Living donors: the Iran experience.

Abstract

Iran is a tropical country with a land area of 631 660 With governmental funding, and through training more dialysis sta and establishment of new units square miles and a population of 97 people per square mile. Although statistically this is not crowded, nearly outside Tehran, the number of patients exceeded the primary expected predictions. The limited capacity of 50% of the land area is a vast expanse of desert, without any inhabitants at all. Consequently, most of those small units was rapidly exhausted, causing many unanticipated problems. the remaining residential parts are highly congested, rural, or underpriviledged urban areas. Home dialysis has not been successful in Iran. CAPD, although started as a trial 15 years ago, stopped Shortage of primary, secondary, and tertiary preventive measures make the whole population highly very soon, and in 1996 was again restarted, being now considered as a cheaper solution and a back-door relief susceptible to many kinds of infectious and noninfectious diseases, some of which may end in ESRD. for congested dialysis units. The first renal transplantation in Iran was carried Life expectancy is somewhat lower in such countries. According to the most recent World Population Data out in 1963 at Shiraz University. The renal transplantation programme in Iran lagged behind in development Sheet published by the Population Reference Bureau (PRB), life expectancy in Iran is 67 years, which is and expansion in comparison to chronic dialysis. One hundred and twelve renal transplantations were persignificantly lower than that observed in the US, Canada (LE=77 years), and Japan (LE=79 years). formed from 1963 to 1984. Ninety-six from living related donors, two from cadavers, and 14 with kidneys There is no doubt that ESRD plays an important role in reducing the life expectancy of many patients. Recent received from abroad, especially from the Eurotransplantation Network. Of interest is that one researches in Asia show that the patient population entering renal replacement therapy (RRT) programme of these kidneys, transplanted 74 h after it was harvested in USA in 1977, was transferred to Europe, and in developing countries is much younger than that in Europe and USA (42 years against 62 years). Over the because it was not suitable for any candidates, was o ered to Iran, grafted into a 16-year-old girl at past decades RRT has increasingly been used in the treatment of ESRD. Behavar hospital in Tehran, and is still functioning well after 20 years. In the same time period 405 patients According to the data released in January 1996 by the ESRD o ce in Iran, 5926 patients su ering from travelled abroad to receive renal transplants at a very high expense, being subsidized and helped by the ESRD are being maintained by intermittent haemodialysis, most of them twice per week, each time for 4 governmental budget. The main barrier for growth of the transplantation programme in Iran was that cadahours, in 121 di erent centres throughout the country. The total number of dialysis machines is 1378, and veric organs were not available for a multitude of reasons. The Brain Death Act was not accepted by more than half of those are old-fashioned RSP machines. Dialysis treatment started in Iran in the parliament, hindering cadaveric organ harvesting. Also, a strong religious reluctance [1] existed at the 1960s, when one patient with acute renal failure underwent haemodialysis utilizing the Kol rotating drum beginning against cadaveric organ donation. As all patients are being dialysed in hospital centres kidney. Chronic intermittent haemodialysis started in 1967 with full governmental funding [2], and the growing number of patients being dialysed increases yearly, a but was limited to some private hospitals with small numbers of patients. In 1976, the Ministry of Health substantial financial strain is experienced. In addition, major problems exist in purchasing and supplying established the o ce for end stage renal disease, and adequate funding, to o er intermittent haemodialysis dialysis requirements from abroad due to the Iran–Iraq conflict. All these factors led to acknowledging the to 300 patients per year, and for training dialysis sta , nurses, and technitians. At that stage there was a irrefutable need of renal transplantation in Iran. In late 1985, the renal transplantation programme was patient-selection policy, and expansion of the programme was slow because of lack of facilities outside o cially started in a major University Hospital, and rapidly expanded; currently renal transplantation is Tehran.