Background: The Middle East is a region with much controversy and limitations regarding deceased organ transplantations. In this report we describe our unique experience with the establishment of our deceased donor organ donation program for Central and Southern Iran.

Methods: During the initial phases in the 70s and 80s, only living related kidney transplantations were allowed in Iran. However, this policy was not continued and was expanded due to severe shortage of hemodialysis facilities and an urgent need to increase the number of kidney transplantations. Accordingly, some centers in Tehran started unrelated kidney transplantation with the support of the government that offered bonuses to persuade unrelated donors. It should be mentioned that, during this time, permission for deceased organ donation was not yet obtained in Iran. The main focus of the Shiraz Transplant Center was to develop a deceased donation program from the beginning. During three decades this center was able to expand its deceased donation program to a degree that in 2008 it completely replaced all its unrelated kidney donations by deceased donations. Prior to 2008, most transplantations were related living and deceased donations, and only in cases where a patient was on the wait list for more than one year and a compatible donor was not found, they were only allowed to have living unrelated donations. The deceased program in the STC has since expanded and has aimed to stop unrelated living donations to achieve some goals which include: to abide by ethical guidelines in organ donations/transplantation such as the declaration of Istanbul, and to finally change the dominant practice of unrelated living donations within the Middle East. These efforts have resulted in an increase of deceased donations in Iran from 1.6 in 2004 to 14.34 per million population in 2019, and in some areas this has reached to as high as 50.

Results: Up to March 2021, in the STC, overall 5389 kidney transplantations have been performed. Figure 1 shows the trend in kidney transplantation in the STC.

Conclusion: Living unrelated donations are still an ongoing issue in the Middle East region. Our center, has implemented a wide deceased donor program and as a result has been able to completely stop unrelated living kidney transplantations. The deceased donor organ donation program should further be expanded within Iran and other countries in the region and continuous campaigns should be held up against any type of unethical issues such as living unrelated transplantations to meet with international standards.