Process and barriers to organ donation and causes of brain death in northeast of Iran

Authors

  • Monavar Afzalaghaee School of Health, Social Determinant of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Keywords:

Brain death, Organ donation, Organ transplant

Abstract

Introduction: Organ transplantation is the treatment of choice for some diseases. However, the need for cadaveric organ donation has either plateaued or is on a decreasing trend in some countries, especially in developed ones. In this study, we aimed to identify the barriers to organ donation in brain dead patients, who were referred to the organ procurement organizations (OPO) in northeast Iran.

Methods: In this cross-sectional study during 2006 to 2013, data were collected from medical records of brain dead patients. Demographic information, cause of brain death, the process of obtaining informed consent, and the reasons for declining organ donation were obtained from the OPO records. The data were analyzed using chi-square test by SPSS 13 software. 

Results: Of 1034 brain dead patients, 751 cases (72.6%) were eligible for organ donation, and, ultimately, 344 cases underwent organ donation. The rate of organ donation increased during the course of the study; medical and legal reasons as well as family refusal to authorize donation were the main barriers to the process. 

Conclusion: Based on the pattern of mortality, the need for living donors in developing countries, such as Iran and other countries in the Mediterranean region, can be reduced by improving the quality of healthcare, efficient identification of brain death, and obtaining consent with appropriate strategies.

 

References

Abouna GM. Organ shortage crisis: problems and possible solutions. Transplant Proc. 2008; 40(1): 34-8.

doi: 10.1016/j.transproceed.2007.11.067. PMID: 18261540.

Morris PJ. Transplantation--a medical miracle of the 20th century. N Engl J Med. 2004; 351(26): 2678-80.

doi: 10.1056/NEJMp048256. PMID: 15616201.

Matesanz R, Mahillo B, Alvarez M, Carmona M. Global observatory and database on donation and

transplantation: world overview on transplantation activities. Transplant Proc. 2009; 41(6): 2297-301. doi:

1016/j.transproceed.2009.05.004. PMID: 19715901.

Pomfret EA, Sung RS, Allan J, Kinkhabwala M, Melancon JK, Roberts JP. Solving the organ shortage

crisis: the 7th annual American Society of Transplant Surgeons' State-of-the-Art Winter Symposium. Am J

Transplant. 2008; 8(4): 745-52. doi: 10.1111/j.1600-6143.2007.02146.x. PMID: 18261169.

Backer H, Piros L, Langer RM. Increasing living donor kidney transplantation numbers in Budapest.

Transplant Proc. 2013; 45(10): 3678-81. doi: 10.1016/j.transproceed.2013.10.001. PMID: 24314995.

Al Sebayel M, Alenazi AM, Sabbagh R, Al Ageel T, Al Enazi M, Al Bahili H, et al. Donor organ shortage

crisis: a case study review of a financial incentive-based system. Transplant Proc. 2014; 46(6): 2030-5. doi:

1016/j.transproceed.2014.06.024. PMID: 25131100.

Mahillo B, Carmona M, Alvarez M, White S, Noel L, Matesanz R. 2009 global data in organ donation and

transplantation: activities, laws, and organization. Transplantation. 2011; 92(10): 1069-74. doi:

1097/TP.0b013e31823360b1. PMID: 22005777.

Gomez MP, Perez B, Manyalich M. International Registry in Organ Donation and Transplantation.

Transplant Proc. 2014; 46(4): 1044-8. doi: 10.1016/j.transproceed.2013.11.138.

Ghods AJ. Renal transplantation in Iran. Nephrol Dial Transplant. 2002; 17(2): 222-8. doi:

1093/ndt/17.2.222. PMID: 11812870.

Ghods AJ. The history of organ donation and transplantation in Iran. Expe Clin Transplant. 2014; 12 Suppl

: 38-41. doi: 10.6002/ect.25Liver.L29. PMID: 24635790.

Aubrey P, Arber S, Tyler M. The organ donor crisis: the missed organ donor potential from the accident

and emergency departments. Transplant Proc. 2008; 40(4): 1008-11. doi:

1016/j.transproceed.2008.03.059. PMID: 18555101.

White SL, Chadban SJ, Jan S, Chapman JR, Cass A. How can we achieve global equity in provision of

renal replacement therapy? Bull World Health Organ. 2008; 86(3): 229-37. doi: 10.2471/BLT.07.041715

PMID: 18368211, PMCID: PMC2647401.

Mahillo B, Carmona M, Álvarez M, Noel L, Matesanz R. Global Database on Donation and

Transplantation: goals, methods and critical issues (www.transplant-observatory.org). Transplantat Rev.

; 27(2): 57-60. doi: 10.1016/j.trre.2013.01.001. PMID: 23477800.

Shaheen FA, Souqiyyeh MZ. How to improve organ donation in the MESOT countries. Ann Transplant.

; 9(1): 19-21. PMID: 15478882.

