Kidney trade in Iran

Last updated

A sign in Iran saying "I am donating my kidney, Blood type A+" with a telephone number in Persian language Sign "Kidney on sale" in Iran.jpg
A sign in Iran saying "I am donating my kidney, Blood type A+" with a telephone number in Persian language

The practice of selling one's kidney for profit in Iran is legal and regulated by the government. In any given year, it is estimated that 1400 Iranians sell one of their kidneys to a recipient who was previously unknown to them. [1] Iran currently is the only country in the world that allows the sale of one's kidney for compensation (typically a payment); consequently, the country does not have either a waiting list or a shortage of available organs. [2] [3]

Contents

According to an article in Clinical Journal of the American Society of Nephrology, the model has avoided many problems associated with organ trade but all models used in other developing countries have failed to slow down the worsening of transplant queues. [4]

A study has shown motivations for donating are purely financial in 43% of cases and mainly financial with a minor altruistic component in another 40%. Of the donors 76% agreed that kidney sale should be banned and if there was another chance they would prefer to beg (39%) or obtain a loan from usurers (60%) instead of vending a kidney. The goals of vending were achieved not at all by 75% of donors. [5] However another study has been more positive, with 86.5% of donors reporting "complete satisfaction" prior to discharge, and only 1.5% reporting regret. [6]

Background

The first kidney transplantation in the Middle Eastern region was conducted in 1967 in Iran. It was not until the mid-1980s that these operations became commonplace. Iran allows kidney donations from both cadavers and compensated donors. Before the April 2000 law passed by parliament justifying the procurement of organs from those deemed clinically brain-dead, donor-compensated transplants represented over 99 percent of cases. It is now estimated that 13 percent of donations come from cadavers. [7] Market proponents, such as the Cato Institute, claim that after financial incentives were introduced into the kidney market, Iran eliminated their transplant waiting list by 1999. [8] However, a closer examination reveals that many Iranians afflicted with end-stage renal disease don't receive a diagnosis and aren't referred for dialysis, so therefore would never be eligible for a transplant. [9] Ahad Ghods, from the Hashemi Nejad Kidney Hospital in Iran, claimed "This is the main reason that the renal transplant waiting list was eliminated quickly and successfully in Iran." [10]

Regulation

The model is organised through voluntary worker organizations. The receivers and the government pay for the donors. Charity organizations help those who cannot pay themselves. [11]

The Charity Association for the Support of Kidney Patients (CASKP) and the Charity Foundation for Special Diseases (CFSD), under control of the Ministry of Health, regulates the trade of organs with the support of the government. The organizations match donors to recipients, arranging for tests to ensure compatibility. In order to prevent corruption or inequality “neither the transplant center nor transplant physicians are involved in identifying potential vendors” [8] The amounts paid to the donor vary in Iran; however, the average figures are between $2,000 to $4,000 for a kidney donation. [2] In contrast, a compatible kidney sold on the global black-market can cost in excess of $160,000 in some cases. [12]

One payment option is the official contract, which gives the donor the US$1,219 (in 2001), and is paid immediately after the surgery. The kidney recipient may also negotiated with the donor by providing additional money or other benefits. [5]

Motivation for selling of kidneys in the Islamic Republic

Government officials acknowledge that people sell their kidneys because they need money. Money needed to cover living expenses, support children and to cover debts. [13] Trading in kidneys preys on the weakest and most desperate segments of Iranian society faced with ever inceasing hardships. The trade is not limited to kidneys but encompasses the advertising and sale of liver, cornea, bone marrow, sperm, and ovum. [14] Rising numbers of teenagers are selling organs in Iran amid the country’s worst ever economic crisis as young donors' healthy organs fetch high prices for desperate families. As poverty has become more widespread in Iran over the past few years, advertisements to sell and donate other body organs are also more commen. [15] Desperate Iranians have been going to fellow Islamic countries such as Iraq to sell their kidneys, and others are being led by middlemen to travel to the United Arab Emirates and Turkey to sell other body parts. [16]

Islamic views

In 1996, Islamic religious scholars from the Muslim Law Council of Great Britain issued a fatwa allowing the practice of organ transplants. [17] [18] However; as this decree allows donation to help save the life of another, it disallows acts of commerce, trade, or compensation in donations. [19]

