Concept Of Brain Death Research Articles

Knowledge of the Brain Death Concept Among Older People

BackgroundThe concept of brain death (BD) is not well understood in the general population; this lack of knowledge is one of the main factors that generates an attitude against organ donation. Older people are a population group that has rarely been studied in relation to organ donation and transplantation (ODT), and it is important to investigate the most important aspects of ODT, such as people’s concept of BD. ObjectivesTo analyze the level of understanding of the concept of BD in people > 65 years of age and the factors that influence their mode of thinking. MethodsA multicenter study was carried out with a representative sample of people > 65 years of age, stratified by sex and geographic location in the southeast of Spain (n = 420). Knowledge of BD as well as the influence of other variables were analyzed through a validated questionnaire about ODT. SPSS version 21.0 (IBM Corp, Armonk, NY, United States) software was used for statistical analysis. Descriptive analysis included Student t test and the χ2 test. ResultsThe questionnaire had a completion rate of 84% (n = 351). In 36% (n = 127) of cases, people ˃ 65 years of age understood the concept of BD. In general, knowledge of this concept has not been associated with other variables including social-family interaction about ODT (P > .05). ConclusionsOlder people do not understand the concept of BD. It is, therefore, necessary to carry out informative campaigns on ODT explaining this concept. This would improve organ donation awareness in this particular group of people.

Population of Cienfuegos (Cuba) and Their Knowledge About the Concept of Brain Death: Multivariate Analysis of the Associated Psychosocial Factors

IntroductionThe favorable knowledge of the concept of brain death (BD) is a determinant for organ donation. ObjectiveTo analyze the level of knowledge of the concept of BD in the population of Cienfuegos (Cuba) and determine the factors that condition it. MethodsSample of Cubans residing in Cienfuegos (n = 636) stratified by age and sex. The assessment instrument is the validated questionnaire of attitude toward donation and transplant, “PCID-DTO-Ríos,” self-administered and anonymously filled out. Statisticsχ2, Student t test, and a logistic regression analysis. ResultsA total of 636 individuals completed the questionnaire. Fifty percent of participants understood the concept of BD and accept it as a person's death (n = 318). Of the rest, 13.4% (n = 85) did not understand it, and 36.6% (n = 233) had a misconception. The marital status (be married and / or with a partner) of the respondent is associated with the knowledge BD (P < .001) as are the following variables: level of education; offspring; having discussed the issue of donation and transplantation with the family; opinion of the couple toward donation and transplantation; religion; and favorable attitude toward the organ donation and transplant. In the multivariate analysis, the following are independent variables: 1. studies (odds ratio [OR] = 4.664; P = .002); 2. has no offspring (OR = 3.129; P < .001); 3. has commented on it in the family nucleus (OR = 2.759; P < .001); 4. despite having an opinion against (OR = 16.999; P < .001); 5. religion (OR = 1.878; P = .042); and 6. favorable attitude toward the donation of cadaver organs (OR = 2.026; P = .011). ConclusionsHalf of the population of Cienfuegos knows and accepts the concept of BD as the death of an individual, associating said acceptance with a favorable attitude toward organ donation.

Ecuadorian Population Residing in Spain and Their Knowledge of Brain Death Concept

BackgroundThe Ecuadorian population forms the largest Latin American immigrant group in Spain. However, their knowledge about the brain death (BD) concept and the relationship with the attitude toward organ donation has been little analyzed. The objective of the study is to analyze the knowledge of the BD concept among the Ecuadorian population resident in Spain. MethodsThe population under study was the population born in Ecuador and resident in Spain. Inclusion criterion was age older than 15 years stratified by age and sex. The assessment instrument was PCID-DTO-Ríos, a validated questionnaire of attitude toward donation and organ transplantation. Field work involved random selection of respondents based on stratification. The support of immigration support associations was required to obtain sample locations. The completion was anonymous and self-administered. ResultsOf the 461 respondents, 22% (n =102) know the BD concept and accept it as the death of the person; 61% (n = 283) do not know it; and for 17% (n = 76) it does not mean the death of the person. The variables related to the correct knowledge of BD are age (P = .007) and marital status (P = .028), with age persisting in the multivariate study (odds ratio, 1.036; P = .008). There is no objective relationship with the attitude toward organ donation. Thus, 60% of those who know the concept are in favor of donating (n = 61), and 59% of those who do not know it are in favor (n = 210; P = .813). ConclusionsThe BD concept is little known among Ecuadorians residing in Spain, and it is not associated with the attitude toward donation.

