An evaluation of the current status of kidney transplant in terms of the type of receipt among Iranian patients

Malekshahi, Arghavan; MortezaNejad, Hamidreza Fallah; Taromsari, Morteza Rahbar; Gheshlagh, Reza Ghanei; Delpasand, Kourosh

doi:10.1186/s41100-020-00314-8

Cited by 7 publications

(12 citation statements)

References 16 publications

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“…Given that potential donors and recipients individually meet and engage in negotiations, it should be considered a completely free bargaining in organs like free trade, which is unacceptable, ethically impermissible and morally flawed. Iran is the only country in the world to have legalized the human kidney trade with LUDs [ 1 , 5 , 30 ].…”

Section: Resultsmentioning

confidence: 99%

“…Iran’s poor donors are forced to become organ vendors as they are mostly “helpless,” “jobless,” “indebted” and “largely destitute” ([ 38 ], 625). However, it is hopeful and encouraging that the Iranian government has recently diverted funds from the unrelated kidney transplant program to DD transplantation ([ 38 ], 626), and the now 14% of transplants from deceased donors indicates that some progress has been made in deceased kidney transplantation in Iran [ 5 ]. Nevertheless, kidneys have mostly been “purchased” from LUDs for transplantation ([ 5 ], 4).…”

Section: Resultsmentioning

confidence: 99%

“…However, it is hopeful and encouraging that the Iranian government has recently diverted funds from the unrelated kidney transplant program to DD transplantation ([ 38 ], 626), and the now 14% of transplants from deceased donors indicates that some progress has been made in deceased kidney transplantation in Iran [ 5 ]. Nevertheless, kidneys have mostly been “purchased” from LUDs for transplantation ([ 5 ], 4). For example, a recently published single centre study shows that approximately 51.8% of the kidneys received were purchased and 48.2% were donated altruistically ([ 5 ], 3).…”

Section: Resultsmentioning

confidence: 99%

“…In spite of the long waiting list for transplant patients, from 1980 to 1985, using government funds, more than 400 dialysis patients traveled to many European countries and the United States for renal transplantation [ 8 , 13 ]. This significant increase in the demand for kidneys ultimately led the Iranian Government to establish a legal, compensated and regulated system for renal donor organ transplantation between unrelated donor-recipient pairs [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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How a compensated kidney donation program facilitates the sale of human organs in a regulated market: the implications of Islam on organ donation and sale

Siraj

2022

Philos Ethics Humanit Med

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Background Advocates for a regulated system to facilitate kidney donation between unrelated donor-recipient pairs argue that monetary compensation encourages people to donate vital organs that save the lives of patients with end-stage organ failure. Scholars support compensating donors as a form of reciprocity. This study aims to assess the compensation system for the unrelated kidney donation program in the Islamic Republic of Iran, with a particular focus on the implications of Islam on organ donation and organ sales. Methods This study reviews secondary documents for philosophical argumentation and ethical analysis of human organ donation and sale for transplantation. Results and discussion According to Islamic law, organ donation is an act of sadaqatul jariyah, and individuals are permitted to donate organs with the intention of saving lives. The commercialization of humans as organ sellers and buyers is contrary to the Islamic legal maxim eethaar, undermining donors of ‘selfless’ or ‘altruistic’ motivations. Such an act should be considered immoral, and the practice should not be introduced into other countries for the sake of protecting human dignity, integrity, solidarity, and respect. I, therefore, argue that Iran’s unrelated kidney donation program not only disregards the position of the Islamic religion with respect to the provision or receipt of monetary benefits for human kidneys for transplantation but that it also misinterprets the Islamic legal proscription of the sale of human organs. I also argue that the implementation of Iran’s unrelated kidney donor transplantation program is unethical and immoral in that potential donors and recipients engage in a bargaining process akin to that which sellers and buyers regularly face in regulated commodity exchange markets. Conversely, I suggest that a modest fixed monetary remuneration as a gift be provided to a donor as a reward for their altruistic organ donation, which is permissible by Islamic scholars. This may remove the need to bargain for increased or decreased values of payment in exchange for the organ, as well as the transactional nature of ‘buyer and seller’, ensuring the philosophy of ‘donor and recipient’ is maintained. Conclusions Offering a fixed modest monetary incentive to organ donors would serve to increase organ supply while protecting donors’ health and reducing human suffering without legalizing the human organ trade.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How a compensated kidney donation program facilitates the sale of human organs in a regulated market: the implications of Islam on organ donation and sale