Similar Middle-eastern models

In Saudi Arabia, transplants are performed using medicinal cadavers rather than living donors. The practice is sponsored and regulated by the government, through the Saudi Center for Organ Transplantation (SCOT). The organization is also responsible for the standards of care, public and formal education, regulations, and monitoring of all types of organ transplants. Because of the limited number of cadaver candidates, there are not enough donations to satisfy demand. [17]

See also

Related Research Articles

<span class="mw-page-title-main">Organ donation</span> Process of voluntarily giving away organs

Organ donation is the process when a person authorizes an organ of their own to be removed and transplanted to another person, legally, either by consent while the donor is alive, through a legal authorization for deceased donation made prior to death, or for deceased donations through the authorization by the legal next of kin.

<span class="mw-page-title-main">Organ transplantation</span> Medical procedure in which an organ is removed from one body and placed in the body of a recipient

Organ transplantation is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ. The donor and recipient may be at the same location, or organs may be transported from a donor site to another location. Organs and/or tissues that are transplanted within the same person's body are called autografts. Transplants that are recently performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source.

<span class="mw-page-title-main">Liver transplantation</span> Type of organ transplantation

Liver transplantation or hepatic transplantation is the replacement of a diseased liver with the healthy liver from another person (allograft). Liver transplantation is a treatment option for end-stage liver disease and acute liver failure, although availability of donor organs is a major limitation. The most common technique is orthotopic transplantation, in which the native liver is removed and replaced by the donor organ in the same anatomic position as the original liver. The surgical procedure is complex, requiring careful harvest of the donor organ and meticulous implantation into the recipient. Liver transplantation is highly regulated, and only performed at designated transplant medical centers by highly trained transplant physicians and supporting medical team. Favorable outcomes require careful screening for eligible recipients, as well as a well-calibrated live or deceased donor match.

<span class="mw-page-title-main">Kidney transplantation</span> Medical procedure

Kidney transplant or renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD). Kidney transplant is typically classified as deceased-donor or living-donor transplantation depending on the source of the donor organ. Living-donor kidney transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient. The first successful kidney transplant was performed in 1954 by a team including Joseph Murray, the recipient's surgeon, and Hartwell Harrison, surgeon for the donor. Murray was awarded a Nobel Prize in Physiology or Medicine in 1990 for this and other work. In 2018, an estimated 95,479 kidney transplants were performed worldwide, 36% of which came from living donors.

A tissue bank is an establishment that collects and recovers human cadaver tissue for the purposes of medical research, education and allograft transplantation. A tissue bank may also refer to a location where biomedical tissue is stored under cryogenic conditions and is generally used in a more clinical sense.

Organ procurement is a surgical procedure that removes organs or tissues for reuse, typically for organ transplantation.

<span class="mw-page-title-main">National Organ Transplant Act of 1984</span>

The National Organ Transplant Act (NOTA) of 1984 is an Act of the United States Congress that created the framework for the organ transplant system in the country. The act provided clarity on the property rights of human organs obtained from deceased individuals and established a public-private partnership known as Organ Procurement and Transplantation Network (OPTN). The OPTN was given the authority to oversee the national distribution of organs.

<span class="mw-page-title-main">Sigrid Fry-Revere</span> American bioethicist

Sigrid Fry-Revere is an American medical ethicist and lawyer who has worked on many issues in patient care ethics, but most recently has been working on the rights of living organ donors.

Organ trade is the trading of human organs, tissues, or other body products, usually for transplantation. According to the World Health Organization (WHO), organ trade is a commercial transplantation where there is a profit, or transplantations that occur outside of national medical systems. There is a global need or demand for healthy body parts for transplantation, which exceeds the numbers available.

The Center for Ethical Solutions (CES), founded by Sigrid Fry-Revere, is a 501(c)(3) non-profit bioethics think tank based in Lovettsville, Virginia whose mission is to find practical solutions to controversial problems in the field of medical ethics. CES supports research and public education, seeking to achieve its goals through research and developing products including books and documentary films to educate the public. Lobbying and participation in political campaigns are specifically excluded from its activities.

