Friday , 23 July 2021

“Hey sister! Do you sell your kidney?”

Radiozmaneh – My name is Sarah. I’m 23, and I live in Northern Iran with my mother and my younger sister. Those who have visited villages in Gilan province, know that most people living in this breathtakingly beautiful, rich nature are poverty-stricken.

Even those who own a piece of land or a rice paddy, are idle for at least six months of the year. We have neither a land of our own, nor any savings. In a word, we are the poorest of the poor. When I was younger, my father used to work on rice paddies as a land worker for half the year, and the other half he worked with his motorcycle, giving rides to people. When I was 12, my father got run over by a ten-wheel truck and passed away. My sister and I were left orphans, and my mother had no choice but to earn our living by cleaning houses. But the pressure of physical labor was too much for her, and when she couldn’t bear it anymore, I had to drop out of school and get a job.  An acquaintance helped me find a job in a beauty salon in a nearby city called “Sowme’eh Sara”. I didn’t earn much, but as the saying goes “something is better than nothing”. My job was to do the cleaning, but I dreamt of learning the profession and becoming a hairdresser so my poor mother can retire. But about a year ago everything suddenly changed, and my life took a turn for the worse. The owner of the salon where I worked decided to close down the salon and move to another city and I lost my job. Around the same time my mother was diagnosed with colon cancer. We sold all we had and borrowed from anyone we could think of to pay for her treatment.

It has been a few months since my mother started chemotherapy and we cannot afford to pay the medical bills anymore. The drugs, the hospital bills, the specific diet, … it’s all too much. There is no one left I can turn to for help. I even went to several charitable organizations, including Imam Khomeini Relief Foundation in our province, but to no avail. In order to be able to pay at least part of my mother’s treatment expenses, and take care of my sister, I need to have at least tens of millions of Tomans, but all I have is debt.

One night, when I was sitting by my sick mother’s bedside, I decided to do what many other people in my situation would do: I decided to sell my kidney.

Kidney sellers have put their phone number on the walls, Tehran, 2020 – Photo: Zamaneh

I had seen it before and I knew in order to sell a kidney people would post some kind of a flyer or write their contact number on the walls in specific streets of the city so the potential clients/buyers could contact them. I talked to a relative of a friend whose brother had had a kidney transplant to find out how dangerous it could be. He told me it depends on the broker I choose to work with. If I end up in the hands of a shady person –and let’s face it, they very often are shady- there could be some problems, but the transplant itself is not a particularly complicated or dangerous operation. 

Different people have different ideas of what constitutes “danger”. But even if one decides to accept the physical and psychological risks of such a surgery –risks that are usually understated-, there is still a complicated procedure to be completed before the actual organ procurement operation; a procedure which is neither that easy nor straightforward. How could Sarah manage to sell her kidney under such circumstances? I am not Sarah. I am a journalist. I had to tell you the above story to take you on the same journey I had to take to research a complicated phenomenon called “commercial kidney trade”. Sarah is a fictional character based on reality which helped me circumvent the prohibitions I would have faced as an Iranian journalist residing abroad had I used my true identity. I still remember the first time I saw a flyer advertising a kidney for sale. Back then I still lived in Iran. I was shocked and asked myself how a person could resort to selling an organ, and whether this was legal. The shock and astonishment stayed with me for years as I watched the number of advertisements grow. They were everywhere: on city walls, on different websites, on social media, even on texting applications. A while ago, I finally decided to take a closer look at the process of selling a kidney in Iran. The present article is the outcome of this research.

One of the most important characteristics of this phenomenon is that living non-related donation of kidneys has been legalized in Iran. Everywhere else in the world commercial organ trade is criminalized, and is carried out in black markets and in underground situations. According to the World Health Organization, organ trade should be criminalized because it could lead to profiteering and human trafficking. But in Iran, in addition to organ donation in case of brain death, receiving a transplant from a living donor has also been sanctioned and is regulated by a government-sponsored “nonprofit organization”. The legal framework for kidney transplantation has been addressed in the Organ Transplantation from Cadaver and from Brain Dead Patients Act (5 April 2000). While this act legalizes organ transplantation, it has chosen not to address the issue of organ trade and transplant tourism. Although, the government and judicial authorities claim that any kind of organ trade outside the legal framework is punishable by law as organ trafficking.

The official organization in charge of policy making for kidney transplantation is The Charity Association for the Support of Kidney Patients (CASKP). Patients in need of a transplant and those who are willing to donate a kidney should both apply through this association to be placed on the national waiting list.