Shaheen FA, Souqiyyeh MZ, Ramprassad K, Attar MB. Current issues and problems of transplantation in

the Middle East: the Arabian Gulf. Transplant Proc. 2001; 33(5): 2621-2. PMID: 11498091.

Lo CM. Deceased donation in Asia: challenges and opportunities. Liver Transplant. 2012; 18 Suppl 2: S5- 7. doi: 10.1002/lt.23545. PMID: 22961949.

Suguitan GA, Cabanayan-Casasola CB, Danguilan RA, Jaro JM. Outcome of referrals for deceased organ

donation to the government organ procurement organization. Transplant Proc. 2014; 46(4): 1074-6. doi:

1016/j.transproceed.2014.01.005. PMID: 24815132.

Mizraji R, Perez S, Alvarez I. Brain death: epidemiology and quality control of solid organ donor

generation. Transplant Proc. 2004; 36(6): 1641-4. doi: 10.1016/j.transproceed.2004.06.066. PMID:

Mahdavi-Mazdeh M, Khodadadi A, Tirgar N, Riazi N. Rate of family refusal of organ donation in dead- brain donors: the Iranian tissue bank experience. Int J Organ Transplant Med. 2013; 4(2): 72-6. PMID:

, PMCID: PMC4089313.

Kwek TK, Lew TW, Tan HL, Kong S. The transplantable organ shortage in Singapore: has implementation

of presumed consent to organ donation made a difference? Ann Acad Med Singapore. 2009; 38(4): 346-8.

PMID: 19434338.

Fischer‐Fröhlich CL. Factors limiting organ donation in Baden‐Württemberg. Clin Transplant. 2013; 27

Suppl 25: 1-5. doi: 10.1111/ctr.12157. PMID: 23909496.

Roels L, Spaight C, Smits J, Cohen B. Donation patterns in four European countries: data from the donor

action database. Transplantation. 2008; 86(12): 1738-43. doi: 10.1097/TP.0b013e3181908e08. PMID:

Shirley S, Cutler J, Heymann C, Hart M. Narrowing the organ donation gap: hospital development methods

that maximize hospital donation potential. J Heart Lung Transplant. 1994; 13(5): 817-23. PMID: 7803422.

Kosieradzki M, Jakubowska-Winecka A, Feliksiak M, Kawalec I, Zawilinska E, Danielewicz R, et al.

Attitude of healthcare professionals: a major limiting factor in organ donation from brain-dead donors. J

Transplant. 2014; 2014: 6. doi: 10.1155/2014/296912.

Khoddami Vishteh HR, Ghorbani F, Ghobadi O, Shafaghi Sh, Barbati ME, Rostami Louyeh A, et al.

Causes and follow-up outcomes of brain dead patients in Shahid Beheshti University of Medical Sciences

hospitals. Pajoohandeh J. 2010; 15(4): 171-8.

Kazemeyni SM, Sorosh AR, Afzali A. Organ yield from deceased donors: initial experience of an organ

procurement unit in Iran. Arch Iran Med. 2009; 12(2): 170-2. PMID: 19249888.

Hajyhosseinloo M, Eftekhari A, Gorbani S, Zarei Z. Study of Brain Death and Organ Donation in West

Azerbaijan Province (2004-2010). Iran J Forensic Med. 2011; 3(17): 149-56.

Capron AM. Six decades of organ donation and the challenges that shifting the United States to a market

system would create around the world. Law Contemp Probs. 2014; 77: 25.

Desschans B, Evrard P. Organ donation and transplantation statistics in Belgium for 2012 and 2013.

Transplant Proc. 2014; 46(9): 3124-6. doi: 10.1016/j.transproceed.2014.09.170. PMID: 25420841.

Fisher A, Herzog LJ, Herzog EM. Five years' experience of an organ donation team in southern Israel.

Israel J Med Sci. 1996; 32(11): 1112-9. PMID: 8960085.

Tenn-Lyn NA, Doig CJ, Shemie SD, Teitelbaum J, Cass DE. Potential organ donors referred to Ontario

neurosurgical centres. Can J Anaesth. 2006; 53(7): 732-6. doi: 10.1007/BF03021634. PMID: 16803923.

Nozary Heshmati B, Tavakoli SA, Mahdavi-Mazdeh M, Zahra S. Assessment of brain death of organ

donors in Iran. Transpl Internat. 2010; 23(5): e7-9. doi: 10.1111/j.1432-2277.2010.01060.x.

Hajyhosseinloo M, Eftekhari A, Gorbani S, Zarei A. Study of Brain Death and Organ Donation in West

Azerbaijan Province (2004-2010). IJFM. 2011; 17(3): 149-55.

Abbasi Z, Peyman A. Brain death and organ donation in Iran. Iran J Med Law. 2012; 6(20): 43-54.

Bendorf A, Pussell BA, Kelly PJ, Kerridge IH. Socioeconomic, demographic and policy comparisons of

living and deceased kidney transplantation rates across 53 countries. Nephrology (Carlton). 2013; 18(9):

-40. doi: 10.1111/nep.12101. PMID: 23692370.

Published

2022-01-18