Organ transplantation in Israel has historically been low compared to other Western countries due to a common belief that organ donation is prohibited under Jewish law. This changed with the passage of new organ donation laws in 2008. If two patients have the same medical need, priority will now go to the patient who has signed an organ donor card, or whose family members have donated an organ. This policy was nicknamed don't give, don't get. The law also defines "brain death" as an indication of death for all legal purposes, including organ donation. Additionally the law provides financial reimbursement to living donors for medical expenses due to donation and lost time at work. Organ trafficking is explicitly banned. Health insurance plans can no longer reimburse patients who go abroad to receive transplants.

A beating heart cadaver is a body that is pronounced dead in all medical and legal definitions, connected to a medical ventilator, and retains cardio-pulmonary functions. This keeps the organs of the body, including the heart, functioning and alive. As a result, the period of time in which the organs may be used for transplantation is extended. The heart contains pacemaker cells that will cause it to continue beating even when a patient is brain-dead. Other organs in the body do not have this capability and need the brain to be functioning to send signals to the organs to carry out their functions. A beating heart cadaver requires a ventilator to provide oxygen to its blood, but the heart will continue to beat on its own even in the absence of brain activity. This allows organs to be preserved for a longer period of time in the case of a transplant or donation. A small number of cases in recent years indicate that it can also be implemented for a brain-dead pregnant woman to reach the full term of her pregnancy. There is an advantage to beating heart cadaver organ donation because doctors are able to see the vitals of the organs and tell if they are stable and functioning before transplanting to an ailing patient.

Several authors have used the terms organ gifting and "tissue gifting" to describe processes behind organ and tissue transfers that are not captured by more traditional terms such as donation and transplantation. The concept of "gift of life" in the U.S. refers to the fact that "transplantable organs must be given willingly, unselfishly, and anonymously, and any money that is exchanged is to be perceived as solely for operational costs, but never for the organs themselves". "Organ gifting" is proposed to contrast with organ commodification. The maintenance of a spirit of altruism in this context has been interpreted by some as a mechanism through which the economic relations behind organ/tissue production, distribution, and consumption can be disguised. Organ/tissue gifting differs from commodification in the sense that anonymity and social trust are emphasized to reduce the offer and request of monetary compensation. It is reasoned that the implementation of the gift-giving analogy to organ transactions shows greater respect for the diseased body, honors the donor, and transforms the transaction into a morally acceptable and desirable act that is borne out of voluntarism and altruism.

In bioethics, ethics of organ transplantation refers to the ethical concerns on organ transplantation procedures. Both the source and method of obtaining the organ to transplant are major ethical issues to consider, as well as the notion of distributive justice.

Organ donation is when a person gives their organs after they die to someone in need of new organs. Transplantation is the process of transplanting the organs donated into another person. This process extends the life expectancy of a person suffering from organ failure. The number of patients requiring organ transplants outweighs the number of donor organs available.

Kidney paired donation (KPD), or paired exchange, is an approach to living donor kidney transplantation where patients with incompatible donors swap kidneys to receive a compatible kidney. KPD is used in situations where a potential donor is incompatible. Because better donor HLA and age matching are correlated with lower lifetime mortality and longer lasting kidney transplants, many compatible pairs are also participating in swaps to find better matched kidneys. In the United States, the National Kidney Registry organizes the majority of U.S. KPD transplants, including the largest swaps. The first large swap was a 60 participant chain in 2012 that appeared on the front page of the New York Times and the second, even larger swap, included 70 participants and was completed in 2014. Other KPD programs in the U.S. include the UNOS program, which was launched in 2010 and completed its 100th KPD transplant in 2014, and the Alliance for Paired Donation.

A body broker is a firm or an individual that buys and sells cadavers or human body parts.

Organ futures is the short term used in academic proposals for futures contracts on organs from human cadavers. They are not legal anywhere at this time.

Organ transplantation in the Indian state of Tamil Nadu is regulated by India's Transplantation of Human Organs Act, 1994 and is facilitated by the Transplant Authority of Tamil Nadu (TRANSTAN) of the Government of Tamil Nadu and several NGOs. Tamil Nadu ranks first in India in deceased organ donation rate at 1.8 per million population, which is seven times higher than the national average.

Organ donation in India is regulated by the Transplantation of Human Organs and Tissues Act, 1994. The law allows both deceased and living donors to donate their organs. It also identifies brain death as a form of death. The National Organ and Tissue Transplant Organisation (NOTTO) functions as the apex body for activities of relating to procurement, allotment and distribution of organs in the country.