But the waiting list is very long, and patients, while struggling with financial, physical, and psychological nuisances of dialysis, usually have to wait for years before they get an organ. The latest statistics indicating the number of patients waiting for a transplant dates back to 2019. According to Mahdi Shadnoosh, head of The Transplantation and Treatment of Diseases Department at the Ministry of Health, 8600 patients have been placed on the waiting list for a transplant, while the number of transplantation surgeries carried out each year is about 2000 cases. In other words, the average wait time for a transplant is 4 years. According to Farahnaz Sadeqbeigi, head of the Organ Procurement Department at Shahid Beheshti University, every day 12 people die due to not receiving a transplant, of which 8 to 10 are kidney patients. Even if we base our judgement solely on the official statistics, one can see why patients would be willing to pay an extra amount to shorten the waiting period. When it comes to one’s life, most people would not shy away from the possibilities that the black market has to offer. But of course, not everyone can afford such extraordinary measures.

Every year more Iranians are falling below the national poverty line. Volunteering to donate an organ, when not incentivized by altruism, can only have one reason: coercion by poverty, given the fact that “one can live with just one kidney, but not without money!”. In such circumstances, if the impoverished seller can get a higher bidder in unofficial market, she would choose that over the government-sanctioned system without thinking twice.

It’s not hard to imagine that someone like Sarah Salehi, who needs more money than the compensation offeredbyCASKP, would also overpass the legal procedure and go directly to the black market; where some are shopping for their lives, and others haggle over the price for a part of their body. But how independent this market actually is from the legal framework? In other words, what doors can this market open to the desperate buyers and sellers? Do any of these doors open to legal organizations’ hallways?

?? Living non-related donation (LNRD) of kidneys has been legalized in Iran and is controlled by The Charity Association for the Support of Kidney Patients (CASKP).
?? The recipient’s family, benevolent charity donors, the Ministry of Health and the Charity Foundation for Special Diseases (CFSD) pay an amount of about 20 million Tomans to the donor as a ‘reward for making a sacrifice’.
?? The price offered for a kidney in the black market is about 300 million Tomans.
?? While the capacity of the medical system for organ transplantation surgeries is 2000 transplantations annually, more than 8600 patients have been placed on the waiting list for receiving an organ from a cadaver or a living donor.
?? Every day 12 people die because of not receiving an organ transplant.    

The black market for kidney trade is not covert in Iran. Before the rise of the social media, flyers could be spotted all over big cities and in crowded streets. Today, such advertisements can still be seen on walls and they are not restricted to kidneys, either. With the growing poverty, they are taking over the social media as well: name and surname, age, blood type, and a contact number. Just like old days when entering the market was as easy as picking up the phone and dialing a number, today a simple text message or a comment can put you in touch with a buyer or a seller.

Instagram is one of the platforms widely used by third-person kidney trade brokers. Unlike other popular social media platforms, access to Instagram has not been blocked by the authorities in Iran. A more thorough search in Google or Instagram using keywords like “kidney”, “kidney-for-sale”, etc. will put you through to hundreds of posts and users. Apparently, users active in this market use simple, easy-to-remember names as a rule, for example you will find IDs like: “looking for a kidney” or “I sell my kidney”.

In order to be able to get in touch with brokers, like a playwright, I created a character called Sarah Salehi. I then created an Instagram account for Sarah using sara.salehi948 as her ID and in her Bio I wrote: “Looking to sell a kidney. Send me a message in direct for more information. Blood type: O+”. Then I posted a picture, repeating the phrase I had used in Bio and added hashtags like #kidney-for-sale, #buy-a-kidney, etc. You can see some pictures of the page I created, below.

After I was done creating the page, I again set to search, and found a number of pages where buyers and sellers had left posts and comments. I followed all the pages that seemed relevant to my purpose. For examples of the pages I followed, see below:

Afterwards, I found some posts that were related to selling a kidney and I left comments saying: “I want to sell my kidney. Blood type: O+”. Below, you can see examples of my comments:

I didn’t have to wait long. After just two days, on 5 February 2020, I received a message from a page whose user ID was “kolie_bi_m”. He later introduced himself as Mahmoud N. (I will not use his full name here). I replied immediately. Screenshots from my conversations with him are included below. In the screenshots you can find all the details each user gave me.

Screenshot 1:
Mahmoud: Hi there, sister*! Did you sell your kidney?
Me: Hello. Not yet, how come? Do you need a kidney?
Mahmoud: No, sister! But if you really want to sell, I can help you.
Me: I want to sell my kidney. How can you help me?
Mahmoud: How old are you, sister? Where do you come from?