Knowledge of the Brain Death Concept Among the Puerto Rican Population Residing in Florida

IntroductionPuerto Rican and Cuban populations constitute the largest immigrant groups in Florida. This leads to an increase in their involvement in the organ donation and transplantation process (ODT); however, there is very little understanding about their attitude toward and knowledge of related key aspects such as brain death (BD). ObjectiveAnalyze knowledge of the BD concept among the Puerto Rican population residing in Florida. Material and MethodsThe population under study is born in Puerto Rico and residing in Florida. Inclusion criteria was the population over 15 years stratified by age and sex. The assessment instrument was a validated questionnaire of attitude toward donation and organ transplantation “PCID-DTO-Ríos.” A random selection of people was surveyed according to stratification. Support from immigration assistance associations in Florida was needed to locate potential respondents. Survey completion was anonymous and self-administered. ResultsOf the 259 respondents, 35% (n = 90) know the BD concept and consider it the death of an individual, 44% (n = 113) do not know it, and 21% (n = 56) do not consider them death. Variables significantly related to the correct knowledge of BD are as follows: sex (P = .012); marital status (P = .043); and couple's opinion (P = .001) and religion (P < .001). In the multivariate analysis, the variables that persist as significant are being married (odds ratio [OR] = 5.231; P = .002); to know the organ donation and transplantation couple attitude as favorable (OR = 4.819; P = .001) and not being Catholic (OR = 4.090; P < .001). ConclusionsOnly one third of the Puerto Rican population residing in Florida knows the concept of BD and accepts it as the death of a person.

Awareness of brain death, organ donation, and transplantation among medical students at single academic institute.

Objective:To assess the knowledge of the concept of brain death, attitude, and level of awareness towards organ donation and transplantation, among medical students and interns at the University of Jeddah, Kingdom of Saudi Arabia.Methods:A cross-sectional study via electronic questionnaire over period of 3 weeks to 2nd through 6th year medical students and interns at university of Jeddah.Results:A response rate of 113 out of 151 (74.83%) was achieved. Among participants, 36% expressed uncertainty when questioned about the concept of brain death. 8.8% of the participants were against the idea of organ donation. 60% of those who refused to contemplate organ donation were unfamiliar with the brain death concept. No significant difference was seen regarding fears about cosmetic disfiguration between those familiar and unfamiliar with the concept of brain death. 60.2% of the study cohort would consider donating their organs to family members but only 29.2% of them had discussed the matter of organ donation and transplantation with them, while 44.2% had discussed the matter with their friends. Majority of medical students (71.7%) were interested in being organ donors.Conclusion:Knowledge of organ donation and transplantation were adequate. Matter accepting brain death and its implication still not clear for most of participants. We believe there is still room to improve. This could be achieved by integrating more education about different aspects of brain death and its implications through medical school years.

Nurses' Challenges in Caring for an Organ Donor Brain Dead Patient and their solution strategies: A Systematic Review.

Background:Caring for brain dead patient is one of the most troublous duties of an Intensive Care Unit (ICU) nurse. This study aimed to determine nursing challenges based on recent literature and identify the strategies to overcome these challenges.Materials and Methods:In this systematic review, the standard systematic review guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used with articles published in PubMed, Science Direct, Scientific Information Database (SID), and Google Scholar databases during 2000–2018 on the keywords “brain dead OR brain death” and “nurses OR nursing.” After the primary search, 212 articles were found. Eventually, 21 articles were selected for the final evaluation.Results:According to the results, the challenges included the concept and diagnosis of brain death, religious, and cultural beliefs opposing organ donation, lack of knowledge about the care process, interactions with the families. The proposed strategies were providing medical and nursing interventions to maintain a brain dead patient for organ donation, providing working conditions that maintain nurses' health, and increase the quality of care.Conclusions:Nurses play an important role in the care process of brain dead patients; therefore, recognizing their challenges can be thefirst step in increasing holistic care and maintaining organ vitality for transplantation. It is suggested that nursing authorities commence special educational programs with the aim to increase the knowledge of nurses about the care process of brain dead patients.