References

  1. ↑ Sarvestani, Nima (31 October 2006). "Iran's desperate kidney traders". This World. BBC. Archived from the original on 13 November 2013. Retrieved 12 June 2011.
  2. 1 2 "Psst, wanna buy a kidney?". Organ transplants. The Economist Newspaper Limited 2011. 16 November 2006. Archived from the original on 25 October 2017. Retrieved 12 June 2011.
  3. ↑ Schall, John A. (May 2008). "A New Outlook on Compensated Kidney Donations". RENALIFE. American Association of Kidney Patients. Archived from the original on 27 September 2011. Retrieved 14 June 2011.
  4. ↑ Ghods AJ, Savaj S (November 2006). "Iranian model of paid and regulated living-unrelated kidney donation". Clin J Am Soc Nephrol. 1 (6): 1136–45. doi: 10.2215/CJN.00700206 . PMID   17699338.
  5. 1 2 Zargooshi, J. (2001–2002). "Iranian kidney donors: motivations and relations with recipients". The Journal of Urology. 165 (2): 386–392. doi:10.1097/00005392-200102000-00008. ISSN   0022-5347. PMID   11176379. Archived from the original on 22 January 2022. Retrieved 26 August 2022.
  6. ↑ Heidary Rouchi, Alireza; Mahdavi-Mazdeh, Mitra; Zamyadi, Mahnaz (January 2009). "Compensated living kidney donation in Iran: donor's attitude and short-term follow-up". Iranian Journal of Kidney Diseases. 3 (1): 34–39. ISSN   1735-8582. PMID   19377257.
  7. ↑ Einollahi B (April 2008). "Cadaveric kidney transplantation in Iran: behind the Middle Eastern countries?". Iran J Kidney Dis. 2 (2): 55–6. PMID   19377209. Archived from the original on 3 March 2016. Retrieved 14 June 2011.
  8. 1 2 Hippen, Benjamin E. (2008). "Organ Sales and Moral Travails: Lessons from the Living Kidney Vendor Program in Iran". Cato Policy Analysis Series (614). SSRN   1263380.
  9. ↑ Griffin A (March 2007). "Kidneys On Demand". BMJ. 334 (7592): 502–505. doi:10.1136/bmj.39141.493148.94. PMC   1819484 . PMID   17347232.
  10. ↑ Ghods A (2006). "Iranian Model of Paid and Regulated Living-Unrelated Kidney Donation". Clin J Am Soc Nephrol. 1 (6): 1136–45. doi: 10.2215/CJN.00700206 . PMID   17699338.
  11. ↑ The Meat Market Archived 11 April 2014 at the Wayback Machine , The Wall Street Journal, 8 January 2010.
  12. ↑ Martinez, Edecio (27 July 2009). "Black Market Kidneys, $160,000 a Pop". CBS News. Archived from the original on 23 April 2011. Retrieved 12 June 2011.
  13. ↑ "'Kidney for sale': Iran has a legal market for the organs, but the system doesn't always work". Los Angeles Times. 15 October 2017. Retrieved 4 September 2024.
  14. ↑ "Iranians Selling Their Organs Abroad Due To Poverty". Iran International. Retrieved 4 September 2024.
  15. ↑ "Children As Young As 16 In Iran Sell Kidneys Amid Poverty". Iran International. Retrieved 4 September 2024.
  16. ↑ Nelken-Zitser, Joshua. "Iranians are putting their livers, corneas, and testicles up for sale on Telegram to pay off debts amid rocketing inflation and poverty". Business Insider. Retrieved 4 September 2024.
  17. 1 2 Al-Khader AA (February 2002). "The Iranian transplant programme: comment from an Islamic perspective". Nephrol. Dial. Transplant. 17 (2): 213–5. doi: 10.1093/ndt/17.2.213 . PMID   11812868.
  18. ↑ "Organ Donation". UK Transplant. February 2005. Archived from the original on 23 July 2011. Retrieved 14 June 2011.
  19. ↑ "Islam and Organ Donation". NHS Blood and Transplant. Archived from the original on 7 June 2011. Retrieved 14 June 2011.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.