Regulated market for kidneys in Iran

Al Roth points to this fabulous paper on the topic. It is written by  Farshad Fatemi at the Sharif University of Technology. It is one of those different papers you would just love to read. It comes as a real surprise that Iran has a well developed kidney market for n20 years.

Some basics first:

The most effective treatment for End-Stage Renal Disease (ESRD) is a kidney transplant (Renal Replacement Therapy: RRT). The only alternative treatment is dialysis and RRT is the only way for the patient to live without needing dialysis on a regular basis. Some researchers predict that the number of patient with ESRD will reach 2 million worldwide by 2010 (Nwankwo et al., 2005). In the US, it is predicted that more than 40% of patients may die while on the waiting list (Matas, 2006). Xue et al. (2001) predict that more than 95,000 patients will be on the waiting list for a kidney transplant by 2010; the figure was more than 65,000 in 2007.

 There are two sources for a kidney transplant, cadaveric kidneys and kidneys from the live donors. Cadaveric kidneys can be harvested either from a brain-dead patient (whose heart is still beating) or cardiacally dead patient; the latter is considered to have a lower quality. Since a normal person can live on just one kidney, she can decide to donate one of her kidneys. The incentive to donate a kidney can be altruistic or obtaining money by selling a kidney. Altruistic kidney donation is mostly a case for emotionally related donors where the donor donates her kidney to either a relative or a close friend. In order to match a kidney from a donor with a potential recipient, their ABO and RdH blood types as well as tissues should be compatible.

He points to studies which show live sources have a better quality than cadavers. 

While the 10 year graft survival probability for live kidneys are 54.7%, the same figure for a cadaveric kidney is only 39.2%

Efforts are being made to increase kidney supply in the world. Either countries have opt-in or opt-out system:

In order to increase the kidneys available from cadavers, two different systems adopted. The most popular one is the opt-in system where people, who wish to donate their organs after their death, sign up to the scheme. For example it is estimated that in the UK one in five people (more than 13 million) signed up to the scheme (Boseley, 2006). This voluntary scheme is run in many countries but usually the donor’s wish is not enough to guarantee that the donation will take place after the donor’s death, since in many cases the consent of next of kin is also required, either by the law or informally. There are campaigns for encouraging organ donations in many countries. However, the shortfall of the number of organs available through this system in recent years is an issue;

The alternative system is the opt-out system which is practised in some European countries, including Spain and Austria. In this system, the donor’s consent is presumed and a person needs to opt out the scheme if she does not want to donate her organs after death. UK also considered switching from opt-in system to this system, where it is under legal and political consideration (Wintour, 2008)

One legitimate argument against this system is that presumed consent means that the state is considered the owner of the body of deceased person. Some consider this to be a problematic assumption (Becker & Elias, 2007). Abadie & Gay (2006) develop an economic model to investigate the effect of presumed consent on the donation rate, their model predicts that the opt-out system may have a positive or negative effect on the rate of donations comparing to opt-in system depending on the model assumptions, however, their empirical analysis for 22 countries over a 10-year period shows after controlling for other determinants, presumed consent legislation has a positive and significant effect on organ donation rates.

Some countries have adopted a different definition of death to get better organs:

Another measure to boost the number of donations is an expansive legal definition of death, such as Spain uses, allowing physicians to declare a patient to be dead at an earlier stage, when the organs are still in good physical condition. This is controversial and has been mentioned as the main reason for individuals not wanting to participate in organ donation schemes.

As a result of this procedure, putting extra effort and resources in procurement process, and the presumed consent system, Spain has one of the highest rates of cadaveric donations in Europe. (See Table A1 in appendix) In summary the high rate of kidney donation in Spain is due to presumed consent policy, enhanced infrastructure for donation, expansive legal definition of death, and more road accidents. However there has been no study to estimate the contribution of each factor.

How about the market in Iran? Live donation is legal across most countries but selling kidneys is legal only in Iran.

In Iran a regulated system for kidney donation with monetary compensation was introduced in 1980s. Under this regime the donor receives a monetary compensation from the recipient and enjoys additional monetary and non-monetary bonuses from the government. The system has been criticised harshly (i.e. Harmon & Delmonico, 2006 and Zargooshi, 2001) as well as receiving some warm support (i.e. Daar, 2006 and Mahdavi-Mazdeh et al., 2008) both inside Iran and internationally. Ghods & Savaj (2006) is one of the most recent papers which tries to reason in support of the system by highlighting the benefits and answering some of the critics. Data show that in 2006 1858 kidney transplantation took place in Iran. 13% and 12% of these transplants were harvested from cadaveric and emotionally related live sources respectively and the other 75% was from unrelated live donations

The author adds there is lot of discussion in medical journals but nothing much in terms of economic perspective. Infact there are some false things associated with Iran kidney market that govt does not allow cadaveric donation on religious grounds.

