Kidneys for Sale: Empirical Evidence From Iran

Moeindarbari, Tannaz; Feizi, Mehdi

doi:10.3389/ti.2022.10178

Cited by 7 publications

(10 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is based on the premise that the best outcome for someone with end-stage kidney disease is a successful transplant and that it would increase the supply of kidney donors. We should emphasise here that we are not advocating replicating Iran’s approach, instead, we merely want to recognise one of its core benefits—the significant reduction in wait time for a kidney transplant (Moeindarbari and Feizi 2022 ). This means that every individual, irrespective of socioeconomic status has access to kidney transplantation.…”

Section: Iran’s Kidney Donation Programmentioning

confidence: 99%

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

Rodger,

Venter

2023

Med Health Care and Philos

View full text Add to dashboard Cite

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.

show abstract

Section: Iran’s Kidney Donation Programmentioning

confidence: 99%

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

Rodger,

Venter

2023

Med Health Care and Philos

View full text Add to dashboard Cite

show abstract

“…Previous research from Iran (13,20), and from Mashhad in particular (11,16), suggests that the degree of exploitation reported by Iranian kidney donors is less severe than those who sell their kidneys on the black market, because Iranian kidney donors are protected by law (11,16). Moeindarbari and Feizi corroborate these findings by pointing out that medical teams in Mashhad have no share of the money paid by the recipient to the donor, that prospective donors are informed about the potential health consequences of their donation and that they receive pre -and post-operative care (6). Any examination of the Iranian model should thus compare the well-being of its donors to those who sell their kidneys on the black market (16,17,21).…”

mentioning

confidence: 93%

“…Moeindarbari and Feizi recognize these concerns and state that a monopsonistic program, where the government pays a fixed sum to donors and where patients do not pay, would allow for more equality and fairness (6). Although a monopsonistic transplant program would not address the conditions of poverty that compel people to sell a kidney, it could reduce the risk of interpersonal exploitation by preventing donors and recipients from negotiating payments (17,18).…”

mentioning

confidence: 99%

Kidneys for Sale? A Commentary on Moeindarbari’s and Feizi’s Study on the Iranian Model

Ambagtsheer

Columb²,

AlBugami

et al. 2022

Transpl Int

View full text Add to dashboard Cite

Over the last years, efforts by transplant professionals and transplant organizations have resulted in the strengthening of laws and sentences against virtually all forms of organ trade (1-4). The prevailing belief is that organ trade can be prevented by countries becoming "self-sufficient" (4, 5). Iran is the only country that reports to have eliminated its kidney transplant wait list (6, 7). Yet, it is largely condemned for having accomplished this by paying living kidney donors (8-10). Transplant professionals from Iran state that they are often prevented from presenting data about the Iranian model at international transplant conferences and in transplant journals. Furthermore, the regulations that underlie Iran's decentralized, semi-regulated organ payment programs, differ between the country's states, leading to differing outcomes (11)(12)(13)(14). These cross-country variations, in conjunction with the limited available data, hampers an in-depth understanding of the Iranian model (10,15,16). 1 Moeindarbari's and Feizi's study contributes to vital knowledge gaps in this regard. Drawing on a unique data-set collected from the Kidney Foundation in Mashhad, Moeindarbari and Feizi present an analysis of price arrangements between 436 donors and recipients. The findings illustrate, amongst other things, the effects of education, gender, age difference and donor-recipient relationships on kidney prices. In addition, the findings suggest that related donors sell their kidneys to close relatives for a significantly lower price. Government payments are additionally made under the scrutiny of the Ministry of Health for all transplant-related expenses. The authors further explain that donors are provided with medical coverage for 1 year after the nephrectomy and that they are exempted from military service (6).There are however some concerns about the Iranian model. Mashhad's kidney transplant program tolerates side payments between recipients and donors besides the fixed government fee. This is problematic because prices fluctuate according to the bargaining skills and abilities of donors and recipients. These unregulated transactions in turn may cause and exacerbate a variety of issues including inequality and interpersonal exploitation. Furthermore, while donors are provided with medical coverage for 1-year post-donation, it is unclear whether life-long follow up is guaranteed.

show abstract

“…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].…”

mentioning

confidence: 99%

“…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.…”

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

View full text Add to dashboard Cite

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

show abstract

Kidneys for Sale: Empirical Evidence From Iran

Cited by 7 publications

References 47 publications

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

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

Kidneys for Sale? A Commentary on Moeindarbari’s and Feizi’s Study on the Iranian Model

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

Contact Info

Product

Resources

About