Since 1980’s when the miraculous immuno­suppressive drug, cyclosporine, has significantly increased graft and recipient survivals, organ transplantation has been considered the treatment of choice for those with end-stage organ failure. The conception of “brain death” (another definition for death) was introduced in 1970’s. Over the past half century, the concept has gained acceptance from both legal and religious points of views in various countries. In fact, organs procured from brain-dead patients are currently the main source of transplants and save lives of hundreds of thousands of people in need of transplantation.

Legal aspects of brain death were first considered and passed in the USA and other western countries; after a long delay, the laws were ratified in a number of Asian countries. Unfortunately, despite of the desperate need for the procedure in many Asian countries, the required legislation on transplantation, if any at all, comes into effect very slowly, especially in Islamic countries.

It seems that religion is the main barrier to extension of transplantation in these countries. A recent report shows that the rate of deceased donation is almost 50 donations per million population (PMP) in Spain and Croatia; It is zero in most Islamic countries—Egypt, Jordan, and Iraq, for example. With a PMP of 15 in Iran, the situation is better; in certain cities of Iran, the rate is as much as 60 PMP. With a population of almost 82 million people, Iran is a large country. The prevailing religion is Islam (99% Moslem: 90% Shia, 10$ Sunni). The remaining 1% includes Christians, Jews, and Zoroastrians. Although one-tenth of Iranians are Sunni, all of those who grant permission for deceased donation are Shiat. Although a number of Sunni clergies have commented positively on this issue, it seems that the problem is mainly cultural. We are working hard in identifying and removing the barriers and will hope to be witnessing a deceased donation rate, as much as values observed in European countries, if not higher, in near future.