The Kidney Transplant Cycle in Iran

The conventional method in Iran for supplying kidneys to patients in need of transplants has a significant difference from all organ donation methods in other countries; in Iran, it is officially and openly possible to purchase one of the kidneys from living donors by paying an amount that is usually equivalent to several thousand dollars. According to a detailed report by the Associated Press, officials state that the implementation of this method in Iran since 1999 has effectively eliminated the waiting time for receiving donated kidneys. In contrast, in Western countries, such as the United States, tens of thousands of people wait in hope of receiving donated organs, and thousands die each year because their needed organs are not provided. Critics say that this method in Iran typically targets poor and low-income individuals who are forced to sell their kidneys to meet their needs. The World Health Organization and other international bodies oppose the 'commercialization' of organ donation. Some believe that implementing a similar method to Iran in other countries would lead to discrimination against low-income individuals who cannot afford to buy a kidney. However, in a situation where the black market for kidney buying and selling is still prevalent in countries like India, Pakistan, and the Philippines, and thousands die each year waiting for donated kidneys, some doctors and experts believe that the U.S. and other countries should adopt parts of Iran's conventional method to save patients' lives. Hashim Qasemi, director of the Kidney Patients Support Association, an organization run by patients, states: 'The motivation for some donors is financial. If these individuals did not have financial needs and motivation, they would not donate their kidneys. But the motivation for some others is charity.' An Associated Press reporter in Tehran was able to speak with an individual who sold one of their kidneys and visited the surgical site. Everyone involved in the donation, purchase, and transplant process emphasizes the altruistic aspects of this work. Nevertheless, advertisements for kidney sales can be seen in various forms on the streets around hospitals in Tehran. The case of kidneys is special among organ donations. While we are all born with two kidneys, most people can live a full and healthy life with just one. Additionally, although the donor and recipient must have compatible blood types, the donated kidney does not need to belong to close family members of the patient. Furthermore, living kidney donors have a longer survival rate compared to those who receive kidneys from deceased donors. Kidney transplant surgery in Iran began in 1967, but after the revolution, the number of surgeries decreased due to foreign sanctions. In the 1980s, the Iranian government allowed patients to travel abroad, even to the U.S., for kidney transplants. However, the very high costs, longer waiting lists for patients, and the costly war with Iraq caused the program for sending patients abroad to be suspended. In 1988, Iran began a plan that is still in place today. Any patient in need of a kidney is referred to the Kidney Patients Support Association, which takes the necessary steps to connect the patient with a donor. The government covers the cost of the surgery, and the donor receives full medical coverage for at least one year after the operation and preferential rates for government medical services for several years thereafter. Those who facilitate contact and transactions do not receive any money. Donors typically receive an amount equivalent to $4,500. Another task of the Kidney Patients Support Association is to seek donations and financial assistance from wealthy individuals and philanthropists to help patients who cannot afford to buy a kidney. According to government statistics, currently, about 1,500 people in Iran receive kidneys from living donors each year, and the total number of kidney transplant surgeries in Iran is about 2,700 annually. Usually, about 25,000 people are tested each year for kidney failure, but most do not seek kidney transplants because they suffer from other serious illnesses. Between 8 to 10 percent of those who apply for kidney transplants are not accepted due to their health deterioration or other considerations. According to reports published in Iran, the average increase in lifespan for those who undergo kidney transplants is between seven to ten years, although some live longer.