Screenshot 2:
Me: (I’m) 23 (and I’m from) Gilan.
Mahmoud: I sold mine 3 months ago. In Tehran, though. Sorry if I ask, why do you want to sell?
Me: Financial need.
Mahmoud: Have you got all your documents?
Me: What documents? I have no idea what I should do. Could you please tell me?

Screenshot 3:
Me: I’d really appreciate it if you could help me.
Mahmoud: I found a broker in Tehran, sister. There is this street, everyone calls it “the Kidney street”. I myself am from Shiraz.
Me: What is the real name of the street?
Mahmoud: He charged me 300 thousand Tomans and put me on the donors’ registry. It only took 2 weeks. The real name of the street is “Farhang Hosseini”, if I’m not mistaken. I’m not sure.
Me: So it only took 2 weeks before you got your surgery?
Mahmoud: That’s right, sister.

Screenshot 4:
Mahmoud: (It took) 2 weeks till all the documents were ready. I went to Tehran with the (organ) recipient, we did all the necessary tests, and I had my surgery 3 days after.    
Me: Don’t you have any health problems now? I’ve heard you can easily live with one kidney, right?
Mahmoud: Thank God, I have no problems. That’s right, sister. You are going to be fine.
Me: Thank God, then. So I will definitely have to go to Tehran, right?

Screenshot 5:
Mahmoud: Look sister, if you want to do it yourself, you will have to apply through CASKP. You will have to pay about 1 (million) 200 thousand (Tomans) for the documents, tests and stuff, and they won’t pay you more than 35 (million) Tomans for the kidney. Of this amount, 34 million (Tomans) is paid directly by the recipient, and the other 1 million (Tomans) by CASKP. But if you decide to work with a broker, just like I did, your application fee will be 300 (thousand) Tomans. I sold my kidney 3 months ago in Tehran and I got 240 (million Tomans). I don’t know how much a kidney is worth now.
Me: I have no money (to pay for the application).

Screenshot 6:
Mahmoud: I understand, sister. I know what you mean.  
Me: Are you saying that you sold (your kidney) for 240 (million Tomans)?
Mahmoud: That’s right. First I went to CASKP. There, the highest price was offered by a man from Tabriz who said he would pay 70 (million Tomans). But I didn’t have the 1 million something to pay for the application, either. So I paid 300 (thousand Tomans) to a broker and all the other expenses, including tests and stuff, were covered by the recipient.
Me: 300 (thousand) Tomans?
Mahmoud: That’s right, sister.
Me: How did you find the broker? I have only written on Instagram (that I want to sell my kidney).

Screenshot 7:
Me: It’d be great if you could put me in touch with your broker.
Mahmoud: But you will have to hurry if you want to sell, sister.
The New Year’s holidays are coming up. What’s your name, sister?
Me: Yes, you’re right. I’m Sarah. Can I ask your name, please?
Mahmoud: I’m Mahmoud. (This is the broker’s ID): @khak_6587.
Send him a message and tell him Mahmoud N. has introduced him.

Screenshot 8:
Me: Thank you very much. That was really kind of you. Is this his Instagram ID?
Mahmoud: Don’t mention it! Yes, That’s Insta(gram).
Me: Thanks again. I will definitely contact him, because I don’t really know what I need to do. You’ve been a great help.
Mahmoud: I will send him a text telling him that you are an acquaintance of mine. He’ll do whatever he can.
Me: That would be great, thank you! God bless you!
Mahmoud: Thank you, you too. I hope everything will go fine.
Me: I hope so. Good bye.
(After a few hours, I got another message from Mahmoud):
Mahmoud: I talked to him, sister. You can send him a message now.

As you can see, Mahmoud is not exactly a broker. He is a middleman between the broker and the seller, and in order to gain my trust, pretends to be a former seller and a well-wisher who knows the market well. According to him anyone like Sarah, who wants to volunteer to donate a kidney, needs to pay 1 million 200 thousand Tomans as an application fee at The Charity Association for the Support of Kidney Patients (CASKP), and then get in line for a long wait. On their website, the registration portal for organ donors is not accessible for residents outside Iran and therefore, I could not personally confirm the application fee that needs to be paid. I asked a friend who lives in Iran to help me, but she also got a similar message. It seems that the online registration option has been included on the website only as a formality. All I could find on other related provincial websites was a list of required documents. In any case, an application fee –no matter how small it might be compared to the amount the seller will receive- gives an opportunity to Mahmoud and people like him to offer less costly, faster ways of approach to the market.

Explanation: As you can see in the picture above, the sign up button is not a real link, but only an image.

In the meantime, there are those who, taking advantage of the situation and without having an actual role in the trade process, charge oblivious patients for this non-existent sign-up process.