When Life Ceases-Relatives' Experiences When a Family Member Is Confirmed Brain Dead and Becomes a Potential Organ Donor-A Literature Review.

IntroductionMost healthcare professionals rarely experience situations of a request for organ donation being made to the patient’s family and need to have knowledge and understanding of the relatives’ experiences.ObjectiveTo describe relatives’ experiences when a family member is confirmed brain dead and becomes a potential organ donor.MethodsA literature review and a thematic data analysis were undertaken, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting process. A total of 18 papers, 15 qualitative and 3 quantitative, published from 2010 to 2019, were included. The electronic search was carried out in January 2019.ResultsThe overarching theme When life ceases emerged as a description of relatives’ experiences during the donation process, including five subthemes: cognitive dissonance and becoming overwhelmed with emotions, interacting with healthcare professionals, being in a complex decision-making process, the need for proximity and privacy, and feeling hope for the future. The relatives had different needs during the donation process. They were often in shock when the declaration of brain death was presented, and the donation request was made, which affected their ability to assimilate and understand information. They had difficulty understanding the concept of brain death. The healthcare professionals caring for the patient had an impact on how the relatives felt after the donation process. Furthermore, relatives needed follow-up to process their loss.ConclusionCaring science with an explicit relative perspective during the donor process is limited. The grief process is individual for every relative, as the donation process affects relatives’ processing of their loss. We assert that intensive care unit nurses should be included when essential information is given, as they often work closest to the patient and her or his family. Furthermore, the relatives need to be followed up afterwards, in order to have questions answered and to process the grief, together with healthcare professionals who have insight into the hospital stay and the donation process.

Evolution of the concepts of brain death and brain stem death

Brain stem death has remained a topic of contention among physicians and laypersons for many years. The evolution of the current definition of brain stem death has been the end result of decades of scientific study and deliberation. Although the concept has been known historically, a scientific probe into the matter had been made possible only during the late 20th century. This led to a healthy discussion regarding the obscure nature of brain stem death among experts on different continents, leading to the current definition provided by the American Association of Neurology in 2010. This review article aims at shedding light on the institution of brain stem death and the evolution of the definition, as we know it today. Brain stem death has remained a topic of contention among physicians and laypersons for many years. The evolution of the current definition of brain stem death has been the end result of decades of scientific study and deliberation. Although the concept has been known historically, a scientific probe into the matter had been made possible only during the late 20th century. This led to a healthy discussion regarding the obscure nature of brain stem death among experts on different continents, leading to the current definition provided by the American Association of Neurology in 2010. This has proved to be a boon for the organ transplantation program; providing the system with a new, ethical donor pool and making available healthy organs that could change the lives of people living with organ failure. All this progress is relatively new and comes hand in hand with controversies. This review article aims at shedding light on the institution of brain death and the evolution of the definition, as we know it today.

THE SOUL: WHY MEDICAL PRACTITIONERS AND ISLAMIC SCHOLARS DO NOT ACCEPT BRAIN DEATH CONCEPT

The concept of brain death refers to the irreversible loss of brain function which includes the brain stem. The diagnosis of brain death is a controversial issue among Muslim scholars and medical experts because it involves the pronouncement of death of a patient whose heart is still beating with the assistance of a ventilator (breathing apparatus). Many countries recognise brain death as true death. However, there are religious scholars and medical experts who disagree with the concept of brain death because they believe that the soul still exists in one’s body although the brain has been diagnosed as dead. From their point of view, the heartbeat shows that the soul is still present in the body. From the perspective of Islam, a person is considered dead when there is separation between the soul and body. This paper will discuss the arguments pertaining to the soul which have been used in rejecting the concept and diagnosis of brain death.

