Let’s imagine that you are one of the 115,000 people on the kidney transplant waiting list in the United States. Wouldn’t it be nice if you could go on Craigslist and type in “kidney” under the sales section?
Well if you are a law-abiding citizen and your life is dependent on a kidney, you have only one legal option: travel to Iran, the only country where buying (and selling) kidneys is legal.
Kidney transplant is unique because living people can donate a kidney with no significant complications. However, demand for kidneys has always exceeded the supply. The United States Department of Health and Human Services recorded over 100,000 patients on the kidney transplant waiting list. The World Health Organization estimates that around 660,000 people in the world require some form of transplant. Advances in medicine have led to an increase in life expectancy in Western societies, consequently increasing the prevalence of end-stage renal disease. Queues for kidneys are lengthening at a rate of seven percent a year in the United States, where last year 4,039 people died while waiting. Since 1999, more than 30,000 US patients have died while waiting for a kidney transplant.
As you walk in the crowded streets of Tehran, you see hundreds of ads taped to the walls along the streets near the major hospitals. One ad reads: “Kidney for sale, 26 years old healthy.” The other reads: “Urgent, KIDNEY for SALE, O+, 21 years old, tested healthy.” Then there is a typed ad that reads: “Healthy B+ kidney for sale, money needed for my wife’s surgery.”
On each ad there is a telephone number that you can directly contact the seller. Some ads are torn, some are typed, while a few of them are sprayed on the wall. The majority of people who are selling their kidneys are in their 20s or 30s. The competition is among the sellers. You simply can pick the youngest seller with your blood type, call them and arrange a meeting.
Ironically, obtaining an Iranian visa is likely going to be a harder process than finding a kidney and performing the surgery.
Selling and buying kidneys in Iran has been legal since 1988. The 1979 revolution was followed by the eight-year Iran-Iraq war. Due to economic sanctions and lack of funds, dialysis equipment was scarce. In response to the shortage, the government started funding programs where it sent patients to Europe for kidney transplants. This led Iranian nephrologists to turn to kidney transplants as an alternative treatment. Cadaveric kidneys and related live donors were the only sources of kidney donations. This caused a substantial increase in demand, which led the government to establish a regulated and compensated non-related live donor donation system.
Under this model, the donor receives financial compensation from the recipient as well as the government or the charity, along with non-monetary bonuses such as free health insurance. The government also offers heavily subsidized immunosuppressive therapy to the recipient. There are also charities that help those who cannot afford to buy a kidney. The process is being facilitated by the Dialysis and Transplant Patients Association (DTPA), a third-party independent charity association that arranges contact between recipients and donors.
As a result of this program, the number of kidney transplant surgeries has risen substantially. By 2005, 19,609 kidney transplants have been performed from which 15,356 were from non-related living donors.Currently, Iran has no kidney transplant waiting list and more than 50 percent of patients with end-stage renal disease are living with a functioning graft. Under this model, it has been shown that the rate of cadaveric and related live donation has increased as well. In 1996, only 1.6 percent of all transplants were cadaveric. By 2006, this figure reached 13.1 percent.
There are regulations that ensure just and legal processes. For instance, it is illegal for the surgical team to get involved in the transaction, and no middleman can receive any payments. All agreements are being settled between the donor and recipient directly.
However, the Iranian system has its own pitfalls. Along with a well-regulated legal system, there is a black market . If you want to sell your kidney, the best place to go is where you can find the highest number of customers: the dialysis clinics. An Iranian nephrologist once told me, don’t be surprised if you see a young man touting “kidney for sale” in dialysis clinics.
It is difficult to assess the long-term outcome of kidney transplantation in Iran since there is no agency keeping records and there is no long term follow-up system. It is crucial to study the Iranian model for kidney transplant and learn about its strengths and shortcomings in order to be able to change policies and improve upon the current system. In the US, there are more than 100,000 patients on the waiting list for kidney transplant. If kidney donation remains altruistic, more patients will die waiting for kidneys. Arguably, selling kidneys cannot be less ethical than passively waiting for another kidney to come along.
Contributing Writer Emeritus
Stony Brook School of Medicine
Bobak Zonnoor is a medical student at Stony Brook School of Medicine in New York. He obtained his BS in neuroscience and behavior from the University of California Davis. His areas of interest are emergency medicine, international medicine, public health, journalism, narrative medicine and literary translation.