There is an excellent literature review of kidney and organ markets. There is research on pricing kidneys and organs:

The early discussion on the economics of a market for human body parts goes back to 1970 when Titmuss argued that buying and selling blood has an adverse effect on the quality of the blood (Titmuss, 1997). Titmuss compares the data from the British system (where paying for the blood was illegal) with the American system (where blood donors got paid) and argues that the latter had a lower quality of denoted blood. Titmuss points out that a significant fraction of the American blood came from individuals with hepatitis and other diseases that could not be screened out, and the blood given under the British system tended to be healthier. Titmuss also argued that monetary compensation for donating blood might reduce the supply of blood donors. This hypothesis often referred to as crowding out effect.

Becker (2006) argues that even if Titmuss was right about the quality of the blood, the American system provides more blood per capita than British system. This means that the crowding out effect is not present. However, the quality of blood is not a major problem now, since the modern screening methods can guarantee the blood is not contaminated.

Superb again. And how did Iran end up developing a kidney market?

The 1979 revolution in Iran was followed in 1980 by an eight year war with Iraq. Dialysis equipment was scarce because of economic sanctions and lack of funds for imports (Nobakht & Ghahramani, 2006). As a result of these events, nephrologists were encouraged to perform kidney transplants. At the beginning, the process relied on few cadaveric kidneys available, along with emotionally related donors. But the large number of patients on the waiting list forced the authorities to establish a regulated market for living unrelated donations. The efforts of charities, established and managed by dialysis patients and their close relatives, helped to develop the market. Table 2 shows a clear picture of the development of kidney transplantation in Iran. It is notable that over a period of 10 year (1996-2006) the rate of cadaveric and live donation increased by 35.1% and 8.1% annually. Cadaveric transplants accounted for 1.6% of total number of transplantation in 1996, this figure reached 13.1% in 2006.

Superb stuff. Read the paper for how there are various institutions that enable this market to perform. There is  market-making as people are matched for blood type, emergency cases etc. Pretty useful stuff.

Some lessons for countries that have black markets for organs which are corrupt and inefficient. What a paper!

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73 Responses to “Regulated market for kidneys in Iran”

  1. Dermal Fillers, Wrinkle Fillers - How much does Botox shots every three months effect the liver and kidneys if known? Says:

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  2. meenakshi mehta Says:

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  3. kombizz Says:

    interesting article to read
    Urgent to Sell

  4. farooq Says:

    am 28yr from Uganda, i want to donate my kidney for some money

  5. adelina stefania Says:

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  6. andree Says:

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  7. annie lucas Says:

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  8. Mahmud Says:

    I want to sell my kidney, bl.gr: O+, age: 43, urgently please.

  9. Mahmud Says:

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  10. Words that aren’t arguments: ‘commercialization’ « Nation of Beancounters Says:

    […] Bonus: highlights from a paper on Iran’s kidney market. […]

  11. sani84 Says:

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  12. vijayalakshmi Says:

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  16. Dr Alex Says:

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  25. Dr. Yeshwanthpur Shankar Says:

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  28. Monticelli.mario Says:

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  29. Dr. Prashant Borade Says:

    Hello everyone

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  30. Prachi Rakesh Says:

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  31. Celtic Hospital Says:

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    • sreedhar Says:

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  32. ehis Says:

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  33. Dr.Lucas Oseremen Says:

    Good day,

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    PERSONAL DETAILS NEEDED:
    ——————————————-

    Full Names:
    Blood Group:
    Sex:
    Age:
    Date Of Birth:
    Language:
    Relationship:
    Telephone Number:
    Profession/Occupation:
    Monthly Income:
    Reason For Selling:
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    State:
    Next Of Kin:
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  39. Dr Denton Cooley Says:

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  40. Dr Denton Cooley Says:

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  41. Dr.Kenneth E Albrecht. Says:

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  42. Jayakumar Says:

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  43. Dr Raymond Says:

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  44. Dr Marquez Says:

