“Insofar as the kidney procurement system
in Iran can be characterized as a “market,” it is
a highly standardized and regulated market
with only modest room for negotiation. Once
potential kidney recipients are identified, they
are evaluated by kidney transplant teams,
including transplant nephrologists and transplant surgeons. Recipients are counseled that it
is in their best interest to identify a biologically
related living donor. If no biologically related
living donor is available or willing to donate,
the recipient is referred to the Dialysis and
Transplant Patients Association. From there,
disposition of the recipient depends on
whether the transplant center has an active
deceased-donor program. For example, at a
major university hospital in Zhiraz, which has
an active deceased-donor program, recipients
referred to DATPA must generally wait six
months for a deceased-donor kidney (though
some recipients elect to circumvent this
requirement by traveling to Tehran for transplantation).
27
If the recipient does not receive a
transplant from a deceased donor after six
months, DATPA identifies an immunologically compatible kidney vendor for the recipient.
28
DATPA is staffed by volunteers with ESRD
and receives no remuneration for matching
kidney vendors with recipients. Neither the
transplant center nor transplant physicians
are involved in identifying potential vendors.
Instead, vendors express their own interest in
participating by contacting DATPA. Once
identified, vendors are referred to the transplant center and evaluated according to the
same medical standards applied to living
donors who are not financially compensated,
3
Today, in the
United States,
more than 73,000
people are
waiting for a
kidney transplant
from a deceased
donor.including the evaluating physician’s right to
use his medical discretion to veto a vendor’s
candidacy.
Vendors are paid in two ways. First, the
Iranian government provides a fixed compensation to the vendor of approximately $1,200
plus limited health insurance coverage, which
currently extends to one year after the
exchange and covers only conditions deemed
related to the surgery.
29
Second, the vendor
receives separate remuneration either from the
recipient or, if the recipient is impoverished,
from one of a series of designated charitable
organizations; this amount is usually between
$2,300 and $4,500.
30
The amount and source
of the second remuneration is arranged
beforehand by DATPA.
31
It is important to
note that noncitizens are not eligible to participate in the Iranian organ procurement system as either vendors or recipients. As with
dialysis, the Iranian government assumes the
cost of treatment, including the kidney procurement, transplant surgery, immunosuppression medications, and postoperative care
of the vendor and recipient. Thus, while the
Iranian market in organs is heavily regulated,
it does allow people to receive several forms of
compensation for their organs, including
financial compensation.
Unlike the rest of the world, and the
United States in particular, the Iranians have
found a way to solve their organ shortage;
and although their market system is not
without problems, it clearly has advantages
over other organ procurement systems, primarily that thousands in need do not die
while waiting for a compatible donor”