Veterinary Spanish Students’ Attitude Toward Presumed Consent in Organ Donation

Veterinarians often are involved in transplantation research projects. They are a fundamental social group who can influence public opinion about organ donation and transplantation (ODT). Objective. The objective was to determine the knowledge of Spanish veterinary students about the concept of brain death and the law of presumed consent. MethodsA sociologic, multicenter, and observational study was carried out in the veterinary students enrolled in Spain (n = 9000) in a complete academic year. A sample of 2815 students was stratified by geographic area and academic year. The students’ attitudes on the psychosocial aspects of ODT were evaluated using a psychosocial validated questionnaire (PCID-DTO Rios). It was self-administered and completed anonymously. Veterinary schools were randomly selected. The questionnaire was applied to each academic year at compulsory sessions. Statistical analysisStudent t test, χ2 test, and logistic regression analysis were used. ResultsThe completion rate was 91% (n = 2558). Of students, 66% (n = 1664) understood the concept of brain death, 30% had doubts, whereas 5% believed that a person with brain death can recover and lead a normal life. Concerning legislation, 63% (n = 1615) were against the law of presumed consent, and 37% were in favor. An analysis of variables determining more favorable acceptance of the law showed that year of study (P = .000), knowing a donor (P = .020), and attitude toward ODT (P = .000) did have an effect on acceptance. Most students, 71% (n = 1875), were interested in attending a talk about ODT. ConclusionOnly 37% of Spanish veterinary students would accept the law of presumed consent. Most students were interested in attending an informative talk about ODT.

P.168: Factors associated with successful family communication regarding brain death and organ donation – a single center experience in UAE.

Background: Family communication regarding brain death and the subsequent request for organ donation is challenging under any circumstances. In the UAE it is particularly difficult as the laws regarding brain death and organ donation were only enacted recently and the community awareness regarding these concepts is fairly low. For these reasons, the rates of consent for deceased organ donation are modest. We sought to determine the factors associated with a positive response from family regarding consent for deceased organ donation. Methods: We conducted a qualitative review of patient charts of all brain death patients where we were able to obtain consent for donation. We then attempted to identify any commonalities that were felt to be associated with a positive response. Results: A total of five cases were identified starting from the year 2017 when the laws in UAE were changed to permit deceased organ donation. A number of themes emerged. 1.Understanding of the concept of brain death in the lay population is poor. 2.In all cases of successful consent, several meetings over several days were needed for families to understand and accept the diagnosis of brain death. 3.“Decoupling” the information of brain death with request for organ donation is of paramount importance. It is rare for families to accept the diagnosis of brain death in the first instance. All successful requests were only made after the family had accepted the diagnosis and was planning on withdrawal of organ support. From past experience, we have encountered several cases of refusal when the request was made too early, before the family had explicitly verbalized understanding. 4.Presence of a first-degree relative at the bedside with authority to make decisions was a common factor in all successful cases. All of our donors happen to be expatriates. 5.In all five cases, family communication was handled by health care staff who had undergone specific training in family communication. 6.In only one of the five cases at our hospital was an interpreter used. Conclusions: The main factors associated with a positive response for deceased organ donation in our hospital include •allowing families sufficient time to accept the diagnosis of brain death •decoupling •having a first-degree relative with decision-making ability available at the bedside •using health care staff trained in family communication These findings need to be confirmed by a future study with a larger sample size.

332.4: What are the most important causes of family’s refusal of organ donation from Iran’s 10 provinces’ organ donation coordinators?