    Dear Sir /Madam,

    Do you want to sell your kidney? Are you seeking for an opportunity to sell your kidney for money due to financial break down and you don’t know what to do, then contact us today and we shall offer you good amount for your Kidney. My name is DR LORENA FITCH am a Nephrologist in LORENA KIDNEY CLINIC. We specialized in Kidney Surgery and we also deal with buying and transplantation of kidneys with a living an corresponding donor. We are located in Turkey, USA, Malaysia,Germany,Poland,Spain. If you are interested in selling or buying kidney’s please don’t hesitate to contact us via email:(LORENAKIDNEYCLINIC@GMAIL.COM)

    LORENA KIDNEY CLINIC FOUNDATION

    Email:LORENAKIDNEYCLINIC@GMAIL.COM

  45. Dr. Frank Justice Mohammed Says:

    If you are interested in selling one of your kidney for a good amount kindly Contact us now “The Apollo Spectra Hospital” as we are looking for kidney donor, Very urgently who are B+ve , O+ve and A+ve with any Indian ID prove.
    Donor should be 21 years or above. Interested Donor should contact us now on my Email: Dr.Frank.Justice_Mohammed@surgical.net

    Regards
    Dr. Frank Justice Mohammed
    phone number: +917264832128

  46. Dr. Frank Justice Mohammed Says:

    Hello Donor, Are you interested in selling one of your kidney for a good amount kindly Contact us now “The Apollo Spectra Hospital” as we are looking for kidney donor, Very urgently who are B+ve , O+ve and A+ve with any Indian ID prove.
    Donor should be 21 years or above. Interested Donor should contact us now on my Email: Dr.Frank.Justice_Mohammed@surgical.net

    Regards
    Dr. Frank Justice Mohammed
    phone number: +917264832128

  47. Dr. James Says:

    Did you want to sell your kidney urgently or donate your kidney? Did you need a kidney donor? You can contact us on via email: ufuakidneyfoundation@gmail.com or tell:+23408133876490 .
    Dr. James

  48. Dr. UFUA Says:

    Did you want to sell your kidney urgently or donate your kidney? Did you need a kidney donor? You can contact us on via email: ufuakidneyfoundation@gmail.com or tell:+23408133876490 .
    Dr. James

  49. johnson Says:

    This is to inform the general public Male or Female who are healthy and 100% serious
    in donating their kidney should urgently contact Dr.
    johnson,I’m a Nephrologist in General Hospital..
    As we have a lot of patients who are here for kidney transplant, Are
    you seeking for an opportunity to donate your kidney for money due to
    financial break down,Our hospital is specialized in Kidney Surgery/transplant
    and other organ treatment, we also deal with buying and transplantation of kidneys
    with a living and healthy donor.we are offering $500,000.00 USD for your kidneys If
    you are interested in donating your kidney please don’t hesitate to
    contact us via Email;c

  50. Dr. Frank Justice Mohammed Says:

    Hello all, Is any donor looking for the right way to sell he’s kidney? If you are interested in selling one of your kidney due to some personal reasons? kindly Contact us now “The Apollo Spectra Hospital” as we are looking for kidney donor Very urgently who are B+ve , O+ve and A+ve with any Indian ID prove as your health and happiness is our major concern, Donor should be of 18 years and above. Interested Donor should contact us now on my Email: Dr.Frank.Justice_Mohammed@surgical.net

    Regards
    Dr. Frank Justice Mohammed
    phone number: +917264832128

  51. Dr Federick Williams Says:

    Your Attention Please,
    Wait! Consider selling your kidney as an Option. ROME MEMORIAL HOSPITAL is urgently in need of Kidneys and Livers, Message us immediately. The National foundation is currently buying healthy kidney. My name is Dr Frederick Williams, We operate in ROME MEMORIAL HOSPITAL. Our Hospital is specialized in Kidney Surgery and we also deal with buying and transplantation of kidneys and Livers with a living an corresponding donor. We are located in NEW YORK, ITALY, CANADA, SPAIN, RUSSIAN, GERMANY, TURKEY, UK, FRANCE ETC: If you are interested in selling or buying kidney’s please don’t hesitate to contact us via Email : Dr_federickwilliams@doctor.com
    Need Genuine Donors.