Siraj

2022

Philos Ethics Humanit Med

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“…Similar results were seen after the Pakistani government banned commercial transplants [ 12 ]. Iran has the opportunity to increase deceased donation efforts, given that deceased donors have only increased from 4% to 10% in 30 years [ 13 ]. Other ways to improve altruistic donation include the removal of disincentives to donate (such as expenses linked to donation, travel expenses, and lost wages) and removal of HLA, ABO, and other incompatibility barriers to living donation through paired exchange [ 14 ].…”

mentioning

confidence: 99%

Kidneys for Sale: Are We There Yet? (Commentary on Kidneys for Sale: Empirical Evidence From Iran)

Jackson¹,

Haugen²,

Segev³

2022

Transpl Int

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Direct financial compensation through organized markets has been proposed as one strategy to increase the number of potential organ donors. However, this controversial practice is legal in only one country in the world-Iran; thus, there are limited data to demonstrate how this type of system might practically function. In a new report, Moeindarbari and Feizi provide granular real-world data on the demographics of kidney vendors and recipients from 2011 to 2018 in the kidney market in Mashhad, Iran [1]. This study provides valuable insights from a direct financial compensation program for organ donation and helps contextualize the debate surrounding this controversial issue.Most prior attempts to quantify the potential impact of direct financial compensation for donors have been limited to surveys or structured interviews about hypothetical compensation and willingness to donate, rather than the real-world data presented in this article [2][3][4][5][6][7]. These have generally found that direct financial compensation to donors would likely increase the number of people who would donate an organ. In one web-based survey of members of the Canadian general public, 54% of people who would not consider donation to a relative without any compensation would actually change to being willing to consider donation for a $10,000 payment [3]. Even among people who would already consider donation to a family member or a friend, a payment of $50,000 would make 60% of people even more likely to donate a kidney in a study from the United States [4].The data presented by Moeindarbari and Feizi confirm that, even in a partially regulated organ sales market, donors are younger than recipients and have fewer years of education. This potentially validates previous concerns of donor exploitation and socio-economic inequalities that have been shown across many countries [8][9][10]. For example, the Phillipine Organ Donation Program allowed for direct financial payment to donors from 2002 to 2008, and 78% of donors did not have a single follow-up visit post-donation [10]. Importantly, Moeindarbari and Feizi point out that in addition to the market price set by the government for a kidney, the recipients are allowed to pay donors, which seems to undermine the idea of a "regulated" market and further engenders donor exploitation. The authors outlined policy recommendations and improvements moving forward to more fairly consider the market value of a kidney in Iran. However, we would suggest that we are not there yet: before we go down the road of commercial sales, there are many other methods to improve altruistic organ donation that have been underexplored and underutilized.An increase in altruistic living and deceased donation could eliminate the need for commercial organ sales entirely. After the Israeli government criminalized organ brokering, altruistic living donation rose by 339% over 10 years [11]. Similar results were seen after the Pakistani government

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A fair exchange: why living kidney donors in England should be financially compensated

Rodger,

Venter

2023

Med Health Care and Philos

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Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only one ‘buyer’—in this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the ‘crowding out’ of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England.

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An evaluation of the current status of kidney transplant in terms of the type of receipt among Iranian patients

Cited by 7 publications

References 16 publications

How a compensated kidney donation program facilitates the sale of human organs in a regulated market: the implications of Islam on organ donation and sale

How a compensated kidney donation program facilitates the sale of human organs in a regulated market: the implications of Islam on organ donation and sale

Kidneys for Sale: Are We There Yet? (Commentary on Kidneys for Sale: Empirical Evidence From Iran)

A fair exchange: why living kidney donors in England should be financially compensated

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