Could Iran have a model commercial kidney donation scheme?

SBS – Organ donation in many countries, including Australia, is altruistic – meaning donors are not paid for their organs. But waiting lists are often long.

In a unique system, Iran operates a commercial donor scheme for kidney patients.

While critics say this can lead to exploitation, waiting lists for kidneys in Iran are almost non-existent.

Without Iran’s kidney program, dialysis would be Zahra Hajikarimi’s ongoing reality.

The machine cleans her blood, three times a week, each treatment taking four hours.

She says commercial donation offers her her best chance.

“It would be very difficult to imagine life without the possibility of a kidney donation. It is very difficult, for even one per cent, to imagine that there is no cure… and you have to live with this disease until the very last moment of your life.”

Under the scheme, potential recipients register with the patient-run Dialysis and Transplant Patients Association.

It matches those in need with a healthy adult donor up to 45 years old.

The Patients Association receives no money for brokering the exchange – however they help negotiate financial compensation for the donor.

A kidney typically costs 135 million Iranian rials – around AU $6,000.

Hashem Ghassemi is the head of the Kidney Foundation of Iran.

“In Iran there were no kidney transplants in the past and patients had no choice but to spend a lot of time and go abroad to wait on a waiting list for a year or two to get a kidney from a deceased person. But now, praise to Allah, this problem has been solved in our country.”

The head of the Kidney Transplant Department at Modarres hospital in Tehran, Majid Ali Asgari, says the government finances the surgery and ongoing health costs for a year.

“Since the very beginning there has been no financial links between us and the patients. Absolutely nothing. Transplants have been free of charge in Iran since the beginning, although they are very costly.”

Live donors now account for the vast majority of kidney transplants in Iran.

It says the waiting list was eliminated in 1999 – a decade after the program was introduced.

In Australia, the waiting time for a kidney transplant from is about three years, while living transplants are up 19 per cent in the year to date.

It follows the introduction of a scheme which reimburses employers for up to nine weeks of leave taken by the donor.

They’re also preferable because surgery can be planned, reducing time between removal and transplantation, thereby improving outcomes.

Professor Jonathan Craig is on the board of Kidney Health Australia and a leading kidney specialist.

“Living with kidney failure is a really unpleasant experience and most of the people who donate are family members and close friends so they know what life is like on dialysis and Australians are very generous people and most donation is out of love and concern for their loved ones.”

While many Iranian donors claim their motives are purely altruistic, there are those who admit to financial pressures.

This donor spoke on condition of anonymity.

“The reason I had to sell my kidney was that my life would have competely fallen apart if I didn’t do that. I would have lost my life, my wife, my child. One is really happy to be able to save a human being’s life, I mean it, it’s a good feeling. But it is a financial problem that makes one do this.”

Some ethicists and doctors argue that compensating donors puts the poor under pressure to donate.

And patients lacking funds are less likely to receive a transplant, with organs likely to go to the highest bidder.

Professor Jonathan Craig says he can’t see this model working for Australia.

“Commercial transplantation is illegal in Australia and I can’t see that changing at all. And the reason is that we want an equitable, just, appropriate, ethically justifiable process for transplantation in Australia. Sure, we want to improve the lives of people on dialysis, but we actually have to protect the lives of vulnerable people. A commercial process that does occur in some parts of the world I think would never occur in Australia; it’s unjust and it’s wrong.”

And then there’s the black market.

Graffitti on a wall outside an organ donation centre offers a kidney for sale and contact details.

Tehran resident Reza Niayesh says the economic sitiuation in his country, gripped by sanctions, is driving people to take great risks.

“A friend of mine recently needed a kidney and he spent a lot of money and agreed to pay even more to the donor but a couple of days ago, the donor texted him and said he wouldn’t sell his kidney. I asked him to come and sign up at the kidney foundation and it is much better. Yes, you are added to a waiting list but it is better for donors and receivers.”

Some argue regulated commercial donations would also go some way to combating the burgeoning black market in kidneys in countries such as India, the Philippines and Pakistan.

As Zahra’s dialysis session ends she says, for her, commercial donation makes sense.

“It would have been a total mess. Trafficking is a negative thing everywhere. How do you control it? There would be no supervision without the current system. You wouldn’t know from whom you were receiving a kidney, you wouldn’t know if they were healthy and if they were suitable. In such a situation one would rather not go through a transplant at all.”