Background: Braindead family’s refusal of organ donation is the main cause of organ shortage worldwide. This study was done to evaluate the most important causes of family’s refusal of organ donation from Iran’s 10 provinces’ organ donation coordinators. Methods: Considering the spread and high number of each province’s hospitals and the lack of knowledge of specialists in those hospitals on organ donation, it is necessary that all special care agents of all hospitals are trained. For this purpose, the five-day organ donation course (IrOSS) was designed. IrOSS’s team includes organ donation and transplantation experts and an executive team which during this course stay in each city and educate province’s authorities and all related expert teams. To determine refusal reasons at the beginning of each course a 20-item questionnaire titled “organ donation refusal reasons” is distributed. Coordinators based on their experiences order the refusal causes of the questionnaire between 1- 20 and if they have any other item in mind, they add it. Afterward, data analyzed by SPSS21. Results: Based on results from these 10 provinces the first and most important reason for family’s refusal in all provinces was family’s lack of understanding of brain death. In table 1, collective results are provided. Fear of blame and guilt were next and at last, were financial expectations and no specific reason. Table 1. Distribution of causes of refusal of organ donation in Iran’s provinces Conclusions: Based on the study results lack of understanding of the concept of brain death was recognized as the first cause in all provinces. To tackle this issue, short- and long-term planning is necessary. In short term, conditions are needed to familiarize organ donation specialist teams with interview principles and techniques and in long-term awareness rising in the society about organ donation. In addition, financial expectations as the last cause shows that Iran’s generous population have no financial expectations to consent to organ donation and sees it as a sacred matter. Keywords: interview, organ donation, IrOSS

Religious denomination influencing attitudes towards brain death, organ transplantation and autopsy-a survey among people of different religions.

(Brain) death, willingness of organ donation and autopsy are relevant questions of life and death. Religious beliefs are expected to have a significant influence on individual attitudes. People with an active relationship to a religion were surveyed about brain death, organ transplantation and autopsy using an anonymous questionnaire. The study was aimed in particular at students of theology and people in religious communities. In addition to a descriptive statistical analysis, a binary logistic regression analysis was carried out. From November 2016 to April 2017, 1306 people took part in the study. Religious denomination had statistically significant implications. Members of a certain religion were found to share similar positions. Significant differences were noted in the attitudes shown by members of different religions and by those without any religious affiliation. Especially the concept of brain death was rejected by Buddhists. The majority of Sunni Muslims, Hindus and Buddhists rejected organ donation following brain death. In all religious groups, the majority did not possess an organ donor card. Catholics and Protestants had more organ donor cards than any other religious group and more likely supported autopsies. Religious denomination plays a central role in the various viewpoints and attitudes. The findings are just as relevant in scientific and public discussions as they are in medical practice and may contribute to increasing sensitivity and professionalism and to facilitate communication.

Global Scientific Outputs of Brain Death Publications and Evaluation According to the Religions of Countries.

In 1950s, the concept of brain death, which began to be discussed primarily in terms of medicine and then in terms of religion, law, and ethics, became a central topic in all world countries as it was an early diagnosis of death. Despite the fact that brain death (BD) diagnosis is of importance for benefitting from organ and tissue transplantation of patients in the world, the literature still involves no bibliometric studies that made a holistic evaluation of the publications about this issue. The present study aims to investigate the top-cited articles about BD published between 1980 and 2018, identify the citation collaboration of the journals, demonstrate the collaboration between the countries, define the relationship between organ transplantation and BD, and reveal the latest developments and trend topics about this issue. In addition, this study aims to investigate the relationship between religions of countries and brain death publication productivity. Documents for bibliometric analysis were downloaded from Web of Science. The literature search was performed using the keywords "brain death/dead" during 1980-2018. The correlations between gross domestic product (GDP), Human Development Index (HDI) and publication productivity of the countries on BD were investigated with Spearman's correlation coefficient. There was a high-level, statistically significant correlation between the number of publications and GDP, and HDI and the number of publications about BD (r = 0.761, p < 0.001; r = 0.703, p < 0.001). The USA was the top country in terms of publication productivity, which was followed by developed countries such as Germany, Japan, France, and Spain. However, the contribution of the undeveloped or developing countries such as China, Brazil, Turkey, Iran, and South Africa was found to be considerably important. While many people in the world die with undamaged organs, many other people die needing those organs. Therefore, it is considered that the collaborations and thus multidisciplinary studies about BD should be increased in the world countries, and the countries should be involved in bigger collaborations instead of little clusters. Especially, Muslim countries should be encouraged to do research and publish studies about the issues of brain death and organ transplantation.

