of government infrastructure and financial resources. © Ba�kent University 2015 Printed in Turkey. All Rights Reserved.

The first renal transplantation in Iran was carried out in 1967. Between 1967 to 1988 almost all renal transplants were from living-related donors and the number of renal transplants performed was much lower than the national demand. In 1988, a compensated and regulated living-unrelated donor renal transplantation program was adopted. As a result, the number of renal transplants performed substantially increased such that in 1999, the renal transplant waiting list was completely eliminated. By the end of 2006, a total of 21251 renal transplants were performed (3641 from living-related, 16544 from living-unrelated and 1066 from deceased-donors). In this program, many ethical problems that were associated with paid kidney donation were prevented. Currently, Iran is the only country with no renal transplant waiting lists, and> 50 of patients with end-stage renal disease have functioning grafts. In April 2000, the legislation was passed by parliament accepting brain death and allowing deceased-donor organ transplantation. By the end of 2006, 18 brain death identification units, 13 organ procurement units were organized, and a total of 1546 deceased-donor organ transplantations were performed (1066 kidney, 327 liver, 122 heart, 20 lungs, 7 pancreas-kidney, 2 heart-lungs and 2 small bowel transplants). The number of deceased-donor organ transplants have slowly but steadily increased in the country. The majority of deceased-donor kidney, liver, and pancreas transplants have been performed by transplant team of Shiraz University of Medical Sciences.

The first renal transplantation in Iran was carried out in 1967. Between 1967 to 1988 almost all renal transplants were from living-related donors and the number of renal transplants performed was much lower than the national demand. In 1988, a compensated and regulated living-unrelated donor renal transplantation program was adopted. As a result, the number of renal transplants performed substantially increased such that in 1999, the renal transplant waiting list was completely eliminated. By the end of 2006, a total of 21251 renal transplants were performed (3641 from living-related, 16544 from living-unrelated and 1066 from deceased-donors). In this program, many ethical problems that were associated with paid kidney donation were prevented. Currently, Iran is the only country with no renal transplant waiting lists, and> 50 of patients with end-stage renal disease have functioning grafts. In April 2000, the legislation was passed by parliament accepting brain death and allowing deceased-donor organ transplantation. By the end of 2006, 18 brain death identification units, 13 organ procurement units were organized, and a total of 1546 deceased-donor organ transplantations were performed (1066 kidney, 327 liver, 122 heart, 20 lungs, 7 pancreas-kidney, 2 heart-lungs and 2 small bowel transplants). The number of deceased-donor organ transplants have slowly but steadily increased in the country. The majority of deceased-donor kidney, liver, and pancreas transplants have been performed by transplant team of Shiraz University of Medical Sciences.

Since the 1980s, many countries have passed legislation prohibiting monetary compensation for organ donation. Organ donation for transplantation has become altruistic worldwide. During the past two decades, advances in immunosuppressive therapy has led to greater success in transplantation and to increased numbers of patients on transplant waiting lists. Unfortunately, the altruistic supply of organs has been less than adequate, and severe organ shortage has resulted in many patient deaths. A number of transplant experts have been convinced that providing financial incentives to organ sources as an alternative to altruistic organ donation needs careful reconsideration. In 1988, a compensated and regulated living-unrelated donor renal transplant program was adopted in Iran. As a result, the number of renal transplants performed substantially increased such that in 1999, the renal transplant waiting list was completely eliminated. By the end of 2005, a total of 19,609 renal transplants were performed (3421 from living related, 15,356 from living-unrelated and 823 from deceased donors). In this program, many ethical problems that are associated with paid kidney donation also were prevented. Currently, Iran has no renal transplant waiting lists, and >50 of patients with ESRD in the country are living with a functioning graft. In developed countries, the severe shortage of transplantable kidneys has forced the transplant community to adopt new strategies to expand the kidney donor pool. However, compared with the Iranian model, none of these approaches has the potential to eliminate or even alleviate steadily worsening renal transplant waiting lists.

During 23 years of civil war in Afghanistan, there has been a continuous flow of more than 5 million refugees out of the country. Iran has hosted about 40 of all refugees. The majority have resided outside of camps with opportunities to integrate locally, having access to the Iranian labor market and government services, such as dialysis and transplantation. Iran also has adopted a compensated living unrelated donor renal transplantation program in which foreigners can receive transplants from living related donors or volunteer living unrelated donors of the same nationality. In June 2004, among 241 refugees with end-stage kidney disease in Iran, 179 were on hemodialysis and 62 underwent renal transplantation. Nine patients received kidneys from living related donors, 1 from a spouse, 50 from Afghani living unrelated donors, and 1 from a cadaveric donor. No refugee had been used as a kidney donor to an Iranian patient. Transplantation of all Afghan refugees in need and the absence of their use as kidney donors to Iranian patients proffer strong evidence against commercialism and a reason to believe that the Iran Model transplantation is practiced with ethical standards. In the last 2 years since the civil war has ended, returning these patients to Afghanistan has raised important ethical concerns. Repatriation of dialysis patients and transplant recipients may be tantamount to their deaths. It is expected that The Transplantation Society and the World Health Organization will establish links with the United Nations High Commissioner for Refugee Offices to provide humanitarian assistance to these patients. © 2005 by Elsevier Inc. All rights reserved.

For the past few years, the social, economic, and political issues surrounding the field of organ transplantation have entered into many ethical discussions. Transplant tourism, and organ trade in particular, have finally received the attention they deserve and many commendable developments have ensued. The "Declaration of Istanbul on Organ Trafficking and Transplant Tourism," the result of a collective effort by hundreds of transplant professionals the world over, is one such example and is now considered the universal charter for ethical conduct in the field of transplantation. The Middle East Society for Organ Transplantation and its official journal Experimental and Clinical Transplantation were among its first endorsers, and it is our policy to ensure that all authors of articles published in our Journal adhere fully to the rules and regulations stated in The Declaration of Istanbul and by the Committee on Publication Ethics. We believe that the medical community must ensure that a foundation of ethical conduct and scientific integrity is maintained throughout the field, and we must strive toward this goal in all our clinical and scholarly efforts. © Ba�kent University 2013 Printed in Turkey. All Rights Reserved.