The street Mahmoud talks about is also interesting. Those who are somehow involved in kidney trade, know “Farhang Hosseini” street in Tehran as Kidney Street. Word has it that the best brokers are to be found here. But why is this street called the Kidney Street? I looked up the street and came upon an interesting fact; The Charity Association for the Support of Kidney Patients (CASKP) is located on this street and brokers usually hang out right in front of its head office. This is where patients are supposed to go for help and medical support, and yet brokers hang around undisturbed, waiting for a rich prey.

Like in any other trade, in kidney trade too, the final profit is determined by the amount the seller manages to ask in exchange for his/her kidney. The legal terminology in Iran classifies any kind of organ transplantation, including transplants from a living person, under the category of organ ‘donation’; an altruistic act denoted by its nonreciprocal nature. Nevertheless, the CASKP offers a compensation in order to encourage “donors”. In October 2019, Majid Ramezani, head of the Association, announced this compensation to be 20 million Tomans and to be provided by the recipients’ family, benevolent charity donors, the Ministry of Health, and the Charity Foundation for Special Diseases (CFSD). He called this compensation a ‘reward for making a sacrifice’.

What is interesting is that according to Mahmoud, the amount that the Association offers is actually higher (35 million Tomans) than the amount announced officially. He also mentioned that even at the CASKP a kind of auction is practiced and someone might offer (in this case a man from Tabriz) to pay twice this amount.      

Another important point in what Mahmoud says is, the brokers allege to be able to get a much higher amount from the buyers, and this, be it true or not, is an important factor in inducing the would-be sellers to sell through brokers instead of the CASKP.

After talking to Mahmoud, on 6 February 2020, I sent a private message on Instagram to the ID Mahmoud had given me. He responded shortly after. Unlike Mahmoud, who tried to be warm and friendly, the broker had a rather unfriendly, standoffish tone.

Screenshots from our conversations are included, below:

Screenshot 1:
Me: Hi! I’ve got your ID from Mr. N.
Broker: Hello! What can I do for you?
Me: I want to sell my kidney. Mr. N. said you could help.
Broker: Age, height, weight, blood type, city of residence, marital status?
Me: Age 23, height 164 cm, weight 58 kg.

Screenshot 2:
Me: weight 58 kg, blood type O+, place of residence Gilan, I’m single.
Broker: Have you got all your documents?
Me: Not yet. I don’t know what I need to do exactly. Mr. Mahmoud said you can help me.
Broker: Your kidney is now worth something between 270 to 310 (million) Tomans. That’s if I sell it for you.

Screenshot 3:
Broker: and all you will have to pay for the sign up process will be 300 (thousand) Tomans. But if you decide to sign up yourself, the cost will be 1 million 400 (thousand Tomans)
and you will receive something between 35 to 50 (million Tomans) for your kidney.
If I take care of it for you, everything will be done in up to 3 weeks and if you want to do it yourself, it could take between 3 months to a year.
Me: Well, if it’s as you say, it’ll be great. Because I’m in a kind of a hurry and I need the money urgently.
Broker: Is your father around?
Me: Unfortunately, no. He passed away.
Broker: God bless him. Do you have his death certificate?

Screenshot 4:
Me: Yes.
Broker: Good.
Me: He passed away when I was a child.
Broker: Send me a clear picture of you ID. Your birth certificate, too. Do you have a driver’s license?
Me: I have my ID and birth certificate, but I don’t have a driver’s license.
Broker: Are you sure about your blood type?
Me: Yes.
Broker: (Send me) a clear 3*4 cm picture.
Me: I found out when I donated blood once.

Screenshot 5:
Me: Ok, just a quick question.
Broker: (Send me) all the pages of your birth certificate, and both back and front of the ID card.
Me: When should I give you the 300 (thousand Tomans)?
Broker: Whenever you want to start the process. If you want to start today, you will have to wire the money and send the documents by 2:00 pm. Otherwise, you will have to wait till Saturday.
Me: Okay, I’ll try to find the money somehow. Do I have to wire it to your bank account?
Broker: Yes.

Screenshot 6:
Broker: This money is not for me. It’s the cost of your registration on the donors’ registry.
Me: Yes, sure. Thanks a lot for your help. God bless you.
Broker: If you wire the money by 2 (o’clock) today, we will start right away.
All transportation costs will also be covered by the recipient. The money will be transferred to your bank account on the day of the surgery before you are admitted at the hospital. You can stay at the hospital from 3 to 10 days –your choice- but a minimum of 3 days is obligatory.
Hospital fees are also taken care of by the recipient.

