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

Context: Nowadays, 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 Acquisition: This 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. Results: Overall, 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, andguidelines, the absence of permanent health insuranceandfollow-up for donors, as well as absence of a comprehensive network organ bank. Conclusions: The 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).