Changing ethics in renal transplantation: presentation of Iran model

This article reviews renal transplant (RTx) activity in USA to show that the ethics of RTx are changing, with steadily increasing numbers of living unrelated donors (LURD). In developing countries the numbers of RTx are inadequate emphasizing the need for controlled LURD RTx programs. The condemnation of all forms of compensated LURD RTx results in many patient deaths and the associated suffering is unethical. The Iran model, adopted in 1988, permits compensated and controlled LURD RTx. It has eliminated the RTx waiting list in Iran. At the end of 2002, among the 14,288 RTxs performed, 78% were from LURDs. The recipients of >50% of the kidneys from LURDs have been from the poor socioeconomic class of Iran. It has been recommended that each society should provide legally binding life-long benefits for LURDs.