Kidneys for cash in Iran

Associated Press

TEHRAN, Iran – The whirling hum of a dialysis machine could have been the soundtrack to the rest of Zahra Hajikarimi’s life but for an unusual program in Iran that allows people to buy a kidney from a living donor.

Iran’s kidney program stands apart from other organ donation systems around the world by openly allowing payments, typically of several thousand dollars. It has helped effectively eliminate the country’s kidney transplant waiting list since 1999, the government says – in contrast to Western nations like the United States, where tens of thousands hope for an organ and thousands die waiting each year.

“Some donors have financial motivations. We can’t say they don’t. If (those donors) didn’t have financial motives, they wouldn’t ... donate a kidney,” Hashem Ghasemi, the head of the patient-run Dialysis and Transplant Patients Association of Iran, told The Associated Press. “And some people just have charitable motivations.”

The AP gained rare access to Iran’s program, visiting patients on dialysis waiting for an organ, speaking to a man preparing to sell one of his kidneys and watching surgeons in Tehran perform a transplant. All of those interviewed stressed the altruistic nature of the program – even as graffiti scrawled on walls and trees near hospitals in Iran’s capital advertised people offering to sell a kidney for cash.
Careful system

Under Iran’s program, created in 1988, a person needing a kidney is referred to the Dialysis and Transplant Patients Association, which matches those needing a kidney with a potential healthy adult donor. The government pays for the surgeries, while the donor gets health coverage for at least a year and reduced rates on health insurance for years after that from government hospitals.

Those who broker the connection receive no payment. They help negotiate whatever financial compensation the donor receives, usually the equivalent of $4,500. They also help determine when Iranian charities or wealthy individuals cover the costs for those who cannot afford to pay for a kidney.

Today, more than 1,480 people receive a kidney transplant from a living donor in Iran each year, about 55 percent of the total of 2,700 transplants annually, according to government figures. For Hajikarimi, a 52-year-old Iranian mother of two, a transplant can’t come soon enough. Her kidneys failed, with doctors finding higher-than-normal protein levels in her urine, and she has been on dialysis for four months.

In that time, physicians determined that Hajikarimi can undergo a transplant, and the nonprofit group managing her case began looking for a donor, a process that typically takes up to six months. Then the recipient and the donor meet to agree to the financial arrangements before the surgery.

Iran says its system safeguards against black-market organ sales by having the nonprofit groups handle all arrangements and hold money in escrow until after the surgery. Foreigners are now largely banned from taking part, squelching the possibility of medical tourism. But Iranians who are dual nationals can benefit from the program.

However, it’s clear that some donors are motivated by the cash payout. Inflation and unemployment remain high in Iran even after last year’s nuclear deal with world powers that saw some sanctions lifted. One man said he applied to sell one of his kidneys to pay off his debts. Debtors can be imprisoned in Iran.

“I am here because if I don’t get the money, my entire life will be ruined,” said the man, who spoke on condition of anonymity for fear of ruining his professional image. “My life and my public face are in danger. This has driven me to do this.”
World takes note

The U.N. health agency’s guiding principles on organ transplantation call for banning organ sales, though it allows for “reimbursing reasonable and verifiable expenses,” including the loss of income by a living donor.

Sigrid Fry-Revere, an expert on the program who wrote “The Kidney Sellers: A Journey of Discovery in Iran,” said Iran’s system offers aspects that could be used elsewhere, though she opposes organ sales for profit.

“You cannot put a price on an organ,” said Fry-Revere, who is president and co-founder of the American Living Organ Donor Network. “This is rewarded goodwill. This is two people getting together to help make each other’s lives better.”

In the U.S., there are more than 99,000 patients currently on the waiting list for a kidney transplant. Last year, there were 17,878 transplants, while 4,481 died waiting, according to UNOS. A 1984 U.S. law makes organ sales illegal.

A series of academic papers and opinion pieces in recent years by doctors and prominent economists like Nobel Prize winner Alvin Roth have explored the idea of allowing paid kidney donations in the U.S. An article in October’s edition of the American Journal of Transplantation written by three physicians and an economist proposed a system in which the U.S. government would pay $45,000 to a living kidney donor and $10,000 to the family of a deceased donor.

“Such compensation would be considered an expression of appreciation by society for someone who has given the gift of life to another,” the paper said.

Some ethicists and doctors argue that compensating donors in the U.S. would put the poor at a disadvantage of getting a transplant while also pressuring them to offer their organs for sale when they face financial trouble.

“We still think profiteering or someone making a profit from a sale and making this a commercial enterprise is a slippery slope,” said Kevin Longino, the CEO of the National Kidney Foundation in the U.S. “It’s still an easy way to exploit poor people and underprivileged people.”