Screenshot 7:
Me: How long do I have to stay at the hospital?
Broker: at least 3 days, but you can stay up to 10 days at the recipient’s expense.
Me: Yes, I got that.
Broker: You wouldn’t have any problems for coming to Tehran, would you?
Me: I don’t think I can prepare the money today, but I sure will till Saturday.
Broker: No problem. Send me your documents.

Screenshot 8:
Me: No, I wouldn’t have any problems.
Broker: We’ll start as soon as you have the money.
Me: I won’t be able to stay long, though.
Broker: Just make sure the photos are clear. We will need to scan them later.
Me: because I have to take care of my mother. Ok, sure.
Broker: You can go back 3 days after the surgery. Are there any other questions?

Screenshot 9:
Me: How much of this money they pay do I have to give to you?
Broker: My commission is 30 (million?) Tomans and it will be paid by the recipient. If someone sells their kidney or liver, it’s obviously because they need the money.
Me: Thank you very much. God bless you.
Broker: You, too. Have a nice day!
Me: You have a nice day, too!

On 7 February 2020, I sent another message to the broker.

Screenshot 1:
Me: Hi. Sorry, I just have a quick question.
Broker: Hi. What’s your question?
Me: In which hospital am I going to get the surgery?
Broker: Labbafinejad Hospital.
Me: Is this my only choice? Is it a good hospital?
Broker: They call it “the kidney hospital”. Most kidney transplant surgeries are done here. Besides, I know all the medical staff there and I can get everything done.

Screenshot 2:
Broker: The surgery will be done by an attending physician. We haven’t had any problems whatsoever over the past 10 years.
Me: Ok, great! Thank you! I’m relieved to hear that.
Broker: You are welcome. Why haven’t you sent me your documents yet?
Me: I have to have them scanned. I’ll send them.
Broker: have what scanned?
Me: My documents.

Screenshot 3:
Broker: Ma’am…
Me: You said yourself they need to be clear.
Broker: You just send me clear pictures of your documents. I’ll scan them myself.
Me: Ok, sure.
Broker: You don’t need to spend your money on such stuff.
Me: Ok, thank you very much.
Broker: You are welcome.
Me: Could you please give me your account details so I could wire the money by Saturday?
Broker: 6037xxxxxxxxxxxxxx. This is a debit card number. Name of the card holder: Khashayar A.
Me: Thank you. I’ll do it as soon as I can.

From this conversation I figured the broker Mahmoud had introduced is probably called Khashayar A. I looked up the card number he had given me through my bank application. The account was with Bank Melli under the same name he had given me.

Besides the great difference in the amount that brokers offer, my conversation with this particular broker, who very casually and without reserve gave me a real name and a debit card number, and the name of the hospital without even trying to verify my identity first, shows how much they feel safe in their field.

According to him, selling through a broker gives the benefit of paying 300 thousand instead of 1 million 200 thousand Tomans for the application and registration process, and thanks to the relations the brokers have with hospital managers, the patient would not have to wait more than 2 weeks to get the surgery. The much higher price haggled by the broker for the seller is also symptomatic of the huge commission he is looking to receive from the clients i.e. patients with kidney disease.

Khashayar A. claims to be working in the field of illicit kidney trade for more than 10 years and he calls the medical staff of Labbafinejad Hospital his “acquaintances”. Labbafinejad hospital in Tehran is one of the most prestigious hospitals for kidney transplantations. According to the latest statistics, as of May 2018 more than 5000 kidney transplant surgeries had been done at this hospital. Telling Sarah her surgery will take place at this hospital could have been a mere stratagem to gain her trust. But if we assume what the broker says is actually true, and we allow that there are brokers who can admit sellers for surgeries at hospitals outside the official waiting list, we have no choice but to hold doctors, who knowingly perform illegal operations with illicit organs, liable and a part of the black market who probably have their own share out of the kidney recipient’s pocket.

After a few hours I got another private message on Instagram from another ID, Parixs, who introduced himself as Karim. Karim’s role was more or less similar to that of Mahmoud, except this time, even before I had seen his message, he had told me all about himself. He had also included lots of details about the surgery. But most importantly, in order to put my mind at ease about what I wanted to do, he had posted a picture of the tests he had done before the surgery, alongside his broker’s contact number. Yet, one of the most important points in Karim’s information was that, there is nothing you cannot buy for a price in this process; for example, the brokers can get you the consent forms you need from your father, mother, or spouse in exchange for 150 thousand Tomans, or at least that’s what they say. You can read my conversation with Karim, below:

Screenshot 1:
Karim: Hi. Do you want to sell a kidney? Advertising it is not the way to go. It’s all a sham. I sold mine through a broker a few months ago. 0905xxxxxxx. This is his phone number. If he doesn’t answer, send him a message on WhatsApp.
Tell him you got his number from Karim. He’ll sell it for you. All you need is a consent form signed by your father, and a blood type card. Even if you don’t have the consent form, they’ll get one for you for 150 (thousand) Tomans. They have people who can do that.
The document Karim had sent me was a drug test, probably belonging to a would-be seller. Whether it actually belonged to him or to another person cannot be determined.