    Waiting for your responds…..
    Best Regards….
    Dr Frederick Williams

  52. Angel Landa Bistrain Says:

    My name is Elizabeth forbes from united states. I want to thank Mr Johnson who helped me to get a loan. He was able to give me a loan of $15,000US Dollars. He can also help you. If you need any financial help, kindly contact his company through email: johnsonsnowberger@outlook.com

  53. dr smith ravi Says:

    Urgently needed A+, B+, O+, blood group donors with Indian passport only and age between 25-35. We give you all expenses like TRAVELING, ACCMODATION, FOOD, & MEDICAL ALL Expenses.
    We will give you honest price for your donation & top best medical treatment it will help your future life
    I give assurance what I mentioned here. If you have any questions or doughts just mail me !!

    My mail id : drsmithravin@gmail.com

    ( FOR AGENTS DONT COPY THE COMMENTS TRY TO CREATE NEW )

  54. Dr. louis Says:

    My name is Doctor Philipson am a nephrologist and the chief medical director at ST. LOUIS INDIA. Do you want to sell your kidney? Are you seeking for an opportunity to sell your kidney for money due to financial break down and you don’t know what to do, then contact us today via dr.louisclinic@gmail.com or call: +918870421469 and we shall offer you good amount for your Kidney
    PRICE: $145,000USD

  55. Drabraham Sachith Says:

    Emergency…… Emergency….. Emergency……………..

    Dear Sir /Madam,
    Do you want to donate or sell your kidney for money, Manipal Hospital (Bangalore,Karnataka) is urgently in need of O+ve and A+ve kidney donors. If anyone is willing to donate please contact us through our………………….

    email…drabraham45@gmail.com
    mobile number. +917339383227

  56. Manipal Hospital Says:

    Hi, We’re looking for kidney donors, Very urgently. B+ve , O+ve and A+ve with India passports/ Voters card or Pan-card Email:manipalhospital123@gmail.com

  57. Dr. Prakash Says:

    If you wish to sell your kidney today,kindly contact us now and you will be rewarded with cash. dr.prakashjagan@gmail.com OR Call +917219264129 very urgently.

  58. Dr. Kelvin Ahmed Says:

    Kidney donor who want to sell their kindney should contact Aditya Birla Memorial Hospital, we are looking for kidney Very urgently, Donor who are B+ve , O+ve and A+ve. Interested Donor should contact us now on my Email: Dr.Kelvin_Ahmed@surgical.net for more details, thanks.

    Regards
    Dr. Kelvin Ahmed
    phone number: +917418483179

  59. Columbia Asia Hospital Says:

    “Are you are interested in selling your kidney for money? Please contact us now and you will be rewarded with Cash.
    Waiting for your responds..
    Best Regards
    Dr. Prakash Jagan
    dr.faseeh.in@gmail.com

  60. DR LORENA Says:

    Dear Sir /Madam,

    Do you want to sell your kidney? Are you seeking for an opportunity to sell your kidney for money due to financial break down and you don’t know what to do, then contact us today and we shall offer you good amount for your Kidney. My name is DR LORENA FITCH am a Nephrologist in LORENA KIDNEY CLINIC. We specialized in Kidney Surgery and we also deal with buying and transplantation of kidneys with a living an corresponding donor. We are located in Turkey, USA,Germany,Spain. If you are interested in selling or buying kidney’s please don’t hesitate to contact us via email:(LORENAKIDNEYCLINIC@GMAIL.COM)

    LORENA KIDNEY CLINIC FOUNDATION

    Email:LORENAKIDNEYCLINIC@GMAIL.COM

  61. LORENA KIDNEY CLINIC FOUNDATION Says:

    Dear Sir /Madam,

    Do you want to sell your kidney? Are you seeking for an opportunity to sell your kidney for money due to financial break down and you don’t know what to do, then contact us today and we shall offer you good amount for your Kidney. My name is DR LORENA FITCH am a Nephrologist in LORENA KIDNEY CLINIC. We specialized in Kidney Surgery and we also deal with buying and transplantation of kidneys with a living an corresponding donor. We are located in Turkey,USA,Poland,Spain. If you are interested in selling or buying kidney’s please don’t hesitate to contact us via email:(LORENAKIDNEYCLINIC@GMAIL.COM)

    LORENA KIDNEY CLINIC FOUNDATION

    Email:LORENAKIDNEYCLINIC@GMAIL.COM

  62. Dr cathriona Says:

    Do you want to sell your kidney? Are you seeking for an opportunity to sell your kidney for money due to financial break down and you don’t know what to do, then contact us today and we shall offer you good amount for your Kidney.My name is (Dr Cathriona) am a Phrenologist in st Andrew hospital . Our hospital is specialized in Kidney Surgery and we also deal with buying and transplantation of kidneys with a living an corresponding donor. If you are interested in selling or buying kidney’s please don’t hesitate to contact us via

    email: dr.cathriona@yahoo.com
    Thanks,
    MANAGEMENT.

