Renal Transplantation is the procedure of choice for most patients with end stage renal disease (ESRD) since it improves the quality of life and is cost effective compared with dialysis. The rapidly increasing incidence of end stage renal disease and inadequate supply of kidneys, especially from deceased donors have created a wide gap between kidney supply and demand, which has resulted in long waiting times and increasing number of deaths during the dialysis-dependency period.

Deceased donor is the preferred source for renal transplantation. But in spite of tremendous efforts even in the countries with the best economic and supportive measures, deceased donation is far behind the need and many recipients on the waiting list lose their lives (about 7 thousands per year in U.S.). Unfortunately, in MESOT countries very few have an active deceased donor transplantation program. Iran is the leading country in deceased donor transplantation followed by Turkey. At present 65% of kidney transplantations in Iran is from deceased donors.

Figure 1: reveals the rate of deceased donations in MESOT countries with active deceased transplant program.

There are several reasons in great achievements in regard to deceased donor program in Iran. Religion has played a very positive role in Iran in donation process and there are very few religious leaders who are not in favor of donation, both deceased and living donation.

Table 1: shows the Fatwas from religious leaders on deceased and living donation.

Second important solution that has enhanced deceased donation in Iran is because intensive care units are responsible to report brain death by law. Hospitals will be downgraded if they do not report brain death on time.

Social awareness programs also have played significant role to support deceased program.

In order to improve graft survival following deceased donor transplantation our strategy is that harvested kidney being transplanted locally as much as possible. By this strategy early grafting (about 3 hours from harvesting to transplanting the kidney) has resulted in better graft survival in deceased donor transplantation.

In this presentation we will discuss challenges and solutions for deceased donation in detail.