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The definition of death remains unresolved. To define death, one has to define the characteristics of a living person and to confirm whether an individual with brain death fulfils any of these characteristics. Although the concept of irreversible cessation of brain function is clear, controversy remains on the treatment of individuals with brain death and beating hearts. An individual with brain death but a beating heart is not breathing on his own and is dependent on medications and machines to maintain respiration, heartbeat, and blood pressure. Muslim scholars remain divided over the issue of whether death also means irreversible cessation of brain function. Questions remain on when it is permissible to remove vital organs for organ transplant. Groups have advocated for uniformity in law and medical practice on the definition of brain death.

Introduction: The anatomical dissection plays a fundamental role in the students' formation as well as in the specialists' updating. In contrast to what happened in the sixteenth century, when medical students and professors from all over the Europe were used to come in Italy, today Italian surgeons have to go abroad to attend training courses, with inevitable economic costs and personal inconveniences. The reason for this circumstance lies in the existence of obsolete and even ethically unacceptable legal rules. The recent unanimous approval by the Italian Senate of the bill on postmortem body donation opens important perspectives., Materals and Methods: The authors, after having reviewed the main historical stages in anatomical dissection, examine the above mentioned recent bill n. 733 (XVIII Legislature) concerning the disposition of one's body and post-mortem tissues for the purposes of study, training and scientific research, taking into consideration also the international context., Discussion: The bill aims to fill the serious legislative gap, not only offering the possibility of satisfying the noble needs of human solidarity, but also giving to future doctors a contact with death capable of promoting human and ethical values such as the respect for life., Conclusions: The Italian legal system presents - right now - serious operational gaps which make body donation practically unapplied. While waiting for the bill to finally see light, it is necessary to engage in educational activities that can promote the culture of this "gift" and, at the same time, that of respect for the body of the deceased person., Key Words: Anatomical dissection, Body donation, Study and research.

The rapid rise of transplantation over the past 60 years has been marked by a number of critical milestones. Donation after circulatory death (DCD) has played an important role in the development of this young field. Although early observations by Dr. Tom Starzl touched on the importance of warm ischemic time, new and exciting data may be changing our views of ischemia. Indeed, as we learn more about the importance of time-to-death for DCD donors after circulatory death, the hemodynamic changes experienced by DCD donors, and the other physiologic perturbations surrounding all forms of death, we are beginning to drill down to the factors that drive recipient outcomes after deceased donor transplant. As far as the future? Only time will tell.

Except for legends and claims of miracles, most histories of transplantation cover only the last 60 years because there were no earlier successes. However, the story of even this era has been documented in such rich detail that a full account would fill several volumes. Thus, this brief summary must be limited to highly selected "landmarks." Some landmarks had an immediate impact, but the importance of others went unrecognized for decades. Some findings that deserved landmark status were overlooked or forgotten, whereas others of no biological significance had major impact. Placing these events in perspective is challenging. Several of transplantation's pioneers are still alive, and most of the others are within living memory. Virtually all of them have produced their own accounts. For the most part, they agree on what the "landmarks" are, but their differences in emphasis and perspective make an interesting story.

Systematic research on the history of anatomy in National Socialism (NS) has only started in recent years. It has shown that anatomists used the bodies of NS victims for anatomical teaching and research purposes. In this they became complicit with the NS regime. There was a high percentage of Nazi party members among the anatomists, but at the same time there were anatomists whose careers were disrupted for so-called "racial" and political reasons. Decisive aspects of this history are first, the fact that traditional sources of anatomical body procurement included increasing numbers of NS victims and second, the gradual change of the traditional anatomical paradigm of working with the dead to a new paradigm of working with the "future dead" in human experimentation. This history has importance for the development of new ethical guidelines in anatomy.

