title: Challenges in organ transplantation.
abstract: Organ transplantation has progressed tremendously with improvements in surgical methods, organ preservation, and pharmaco-immunologic therapies and has become a critical pathway in the management of severe organ failure worldwide. The major sources of organs are deceased donors after brain death; however, a substantial number of organs come from live donations, and a significant number can also be obtained from non-heart-beating donors. Yet, despite progress in medical, pharmacologic, and surgical techniques, the shortage of organs is a worldwide problem that needs to be addressed internationally at the highest possible levels. This particular field involves medical ethics, religion, and society behavior and beliefs. Some of the critical ethical issues that require aggressive interference are organ trafficking, payments for organs, and the delicate balance in live donations between the benefit to the recipient and the possible harm to the donor and others. A major issue in organ transplantation is the definition of death and particularly brain death. Another major critical factor is the internal tendency of a specific society to donate organs. In the review below, we will discuss the various challenges that face organ donation worldwide, and particularly in Israel, and some proposed mechanisms to overcome this difficulty.
authors.affiliation: Director, Rambam Health Care Campus, Haifa, Israel; Professor of Medicine & Biomedical Engineering, Women's Division - Dr Phillip & Sarah Gotlieb Chair, Technion, Haifa, Israel; Chairman of the Steering Committee of the Israel National Transplantation center, Ministry of Health, Tel Aviv, Israel.
authors.forename: Rafael
authors.initials: R
authors.lastname: Beyar
keywords: Israel National Transplantation Committee; brain and respiratory death; organ transplantation
references.citation: Clin J Am Soc Nephrol. 2008 Sep;3(5):1227-31
references.pmid: 18701611
references.citation: Neurology. 1995 May;45(5):1012-4
references.pmid: 7746374
references.citation: N Engl J Med. 2011 Apr 7;364(14):1287-9
references.pmid: 21410390
references.citation: Lancet. 2010 Oct 16;376(9749):1303-11
references.pmid: 20727576
references.citation: Am J Transplant. 2006 Mar;6(3):459-66
references.pmid: 16468954
references.citation: Clin Transplant. 1998 Dec;12(6):525-9
references.pmid: 9850445
references.citation: Am J Transplant. 2009 Apr;9(4 Pt 2):869-78
references.pmid: 19341412
references.citation: Am J Transplant. 2009 Dec;9(12):2825-36
references.pmid: 19788503
references.citation: Nature. 1998 Apr 30;392(6679 Suppl):11-7
references.pmid: 9579856
references.citation: Nat Rev Nephrol. 2010 May;6(5):297-306
references.pmid: 20234355
references.citation: Neurology. 2002 Jan 8;58(1):20-5
references.pmid: 11781400
references.citation: Kidney Int. 2009 May;75(10):1088-98
references.pmid: 19225540
references.citation: Transplantation. 2008 Aug 27;86(4):502-10
references.pmid: 18724216
references.citation: Crit Care Med. 2004 Jun;32(6):1284-8
references.pmid: 15187507
references.citation: Neurology. 2008 Jan 22;70(4):284-9
references.pmid: 18077794
references.citation: Clin Chest Med. 2011 Jun;32(2):265-77
references.pmid: 21511089
references.citation: BMJ. 2009 Jan 14;338:a3162
references.pmid: 19147479
references.citation: JAMA. 2005 Apr 20;293(15):1883-90
references.pmid: 15840863
references.citation: Transpl Int. 2011 Apr;24(4):373-8
references.pmid: 21392129
references.citation: Clin Transpl. 2008;:75-88
references.pmid: 19708447
references.citation: Neurocrit Care. 2009;11(2):276-87
references.pmid: 19444652
references.citation: Transpl Int. 2011 Jul;24(7):676-86
references.pmid: 21504489
references.citation: JAMA. 1981 Nov 13;246(19):2184-6
references.pmid: 7289009