Restoration of cellular activity after decapitation.

A new study has demonstrated recovery of brain circulation and some cellular function in a decapitated pig model. Although these results are exciting and thought-provoking, they do not challenge the concept or practical implications of brain death, as no evidence of global electrical activity or functional recovery of the brain was presented.

Epidemiology of Brain Death in Pediatric Intensive Care Units in the United States

Guidelines for declaration of brain death in children were revised in 2011 by the Society of Critical Care Medicine, American Academy of Pediatrics, and Child Neurology Society. Despite widespread medical, legal, and ethical acceptance, ongoing controversies exist with regard to the concept of brain death and the procedures for its determination. To determine the epidemiology and clinical characteristics of pediatric patients declared brain dead in the United States. This study involved the abstraction of all patient deaths from the Virtual Pediatric Systems national multicenter database between January 1, 2012, and June 30, 2017. All patients who died in pediatric intensive care units (PICUs) were included. Patient demographics, preillness developmental status, severity of illness, cause of death, PICU medical and physical length of stay, and organ donation status, as well as comparison between patients who were declared brain dead vs those who sustained cardiovascular or cardiopulmonary death. Of the 15 344 patients who died, 3170 (20.7%) were declared brain dead; 1861 of these patients (58.7%) were male, and 1401 (44.2%) were between 2 and 12 years of age. There was a linear association between PICU size and number of patients declared brain dead per year, with an increase of 4.27 patients (95% CI, 3.46-5.08) per 1000-patient increase in discharges (P < .001). The median (interquartile range) of patients declared brain dead per year ranged from 1 (0-3) in smaller PICUs (defined as those with <500 discharges per year) to 10 (7-15) for larger PICUs (those with 2000-4000 discharges per year). The most common causative mechanisms of brain death were hypoxic-ischemic injury owing to cardiac arrest (1672 of 3170 [52.7%]), shock and/or respiratory arrest without cardiac arrest (399 of 3170 [12.6%]), and traumatic brain injury (634 of 3170 [20.0%]). Most patients declared brain dead (681 of 807 [84.4%]) did not have preexisting neurological dysfunction. Patients who were organ donors (1568 of 3144 [49.9%]) remained in the PICU longer after declaration of brain death compared with those who were not donors (median [interquartile range], 29 [6-41] hours vs 4 [1-8] hours; P < .001). Brain death occurred in one-fifth of PICU deaths. Most children declared brain dead had no preexisting neurological dysfunction and had an acute hypoxic-ischemic or traumatic brain injury. Brain death determinations are infrequent, even in large PICUs, emphasizing the importance of ongoing education for medical professionals and standardization of protocols to ensure diagnostic accuracy and consistency.

Brain stem death - an overview.

The concept of brain death has been a very intriguing topic and has taken many forms over the years. Brain stem death is a complex state of inactivity defined by the loss of reflexes of the pathways that pass through the brain stem, the 'shaft' of the brain which links the spinal cord to the cerebral cortex and the cerebellum where there is apnoea, loss of eye movement and pain sensation. There are many criteria, based on which a person can be said to be brain dead. The best recognised of these are the Harvard, Minnesota and Philadelphia criteria. India follows the UK notion of brain stem death, and the Transplantation of Human Organs Act was passed in 1994 by the Indian parliament, which legalised brain-stem death, and in 1995 ordered the brain death certification procedure, which is certified by a 'Board of Medical Experts'. Also, there are some legal and ethical implications that have to be considered in cases of disagreement in diagnosis among the panel of doctors, time of death in cases when patients' relatives disagree or request more time for organ donation or to disconnect the life support system. In routine clinical practice, the issues pertaining to brain stem death should be dealt with by experienced physicians, counselling the family members or relatives and educating them about organ donation.