This article describes the background, beginnings, development, evolution and outcomes of kidney transplantation in Cuba. Nephrology as a medical specialty in Cuba began in 1962 and was formalized in 1966. Conditions were created to implement renal replacement therapy (including transplants), bring nephrology care to the entire country and train human resources who would assume this responsibility, making Cuba one of the first countries with a comprehensive program for renal patient care. After three unsuccessful cadaveric-donor kidney transplantations in 1968-69, the ensuing history of kidney transplantation can be summarized in the following three stages. 1970-1975: In January 1970, cadaveric-donor kidney transplantation began at the Nephrology Institute. That year, 17 kidney transplantations were performed; four of these patients lived with functional kidneys for 15-25 years; 10-year graft survival was 23.5% (Kaplan-Meier survival curve); HLA typing began in 1974. By December 1975, 170 grafts had been done in three hospitals. 1976-1985: Seven transplantation centers performed 893 grafts during this period. HLA-DR typing was introduced in 1976 and the National Histocompatibility Laboratory Network was founded in 1978. The first related living-donor kidney transplantation was done in 1979. 1986-2011: The National Kidney Transplantation Coordinating Center and the National Kidney Transplantation Program were created in 1986; the first combined kidney-pancreas transplantation was performed the same year. In 1990, cyclosporine and the Cuban monoclonal antibody IOR-T3 were introduced for immunosuppression to prevent rejection, as were other Cuban products (hepatitis B vaccine and recombinant human erythropoietin) for transplant patients. By December 2011, the cumulative number of transplants was 4636 (384 from related living donors). With over 40 years of experience, kidney transplantation is now well established in Cuba; it is free and universally accessible, on the basis of need and appropriateness.

The debate on the legal frameworks of organ transplantation in Germany began in the 1960s with the upcoming of new medical treatments. Since there were two German States at that time, the Federal Republic of Germany (FRG) and the German Democratic Republic (GDR), the process of the discussion on the way to legislation took place under two very different circumstances. In 1975 the GDR implemented a decree regarding the legal aspects of organ transplantation. Meanwhile the discussion in the FRG proceeded with no result until 1997. The analysis of articles in German medical and juridical journals in the period 1960-1989 showed that the discussion in the GDR was less intensive than in the FRG and nearly stopped after the decree from 1975. The majority of the East-German authors preferred an arrangement that will keep the next of kin of a deceased person out of the process of organ transplantation. They argued for the so-called "Widerspruchslösung" (dissent solution): During his lifetime, the donor must have denied organ removal after his death; otherwise organ explantation will be performed. The law of 1975 was consistent with this preference. In West-Germany the motifs concerning the legal aspects of organ transplantation changed over the time. The discussion started with the same arguments that were used in East-Germany. The physicians wished some kind of "Widerspruchslösung" manifested by a draft law, but their requests changed over time. In the early 1980s, most of the West-German authors pleaded for what had become the code of practice because no bill was passed by the politicians: the "Zustimmungslösung" (consent solution). The physician was obliged to ask the next of kin if there was any statement of the potential donor towards organ donation. Some authors even considered a bill unnecessary, as the system organ transplantation in West-Germany was working well without it. A massive change in the West-German medical society from fighting for a "Widerspruchslösung" to acceptance of a "Zustimmungslösung" or even no legal frame at all was observed.

Organ shortage for transplantation remains a worldwide serious problem for kidney patients with end-stage renal failure, and several countries have tried different models to address this issue. Iran has 20 years of experience with one such model that involves the active role of the government and charity foundations. Patients with a desperate demand for a kidney have given rise to a black market of brokers and other forms of organ commercialism only accessible to those with sufficient financial resources. The current Iranian model has enabled most of the Iranian kidney transplant candidates, irrespective of socioeconomic class, to have access to kidney transplantation. The Iranian government has committed a large budget through funding hospital and staff at the Ministry of Health and Medical Education by supporting the brain death donation (BDD) program or redirecting part of the budget of living unrelated renal donation (LURD) to the BDD program. It has been shown that it did not prevent the development and progression of a BDD program. However, the LURD program is characterized by several controversial procedures (e.g., confrontation of donor and recipient at the end of the evaluation procedure along with some financial interactions) that should be ethically reviewed. Operational weaknesses such as the lack of a registration system and long-term follow-up of the donors are identified as the 'Achilles heel of the model'.

Background/aims: Kidney transplantations at our center rely mainly on living donors. The purpose of this study was to suggest future donor supply directions by reviewing changing trends in donor type., Methods: During the past 40 years, 1,690 kidney transplantations were performed at our center. We divided the follow-up period into four decades and the donor population into three groups: living related, living unrelated, and deceased. We analyzed changing trends in donors from each group for each decade. Patients receiving overseas transplantation were also included., Results: The proportion of living related donors decreased from 84% (54/64) in the 1970s to 61% (281/458) in the 2000s. Living unrelated donors showed a sustained proportion of around 20% after 1990. However, among living unrelated donors, the proportion of spouse donors increased from 4.6% (17/369) in the 1980s to 8.5% (39/458) in the 2000s. Transplants from deceased donors were only 3.3% (12/369) in the 1980s. However the proportion of deceased donors increased gradually, reaching 13.2% (105/799) in the 1990s and 19.9% (91/458) after 2000. Overseas transplantations increased after 2000 and reached 20% of all cases treated in our center during the 2000s. Such transplantations peaked in 2006 and decreased markedly thereafter., Conclusions: The proportion of each donor type has continuously changed, and the changes were associated with changes in the social structure and system. We expect that this study could be an important reference for other countries to estimate future changes of donor type.

