Coercion, dissatisfaction, and social stigma: an ethnographic study of compensated living kidney donation in Iran

Abstract

This article updates the qualitative research on Iran reported in the 2012 article by Tong et al. "The experiences of commercial kidney donors: thematic synthesis of qualitative research" (Tong et al. in Transpl Int 25:1138-1149, 2012). The basic approach used in the Tong et al. article is applied to a more recent and more comprehensive study of Iranian living organ donors, providing a clearer picture of what compensated organ donation is like in Iran since the national government began regulating compensated donation. Iran is the only country in the world where kidney selling is legal, regulated, and subsidized by the national government. This article focuses on three themes: (1) coercion and other pressures to donate, (2) donor satisfaction with their donation experience, and (3) whether donors fear social stigma. We found no evidence of coercion, but 68% of the paid living organ donors interviewed felt pressure to donate due to extreme poverty or other family pressures. Even though 27% of the living kidney donors interviewed said they were satisfied with their donation experience, 74% had complaints about the donation process or its results, including some of the donors who said they were satisfied. In addition, 84% of donors indicated they feared experiencing social stigma because of their kidney donation.

Marketplaces, Markets, and Market Design

“…101 The legal market in Iran appears to be one in which the donor/sellers nevertheless suffer from the kind of stigma that, e.g., sex workers continue to suffer in places where prostitution is legal. See Mireshghi (2016), Fry-Revere et al (2018), and Nayebpour and Koizumi (2018) for surveys of kidney donor/sellers in Iran. See also http://marketdesigner.blogspot.com/search/label/Iran.…”

Legislation and Policy Recommendations on Organ and Tissue Donation and Transplantation From an International Consensus Forum

“…Consequently, jurisdictions should consider formally establishing agreements that specify the necessary collaboration of clinical teams in all involved countries to ensure proper assessment and followup care of the recipient and, if appropriate, the donor. 2,44,[98][99][100] Exchanging organs across jurisdictional boundaries within a country (eg, from one state or province to another) should be regulated through national data sharing agreements that allow for the exchange of confidential patient information for the use of clinical and quality improvement purposes.…”

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

“…Regret may be related to the negative outcomes associated with the poor preoperative and follow-up care provided, for example, one donor had hypertension and two had poorly defined cardiac disease. Despite no evidence of coercion, more subtle pressures have been identified (Fry-Revere et al 2020 ), and there remain serious concerns about the quality of the informed consent process. In one sample of kidney donors, 60% had not been informed about the risks and benefits of kidney donation (Khatami et al 2015 ).…”