Screenshot 2:
Me: Hi. Yes, I’m looking to sell. I don’t have the documents yet.
Karim: What (don’t you have)? The consent form, you mean?
(Karim sent me another picture of an envelope containing test results which did not include any significant information and continued:)
Karim: Tell them your father lives abroad. Pay them 150 (thousand) Tomans and they’ll take care of it for you. That’s what I did.
Me: I don’t have a father.
Karim: If you tell them that, they’ll ask you for his death certificate. Tell them that he is not here, and that you need the form under your mother’s name instead. You pay 150 (thousand) Tomans and they’ll take care of it for you.
Me: I’m completely broke (and I can’t afford the 150 thousand Tomans for the consent form). I’m of legal age, why do I even need a consent form?

Screenshot 3:
Karim: Take a look at this picture.
(He sent me a picture including the requirements for kidney donors):
The kidney donors must:
Be between 22 to 45 years old.
For married donors, a consent form signed by the spouse, and for single donors, consent form signed by the father is necessary. In case the single donor’s father has passed away, the death certificate must be included, and the mother will provide the consent.
Donor’s birth certificate + a copy. Donor’s ID card (front and back), the ID card of the person who signs the consent form+ a copy (front and back)
A blood type certificate
2 photographs (3*4 cm)
A promissory note for 1 million Tomans
Donor’s weight must be under 80 Kg
The donor will receive his/her reward after the surgery through a cheque for 18 million Tomans at the Association’s office.
The donor will also receive a reward of 1 million Tomans from the Association.All the tests and analyses will be paid for by the recipient.

Karim did not send me any more messages.

On 9 February, I received another message from Mahmoud.

Screenshot 1:
Mahmoud: Hi, sister! Has your problem been resolved?
Me: Hi. I texted your acquaintance and he told me what I need to do. I haven’t been able to prepare the money, though.
Mahmoud: Damn it, that’s too bad. I’ll tell you what, you come up with half the money, and I’ll give you the rest myself.

Besides middlemen and brokers, I also got some messages from people who seemed to be kidney patients in need of a transplantation. A woman, whom I will call Razieh, contacted me and offered me 70 million Tomans for my kidney; a price much lower than what the brokers had promised. Razieh said she is just a teacher and she won’t be able to pay more than 70 million Tomans. I told her brokers can get me about 300 million Tomans for my kidney. She warned me: “Don’t let them fool you! That’s what they say to make you sell through them. But as soon as you give them the kidney, they are going to give you much less than they had promised.”

I was contacted by all the aforementioned persons on Instagram in less than a week.

At this point I had to end my conversation with them lest they want to find out more about my identity. A heavy snowfall in Gilan province caused an overall power blackout during which there was no internet connection and shortly afterwards, the Covid-19 pandemic broke out and as a result, the brokers gave up trying altogether.

Almost all of them deleted their messages immediately. My last attempts to contact them to reveal my true identity and ask for their permission to use their names and the information they had given me were futile as many of the accounts had already been deactivated or deleted, and this made reporting them to Instagram (Facebook) more complicated.

?? Instagram:
Mahmoud, a broker’s middleman, claims to have sold a kidney recently (3 months before) through a broker he had found on ‘kidney street’ for a higher price and with less costs.
Khashayar broker controls my personal information, and estimates my kidney’s price to range from 270 to 310 million Tomans. He claims to have been working in kidney black market with the help of his relations at Labbafinejad Hospital in Tehran for more than 10 years without ever encountering a problem.  
Karim, broker’s middleman, claims to have sold his kidney with the help of a broker. He gives me his broker’s contact number.
Razieh, direct buyer, a simple teacher, offers me 70 million Tomans for my kidney.

?? Interviewees:
Masoud, kidney patient under 30 years of age, after 4 years of dialysis has recently received a kidney transplant. Has gone through the legal framework but has finally managed to buy a kidney through a person pulling the strings for him at CASKP.
Shaghayegh, kidney patient, after waiting for a long time and since her family could not afford to buy her a kidney, she received a kidney from her father who was a match for her.