Physician Experiences with Communicating Organ Donation with the Relatives: A Dutch Nationwide Evaluation on Factors that Influence Consent Rates

BackgroundThe aim of this nationwide observational study is to identify modifiable factors in communication about organ donation that influence family consent rates.MethodsThirty-two intensivists specialized in organ donation systematically evaluated all consecutive organ donation requests with physicians in the Netherlands between January 2013 and June 2016, using a standardized questionnaire.ResultsOut of 2528 consecutive donation requests, 2095 (83%) were evaluated with physicians. The questionnaires of patients registered with consent or objection in the national donor registry were excluded from analysis. Only those questionnaires, in which the family had to make a decision about donation, were analyzed (n = 1322). Independent predictors of consent included: requesting organ donation during the conversation about futility of treatment (OR 1.8; p = 0.004), understanding of the term ‘brain death’ by the family (OR 2.4; p = 0.002), and consulting a donation expert prior to the donation request (OR 3.4; p < 0.001).ConclusionsOur study showed that decoupling the organ donation conversation from the conversation about futility of treatment was associated with lower family consent rates. Comprehension of the concept of brain death by the family and consultation with a transplant coordinator before the organ donation request by the physician could positively influence consent rates.

Challenges and Future Recommendation for Kidney Transplantation in Iran: A Narrative Review

ContextNowadays, the demand for a kidney allograft is increasing in Iran as well as the rest of the world, which is growing the wait list. The Iranian model of a kidney transplant was initiated for solving organ shortage and has been extremely controversial both inside and outside of Iran.Evidence AcquisitionThis narrative review was done by using Iranian and international databases to retrieve literature dealing with the Iranian model of kidney transplantation. All publications up until January 2018 were included. It has drawn out the weaknesses and strengths as well as the advantages and disadvantages, then, it provides some suggestion for better functioning of the Iranian model.ResultsOverall, 61 publications were retrieved and selected. After exclusion of unsuitable and duplicate articles, 17 were included. The main strengths of the Iranian model were having a lawful structure, supporting health centers and patients financially by government and charity funds, as well as reducing the waiting list. The main weaknesses include inadequate public awareness regarding the concept of brain death, the absence of a well-defined kidney registry system, need for renewing existing laws, regulations, and guidelines, the absence of permanent health insurance and follow-up for donors, as well as absence of a comprehensive network organ bank.ConclusionsThe transplant authorities in Iran should work on reinforcement of the model by solving and overcoming some challenges. Preventing organ failure, as well as its risk factors, public education and encouraging organ donation from individuals who are brain dead, improving the outcomes of circulatory death donation, and investment in tissue engineering could significantly reduce organ shortage. The final solution is living unrelated renal donation (LURD).

Human and Human Death as a Neuroscience Ethics Problem

The article deals with the philosophical problem field of modern neuroethics. The general idea of the state of modern neuroethics is given and it is shown that research in this area encompasses both fundamental problems that classically belonged to the field of philosophy research (for example, such as the problem of psychophysical dualism, the physical bases of consciousness, freedom of will and its interrelation with brain activity) and problems with applied orientation, explicating the ethical-social and legal dimension of innovation development in the field of neuroscience and actualizing the analysis of their social risks. It is shown that the development of neuro-ethics in the modern world became possible thanks to a special way of functioning of modern science, which was called the technology of science and to the development of the phenomenon of technological development ethification, which in practical terms was expressed in the study of the problem of the correspondence of the results of innovative scientific and technical projects to the interests of various social groups, their expectations and values, and also helped to determine the status of new technologies in relation to social reality. The article gives an idea of the existing normative field necessary for the development of neuro-ethics. On the basis of using the resource of discourse analysis of R. Harre, who singled out personal grammar (P-grammar), organism grammar (O-grammars) and molecular grammar (M-grammar), a philosophical analysis of such a problem of modern neuroethics as brain death was carried out. Also was given a structural description of new biotechnogenic identities of human being. The conclusion is drawn that the concept of brain death is an example of the conventional nature of scientific truth, the formation of which is influenced by various socio-cultural and economic factors. In the context of the development of neuroscience and the emergence of new methods of brain regeneration, it can be rethought.