INTRODUCTION AND SOURCES OF DATA: This paper briefly outlines the history of research on the recently dead, before critically exploring 1. In what sense can we harm the dead? 2. What are the justificatory arguments for employing family or parental consent for medical research on dead relatives? AREAS OF AGREEMENT, CONTROVERSY, GROWING POINTS OF INTEREST AND AREAS TIMELY FOR DEVELOPING RESEARCH: The controversy surrounding harm in relation to research on dead bodies largely depends on how dead people are perceived. That is, 1. As Cadavers. 2. As Ante-mortem persons. 3. By Significant others. Controversy over whether we need to have consent from significant others (bereaved relatives) depends on the weight we give to the bereaved and their experience of the dead. Understanding this is timely in developing research and is relevant to the issue of consent around organ donation for transplants.

Continued progress in organ donation will help enable transplantation to alleviate the increasing incidence of end-stage organ disease. This article discusses the implementation and effect of the federally initiated Organ Donation Breakthrough Collaborative; it then reviews organ donation data, living and deceased, from 1995 to 2004. It is the first annual report of the Scientific Registry of Transplant Recipients to include national data following initiation of the collaborative in 2003. Prior to that, annual growth in deceased donation was 2%-4%; in 2004, after initiation of the collaborative, deceased donation increased 11%. Identification and dissemination of best practices for organ donation have emphasized new strategies for improved consent, including revised approaches to minority participation, timing of requests and team design. The number of organs recovered from donation after cardiac death (DCD) grew from 64 in 1995 to 391 in 2004. While efforts are ongoing to develop methodologies for identifying expanded criteria donors (ECD) for organs other than kidney, it is clear DCD and ECD raise questions regarding cost and recovery. The number of living donor organs increased from 3493 in 1995 to 7002 in 2004; data show trends toward more living unrelated donors and those providing non-directed donations.

As the number of pre- and post-transplant solid organ recipients continues to grow, it becomes important for all physicians to have an understanding of the process of organ procurement and allocation. In the United States, the current system for allocation and transplantation of human solid organs has been heavily influenced by the experience in deceased donor liver transplantation (DDLT). This review highlights the significant changes that have occurred over the past 10 years in DDLT, with specific attention to the impact of the Model for Endstage Liver Disease (MELD) score on organ allocation and pre- and post-transplant survival. DDLT is managed by the United Network for Organ Sharing (UNOS) which oversees organ procurement and allocation across geographically defined Organ Procurement Organizations (OPOs). For many years, deceased donor livers were allocated to waiting list patients based on subjective parameters of disease severity and accrued waiting time. In addition, organs have traditionally been retained within the OPO where they are procured contributing to geographic disparities in disease severity at the time of transplantation among deceased donor recipients. In response to a perceived unfairness in organ allocation, Congress issued its "Final Rule" in 1998. The Rule called for a more objective ranking of waiting list patients and more parity in disease severity among transplant recipients across OPOs. To date, little progress has been made in eliminating geographic inequities. Patients in the smallest OPOs continue to receive liver transplants at a lower level of disease severity. However, strides have been made to standardize assessments of disease severity and better prioritize waiting list patients. The MELD score has emerged as an excellent predictor of short-term mortality in patients with advanced liver disease, and patients listed for liver transplantation are now ranked based on their respective MELD scores. This has improved organ access to the most severely ill patients without compromising waiting list mortality or post-transplant survival. The current system for DDLT remains imperfect but has improved significantly in the past decade. As the number of patients in need of DDLT grows, the system will continue to evolve to meet this increasing demand.

The condition of newborn infants with anencephaly, a neural tube defect, is incurable and uniformly fatal. Although physicians reached a consensus two decades ago on the appropriateness of using these infants' organs, ethical and legal questioning has since challenged the grounds on which medical authorities justified transplantation. Advocates have proposed three conceptual strategies to warrant procuring anencephalics' organs: redefining death, excluding the infants from possessing personhood, and intubating and ventilating them while keeping a vigil for brain death. Each of these conceptual schemes has arguable shortcomings in its construction, however; as such, the case for using anencephalic infants as sources of organs has yet to be conclusively demonstrated.