Discerning the great number of poverty-stricken individuals (either Iranian or non-Iranian citizens) who are willing to participate in illegal organ trade out of necessity is not that difficult. You wouldn’t even need to do what I did on the social media. Just type in “selling a kidney” in any search engine, open any related article, and go to the comments section. For example, an article titled “A Guide to Kidney Trade with a Table of Prices” published in 2018 has gotten many comments, of which more than 90 percent include personal information and contact numbers provided by potential sellers who are desperately in financial need.

Another example is a website that published an article related to the topic of illicit kidney trade last year and in about a year, they have received more than 1200 requests including personal and medical details from would-be kidney and liver sellers.  

Other websites chose names similar to that of the CASKP so they can attract donors, for example Kidney Donation Foundation.

Some websites go so far as to publish cautionary guidelines for the donors, teaching them how to protect themselves while dealing with brokers.

Local media in Iran is also well aware of the existence and immensity of the black market dealing in kidney trade. Etemad Newspaper quoted ISNA News Agency on the use of Telegram application by kidney sellers. Before it was filtered by the authorities, this application was as widely used for this purpose as Instagram is used today. Back in 2014, Salamat News Website, in an extensive report, mentioned illicit kidney transplantation surgeries and quoted Mostafa Qasemi, head of CASKP at the time, that had said: “out of 1800 kidney transplant surgeries, 1000 have been done out of sight of the law and without the Association’s knowledge or cooperation.” In September 2019, another article was published in Resalat Newspaper which included a long interview with a broker who claimed he would make a minimum of 250 million Tomans a month. Although, due to the severe regime of restrictions and censorship that govern the news and media in Iran, the media does not address questions like how the brokers manage to skip the long waiting list, or how these under-the-table sales happen with the help of those “inside the legal framework”. These restrictions and censorships have also affected doctors and patients struggling with this problem.

Many patients who have had a kidney transplant confirm the role brokers play in the market and the relationship they have with the CASKP. According to a patient, whom I will call Masoud, brokers’ role is quite significant in this trade. Masoud suffered from kidney malfunction, and after going through dialysis for 4 years, he recently got a transplant. When his problem started, he was only 24 years old, and although according to the policies, patients under 30 should be ranked prior on the waiting list to receive an organ from a cadaver, he was forced to buy a kidney at last. I asked him:

  • You were young. Why did you have to wait 4 years?”
  • Because I had neither money, nor someone to pull the strings for me.
  • Do you need those to get a transplant?
  • Sure, CASKP’s waiting list is just a sham. They pretend they want to help the patients but the reality is totally different.
  • What is the reality?
  • Brokers and bribery. Let me tell you how it works. Those who have kidney problems have to apply for a transplant through the CASKP. So do those who want to volunteer to donate a kidney. Of course, donors receive about 30 million Tomans, so donating does not exactly mean you do it for free. Everything is fine up to this point and there seems to be no problem. But the problem is, the managers at CASKP respect the waiting list only partially while they sell most places on the list.
  • Are you saying that CASKP itself is responsible for selling places on the waiting list?
  • Exactly. If you have money, you’ll let them know you are willing to pay good money provided they give you a closer date for surgery. If there is a suitable donor available, they will inform him/her about the offer behind closed doors and the rich person will get his kidney outside the waiting list.   
  • How did you manage to solve your problem?
  • I had to go through dialysis for 4 years till I finally found someone inside CASKP to help me and I finally managed to buy a kidney.
  • You mean even after 4 years, and despite the fact that you were under 30, you still did not receive a transplant from a cadaver and you had to pay for a kidney?
  • Yes. I was just lucky, because I found someone inside CASKP who helped me find a kidney for a reasonable price and get my surgery in due time.

Masoud says there is nothing money can’t buy. He has witnessed how the brokers managed to get a transplant for a patient who was not an Iranian citizen (he was an employee at a foreign embassy).

According to “The Instructions for Kidney Donations and Transplants from Living Donors” ratified by the Ministry of Public Health, Iranian citizens cannot neither give nor receive an organ from the citizens of other countries and participation in the market would be confined to citizens of Iran. This ruling is not free from racist qualities and it has been executed at least about citizens of Afghanistan who live in Iran. Nevertheless, this law has not eliminated transplant tourism. There have been cases where foreign patients have entered the country as a tourist and again, thanks to brokers and large sums of money changing hands, managed to get fake documents and receive an organ without having to wait their turn on the waiting list.