  63. Bryan Brett Says:

    Hello.
    Apollo Hospital is in need of kidney donor, and we are ready to buy your kidney in the amount of $350,000.00, so if you are ready to sell your kidney for us kindly contact us for more details now.

    email: bryanbrett2@gmail.com
    No. +919206193179

  64. Mike Willson Says:

    Do you want to sell your kidney? We are urgently in need of kidney donors at LILAVATI HOSPITALS India for the sum of [$450,000USD],

    Contact DR MIKE WILLSON for more details

    Mobile: 917036576981

    WHATSAPP: +917036576981

    NOTE: We are concern about saving lifes please only genuine donors should contact and fraudulent should keep off, Thanks.

  65. prime hospital Says:

    Prime Indian hospital
    Are you in debt? Do you need to raise cash for health care costs or paying debts or in a state of financial breakdown? Wait! Consider selling your kidney as an Option. If you wish to sell your kidney today. Message us immediately.A kidney is bought for a maximum amount of $100,000.00US Dollars.The National foundation is currently buying healthy kidney.My name is Dr. Mangle, am a Nephrologist in the kidney National hospital.Our Hospital is specialized in Kidney Surgery and we also deal with buying and
    transplantation of kidneys with a living an corresponding donor. We are located in Indian, Canada, UK,Turkey, USA, Malaysia, South Africa etc. If you are interested in selling or buying kidney’s please don’t hesitate to contact us via Email : (drmanglemangle@gmail.com)

    Waiting for your responds….

  66. Dr Ben Morgan Says:

    Dear Sir /Madam,
    Do you want to sell your kidney for MONEY; Apollo Hospital, is currently in need of men and female donors for O+ve and A+ ve kidney donor. If anyone is willing to donate a kidney please contact us immediately and we shall offer you Rs 50 Lahks for your Kidney.
    best Regards
    Dr Ben Morgan
    E-mail:shifamedicalhealthcare@gmail.
    call +917411951612

  67. Dr Ben Morgan Says:

    Hello everyone, Kidney donor is urgently needed A+, B+, O+, blood group donors between the age of 20-65. We give you all the entire best attempt, we will give you honest price and best treatment for your transplant as top best medical treatment it will help your future life, kindly contact us for more information:

    Best regard
    Dr Ben Morgan
    No. +917411951612
    email: shifamedicalhealthcare@gmail.com

  68. Dr Ben Morgan Says:

    Hello.
    Do you want to buy or sell your kidney for money? Because Shifa Hospital is urgently in need of O+ve B+ve and A+ve kidney donors. So if anyone is willing to donate or buy please contact us for more details:

    Best regard
    Dr Ben Morgan
    No. +917411951612
    email: shifamedicalhealthcare@gmail.com

  69. johnson Says:

    This is to inform the general public Male or Female who are healthy and 100% serious
    in donating their kidney should urgently contact Dr.
    johnson,I’m a Nephrologist in General Hospital..
    As we have a lot of patients who are here for kidney transplant, Are
    you seeking for an opportunity to donate your kidney for money due to
    financial break down,Our hospital is specialized in Kidney Surgery/transplant
    and other organ treatment, we also deal with buying and transplantation of kidneys
    with a living and healthy donor.we are offering $308,000.00 USD for your kidneys If
    you are interested in donating your kidney please don’t hesitate to
    contact us via Email;generalhospital121@gmail.
    com

  70. Dr Prakash Gupta Says:

    Make better living for cash from online by donating your organ.
    Waiting for your responds…
    Best Regards
    Dr Prakash Gupta
    guptadrprakash6@gmail.com
    Contact: +917875049172

  71. Kalibhai Says:

    Hello.

    Narayana hospital is looking for Kidney donor A+, B+, O+, blood group donors between the age of 22-65. We give you all the entire best attempt, we will give you honest price for your donation & top best medical treatment it will help your future life, kindly contact us for more information. we are willing to pay RS 2 crore

    DR Samuel Kalibhai;(+919886508741)
    email: narayanahosp1@gmail.com

  72. Mr Doctor Says:

    do you want to sell your kidney if yes email doctorcollins3@gmail.com offer batter amount of 800.000$ per_ one kindey thanks

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