I will call another patient I talked to Shaghayegh. Shaghayegh’s family, who survives on a shoestring budget, had to pay for her dialysis for years until she got a transplant. When I called her, she answered with a shaky voice. I tried to reassure her, and told her I was calling from a secure line, but she was still very scared and couldn’t speak freely:

  • Did you apply for a transplant through the CASKP?
  • At first, yes. But after we found out receiving an organ from a cadaver may take years, and since we didn’t have the means to buy a kidney, my father got tested and fortunately, he was a match and gave me one of his kidneys.
  • What would you have done if he was not a match?
  • We would have found a way. The Association would have found a way to help me.
  • Do you know anything about the mafia of kidney trade?
  • I really don’t. I mostly keep to myself.
  • So you don’t know anything about brokers in kidney black market?
  • I know they exist, but I don’t know anything about the mafia stuff. I’m sure the government will deal with them. I’m not a political person, I don’t know much about such things.
  • This is not a conversation about politics. I’m doing a research on organ trade network and the problems patients have to deal with. Don’t you have any worries or problems?
  • I do, I mean most of the times I worry what would happen if my body rejects this kidney, because that could happen, you know? We are not a well-off family and can’t pay for treatments or another transplant. It takes years to receive a kidney through CASKP, so we would have to go to the brokers and that costs a fortune. But I’m sure the authorities will help, so I needn’t worry. Thanks God they take good care of patients.

Shaghayegh was very worried and didn’t talk much which was not surprising. If you have ever lived in Iran, you know that tapping lines, especially when it comes to international phone calls, is “normal”. The police state dominant in the society and the very broad definition of what constitutes a crime could turn anything into a political issue and a crime against national security. Shaghayegh, besides worrying about the phone call, was worried about her body rejecting the kidney she had received in which case she would have to go to the brokers.

Of all the physicians I called, none agreed to their names or their work place being revealed, in view of security concerns. A physician, whom I will call Nasser, told me: “Look, Ma’am! I’m not looking for trouble. Go find someone else to talk to!” and hung up.

Another physician, whom I call Samaneh, refrained from answering any of my calls. So I had to email my questions to the person who had introduced her. This way she could answer the questions in person and not over the phone. Samaneh had commented: “This is a very dangerous issue to get involved with. It’s not just about a few brokers. Important authorities are involved in organ trade mafia.” She had advised my acquaintance not to get involved in this “dangerous issue”, either.

Another physician, whom was also introduced to me by a friend, refused being interviewed, saying it was risky and that he didn’t want to get into trouble.   

Despite all this, a physician from a prestigious hospital in Tehran agreed to talk to me and confirmed my findings. According to this person, besides trading organs donated by living donors, organs procured from brain dead patients can also somehow be bought at a higher price, outside the waiting list.

As I mentioned before, names of the hospitals will be kept secret out of regard for the interviewees’ privacy.

As you have noticed, entering kidney black market as a seller is quite simple and the vastness of this market is easily perceivable. But little have been done to change this situation, and all comments made are rather vague and general. In 2019, the Ministry of Public Health announced that organ donations from a living person will be exclusively restricted to kidney transplants, and that new policies and a new registration portal will be set up to minimize the illegal kidney trade. Although, it was not possible to determine if the new portal actually eliminates the chance of illegal organ trade without being able to access the portal.

Access to Ministry of Public Health’s website is denied to residents outside Iran, so I asked a friend in Iran to look up the portal on the website of the Ministry of Public Health. The only thing that could be found was a link that led to Iran’s Center for Organ Donation; a non-governmental organization which claims to be promoting organ donation. Therefore, the new online portal mentioned by the Ministry of Health does not actually exist.

The head of the Transplantation and Treatment of Diseases Department at the Ministry of Health has only contended that the Ministry will, from now on, categorize and prioritize patients with kidney diseases according to new criteria which are specified in the “living” guidelines. According to the new policies, unless the donor is a first degree relative, all patients will be subject to and ranked by the criteria.

The question is how are these new policies going to help patients waiting the line, whose days are numbered, and whose numbers are four times as much the annual capacity for kidney transplants? Even more important is the fact that the Ministry of Public Health has turned a blind eye to brokers and their potential accomplices inside the legal framework, at the same time ignoring the existence of a long line of sellers struggling with financial needs.

The lives of kidney patients and destitute sellers is being traded by several layers of criminal and legal middlemen. The hidden doors of CASKP, which open to organ black markets, are not unknown to the patients, and if they can afford it, they would inevitably go through these doors to buy themselves some extra time. This is just a glimpse into a bigger medical care system in which people’s lives are reduced to commodities to be sold and bought by money. This report was prepared before the outbreak of Covid-19 pandemic in Iran. There is no doubt that the pandemic outbreak has made life much harder for those struggling with kidney disease and it will increase the number of would-be organ sellers.

  • A form of address used in Iran by more traditional or religious persons while talking to a younger female stranger